Multiple Myeloma Treatment in India

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What is Multiple Myeloma?

Multiple myeloma is a type of blood cancer that occurs in the bone marrow and represents a cancer of the plasma cell. Healthy plasma cells are like small factories producing antibodies. Multiple myeloma can interfere with the production of new blood cells in the bone marrow, resulting in anaemia, increased risk of infection, and excessive bleeding from wounds. It also produces a substance that weakens bones and abnormal proteins causing kidney damage and other problems.

Treatment options will depend on whether the patient is newly diagnosed with myeloma or is experiencing a recurrence of the disease. Multiple myeloma is incurable, but the treatment can control disease progression and symptoms.

What are the symptoms of Multiple Myeloma?

The symptoms of multiple myeloma are:

  • Bone pain
  • Constipation
  • Easily broken bones
  • Fatigue and weakness
  • Fever and chills
  • Frequent infections
  • Holes in the skull (lytic bone lesions)
  • Nausea with or without vomiting
  • Night sweats
  • Pain or numbness of the fingers or surface areas when exposed to cold
  • Pale skin
  • Unexplained weight loss
  • Weakness

Serious symptoms that might indicate a life-threatening condition:

  • Bluish colouration of the lips or fingernails
  • Change in level of alertness, such as passing out or unresponsiveness
  • sudden change in behaviour, such as lethargy and hallucinations
  • Chest pain, chest tightness, chest pressure, palpitations
  • High fever (higher than 101 degrees Fahrenheit)
  • Rapid heart rate (tachycardia)
  • Breathing problems, such as shortness of breath, difficulty breathing and wheezing
  • Seizure
  • Uncontrolled or heavy bleeding, haemorrhage

How is multiple myeloma diagnosed?

A physician will use blood tests, urine tests, imaging tests and biopsy to make a diagnosis. Further tests will be needed if your doctor finds signs of myeloma when you don’t have symptoms. Your doctor can monitor the progression of the disease using the following tests:

  • Blood and urine tests – Blood and urine tests are used to check for M proteins. These proteins are caused by multiple myeloma. Blood tests can also be used to assess, kidney function, blood cell counts, calcium levels, uric acid levels and the percentage of plasma cells in the bone marrow.
  • Imaging tests – X-rays, MRI scans or CT scans can be used to determine whether bones have been damaged by multiple myeloma.
  • Biopsy – During a biopsy, your surgeon removes a small sample of bone marrow with a long needle and it will be checked for abnormalities. Various tests can determine whether you have multiple myeloma or some other condition. If multiple myeloma is found, the tests can show how far it’s progressed. This is known as staging cancer.

How is staging for Multiple Myeloma done?

Myeloma that is not causing active symptoms is called the “smoldering stage,” or Durie-Salmon stage 1. This means that there are myeloma cells present in your body, but they are not progressing or causing any damage to your bones or kidneys. They may also be undetectable in your blood.

  • Stage 1 – In this stage, a small number of myeloma cells in your blood and urine will be present. Your hemoglobin levels are slightly below normal and your bone X-rays may look normal.
  • Stage 2 – In this stage, a moderate number of myeloma cells will be present. Hemoglobin levels are usually much lower than normal. Monoclonal immunoglobulin may be increased, and blood calcium levels may also be high. X-rays may show several areas of bone damage.
  • Stage 3 – In the final stage of multiple myeloma, a high number of myeloma cells are found. Your hemoglobin level is usually below 8.5 grams per deciliter, and calcium blood levels are high. There are many areas of bone destruction which are caused by cancer.

What are the risk factors for Multiple Myeloma?

The risk factors for multiple myeloma include:

  • Advanced age
  • Exposure to certain chemicals
  • Family history of multiple myeloma
  • Males are more prone to be diagnosed with multiple myeloma
  • Obesity
  • Personal history of certain blood disorders
  • Radiation exposure

What are the treatment options for Multiple Myeloma?

There are many ways for treating multiple myeloma; the specific approach taken will depend on the stage of the disease, what symptoms are present, whether kidney damage has occurred, and whether any other health problems exist. Treatment approaches will include the following:

  • Biologic therapy to increase the immune system’s ability to fight cancer
  • Chemotherapy: to attack cancer cells
  • Immunotherapy: Immunomodulators(drugs) to reduce the production of abnormal proteins by cancer cells
  • Participation in a clinical trial testing assuring new treatments for multiple myeloma
  • Radiation therapy: Using radiation to destroy cancer cells and helps to control pain and reduce the risk.
  • Bone Marrow Transplant: Also known as stem cell transplant is done to provide healthy stem cells that can make new blood cells
  • Steroids to slow growth of cancer cells and enhance other therapies
  • Targeted therapy helps to limit the production of new cancer cells

What is the outcome for Multiple Myeloma?

Multiple Myeloma can be asymptomatic and will progress slow for some people. Poor kidney function and faster-growing cancer cells will indicate a poor outlook. After treatment, you will need regular follow-up testing and you will be advised to drink lots of fluids to enable your kidneys to function properly. Because of your weak immune system, you will also have to take extra precautions to avoid infections.

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