Multiple Myeloma Treatment in Delhi, India

Multiple myeloma is a type of cancer that affects plasma cells, a type of white blood cell found in the bone marrow. Plasma cells are an essential part of the immune system, producing antibodies to help fight infections. In multiple myeloma, cancerous plasma cells multiply uncontrollably and produce abnormal proteins. This overproduction can lead to damage in the bones, immune system, kidneys, and red blood cell count.

The exact cause of multiple myeloma is not known. However, it involves genetic mutations that occur in plasma cells, leading them to grow and divide at an abnormally rapid rate. These changes can be influenced by a combination of genetic predispositions and environmental factors.

Several factors can increase the risk of developing multiple myeloma:

• Age: Most people diagnosed with multiple myeloma are over 60 years old.
• Gender: Men are more likely to develop multiple myeloma than women.
• Race: African Americans have a higher incidence of multiple myeloma compared to other races.
• Family History: Having a family member with multiple myeloma increases the risk.
• Monoclonal Gammopathy of Undetermined Significance (MGUS): This condition, characterised by an abnormal level of monoclonal protein in the blood, can progress to multiple myeloma.
• Exposure to Radiation or Chemicals: Exposure to certain chemicals, such as benzene, and high levels of radiation can increase the risk.

Symptoms of multiple myeloma can vary widely and may include:

• Bone Pain: Particularly in the back, ribs, and hips.
• Fractures: Weakened bones can lead to fractures.
• Fatigue: Due to anaemia caused by the disruption of normal blood cell production.
• Frequent Infections: Abnormal plasma cells can impair the immune system.
• High Blood Calcium Levels: Leading to nausea, vomiting, constipation, and confusion.
• Kidney Problems: Abnormal proteins produced by myeloma cells can cause kidney damage.
• Weight Loss: Unintentional weight loss may occur.
• Numbness or Weakness: Particularly in the legs, due to spinal cord compression.

Early detection and treatment are crucial in managing multiple myeloma, as the symptoms can often overlap with other conditions. If any of these symptoms are present, it is important to seek medical advice for proper diagnosis and management.

Diagnosing multiple myeloma typically involves a combination of the following tests and procedures:

Blood Tests

• Complete Blood Count (CBC): To check for anaemia and other abnormalities in blood cells.
• Serum Protein Electrophoresis (SPEP): To identify abnormal proteins produced by myeloma cells.
• Free Light Chain Assay: To detect free light chains in the blood, which are often elevated in multiple myeloma.
• Blood Calcium Levels: High levels can indicate bone damage.
• Kidney Function Tests: To check for kidney damage due to myeloma proteins.

Urine Tests

• Urine Protein Electrophoresis (UPEP): To detect Bence Jones proteins, which are light chains produced by myeloma cells.

Imaging Tests

• X-rays, MRI, CT scans, and PET scans: To identify bone damage or tumors caused by myeloma cells.

Bone Marrow Biopsy

• A sample of bone marrow is taken, usually from the hipbone, to examine under a microscope for the presence of myeloma cells.

Cytogenetic Analysis

• Tests to identify specific genetic abnormalities in myeloma cells, which can help determine the prognosis and guide treatment.

Treatment for multiple myeloma depends on the stage of the disease, the patient’s overall health, and specific characteristics of the myeloma. Common treatments include:

Targeted Therapy

Drugs like bortezomib, carfilzomib, and ixazomib target specific proteins in myeloma cells, helping to destroy them.

Immunotherapy

Medications like daratumumab, elotuzumab, and lenalidomide enhance the immune system's ability to fight myeloma cells.

Chemotherapy

Drugs like melphalan, cyclophosphamide, and doxorubicin are used to kill rapidly dividing myeloma cells.

Corticosteroids

Drugs such as dexamethasone and prednisone are used to reduce inflammation and are often combined with other treatments to enhance their effectiveness.

Stem Cell Transplant

High-dose chemotherapy followed by a transplant of the patient's own stem cells (autologous stem cell transplant) to help rebuild healthy bone marrow.

Radiation Therapy

Used to target and kill myeloma cells in specific areas, especially if there is a localised bone lesion causing pain or risk of fracture.

Supportive Care

Treatments to manage symptoms and side effects, such as bisphosphonates (e.g., zoledronic acid) to strengthen bones, pain management strategies, and medications to protect kidney function.

Multiple myeloma is a type of blood cancer that affects plasma cells in the bone marrow. It can lead to various complications due to the abnormal plasma cells accumulating and interfering with the production and function of normal blood cells. Some common complications include:

Bone Problems

• Bone Pain and Fractures: The cancerous cells can cause bone damage, leading to pain and an increased risk of fractures, especially in the spine, ribs, and pelvis.
• Hypercalcemia: Hypercalcemia, caused by the release of calcium from damaged bones, can lead to nausea, vomiting, confusion, and kidney problems.

Blood Issues

• Anaemia: The overproduction of abnormal plasma cells can reduce red blood cell production, leading to anaemia and causing fatigue, weakness, and shortness of breath.
• Leukopenia: A decrease in white blood cells can make patients more susceptible to infections.
• Thrombocytopenia: A reduction in platelets can lead to increased bleeding and bruising.

Kidney Problems

• Kidney Damage: Excess proteins produced by myeloma cells can damage the kidneys, leading to kidney failure.
• Dehydration and Electrolyte Imbalance: Hypercalcemia can further exacerbate kidney problems.

Infections

• Weak Immune System: Patients with multiple myeloma have a weakened immune system, making them more vulnerable to bacterial, viral, and fungal infections.

Nervous System Issues

• Spinal Cord Compression: Tumours or collapsed vertebrae can press on the spinal cord, leading to pain, numbness, or weakness in the limbs.
• Peripheral Neuropathy: Some treatments for multiple myeloma can cause nerve damage, leading to tingling, numbness, and pain, particularly in the hands and feet.

While there is no sure way to prevent multiple myeloma, certain strategies may help reduce the risk or aid in early detection:

Healthy Lifestyle

• Diet and Exercise: Maintaining a healthy diet and regular exercise routine can boost overall health and potentially lower the risk of various cancers, including multiple myeloma.
• Avoiding Tobacco and Excessive Alcohol: These substances can increase cancer risk and should be avoided.

Regular Health Check-Ups

Routine medical check-ups can help detect abnormalities early. Blood tests, urine tests, and imaging studies can sometimes identify issues before they develop into serious complications.

Awareness of Risk Factors

Understanding and monitoring risk factors, such as age (most common in people over 60), gender (more common in men), race (more prevalent in African Americans), and family history of blood cancers, can help in early detection and intervention.

Avoiding Exposure to Harmful Substances

Reducing exposure to certain chemicals, pesticides, and radiation that are known to increase cancer risk can be beneficial.

Monitoring and Managing Precursor Conditions

Conditions such as monoclonal gammopathy of undetermined significance (MGUS) and smouldering myeloma can precede multiple myeloma. Regular monitoring and early intervention in these conditions can help manage the risk of progression to multiple myeloma.

While these steps can help manage risk, individuals need to consult healthcare professionals for personalised advice and regular screenings, especially if they have risk factors associated with multiple myeloma.

How does chemotherapy work for multiple myeloma? 

Chemotherapy for multiple myeloma works by using drugs to kill rapidly dividing myeloma cells, typically targeting their DNA or machinery involved in cell division. This helps to reduce the number of myeloma cells in the body and control the progression of the disease.

How can multiple myeloma affect the bones? 

Multiple myeloma can affect the bones by causing bone destruction. Myeloma cells produce substances that stimulate osteoclasts, which are cells responsible for breaking down bone tissue. This leads to weakened bones, bone pain, fractures, and other skeletal complications.

Can multiple myeloma lead to kidney problems? 

Yes, multiple myeloma can lead to kidney problems. The abnormal proteins produced by myeloma cells can accumulate in the kidneys and cause damage over time, leading to kidney dysfunction or failure if left untreated.

What lifestyle changes can help manage multiple myeloma? 

Some lifestyle changes that can help manage multiple myeloma include maintaining a healthy diet, staying physically active as tolerated, managing stress levels, avoiding smoking and excessive alcohol consumption, and following medical advice regarding medications and treatments.

How often should multiple myeloma patients see their doctor? 

Multiple myeloma patients should see their doctor regularly as recommended by their healthcare team. This typically involves frequent check-ups, monitoring of blood tests and imaging studies, and adjustments to treatment plans as needed based on the patient's response and any new symptoms.

What is the prognosis for multiple myeloma? 

The prognosis for multiple myeloma can vary widely depending on factors such as the stage of the disease at diagnosis, the patient's overall health, and response to treatment. While multiple myeloma is generally considered incurable, advancements in treatment have significantly improved outcomes and life expectancy in recent years.

What are common side effects of multiple myeloma treatments? 

Common side effects of multiple myeloma treatments can include nausea, vomiting, fatigue, hair loss, bone marrow suppression leading to low blood cell counts, increased risk of infections, neuropathy (nerve damage), and gastrointestinal issues. The specific side effects can vary depending on the type of treatment used.

Is multiple myeloma curable? 

Multiple myeloma is typically not considered curable in the traditional sense, but many patients can achieve remission with treatment. Some patients may have long periods of remission where the disease is under control, while others may experience periods of relapse and require ongoing treatment.

What are the stages in multiple myeloma? 

Multiple myeloma is staged based on factors such as levels of abnormal proteins, calcium, and blood counts, as well as the presence of bone lesions and kidney function. The stages range from I (early stage with low levels of myeloma cells and minimal symptoms) to III (advanced stage with higher levels of myeloma cells and more severe symptoms).

Can multiple myeloma affect younger people? 

Yes, although multiple myeloma is more commonly diagnosed in older adults, it can affect younger people as well. In younger individuals, the disease may present differently and treatment approaches may need to be tailored accordingly.

What role do genetics play in multiple myeloma? 

Genetics can play a significant role in multiple myeloma. Certain genetic mutations and abnormalities in plasma cells can increase the risk of developing the disease. Family history of multiple myeloma or related conditions like monoclonal gammopathy of undetermined significance (MGUS) can also contribute to the risk.

Is there a link between multiple myeloma and other cancers? 

Multiple myeloma is not typically linked to other cancers in a direct causative manner. However, some individuals may have a higher risk of developing multiple myeloma if they have a history of other cancers or certain genetic predispositions.

What is MGUS, and how is it related to multiple myeloma? 

MGUS stands for monoclonal gammopathy of undetermined significance. It is a condition where there is an abnormal protein (monoclonal protein or M protein) in the blood, but there are no other signs or symptoms of multiple myeloma or related disorders. MGUS can sometimes progress to multiple myeloma over time.

What are the long-term effects of multiple myeloma treatment? 

Long-term effects of multiple myeloma treatment can include bone density loss (osteoporosis), neuropathy (nerve damage), secondary cancers due to treatment, kidney damage, and effects related to stem cell transplants, such as infertility or hormonal changes. Monitoring and management of these effects are important for ongoing care.

Reviewed By Dr. Nivedita Dhingra - Associate Director - Medical Oncology (Haematology, Hemato–Oncology), Bone Marrow Transplant, Cancer Care / Oncology on 11 Nov 2024.