Multiple Myeloma: Deadly to Chronic

There are 4 stages. Myeloma that doesn’t present with active symptoms is called the “smoldering stage.” It may be undetectable in the blood in this stage.

Multiple myeloma is a cancer of the plasma cells. The plasma cells are a type of white blood cell present in the bone marrow. Plasma cells are part of the immune system and help fight against infections by producing antibodies that recognize and attack microorganisms. In multiple myeloma, cancer cells accumulate in the bone marrow and replace healthy blood cells. The cancerous plasma cells multiply rapidly and have definite bodily functions. Instead of producing beneficial antibodies, the cancer cells produce abnormal proteins called monoclonal protein or M protein, which cause complications. Multiple myeloma can eventually damage the bones, immune system, kidneys, and red blood cells. Initially, the symptoms may be generalized and nonspecific, such as loss of appetite, bone pain, and fever. Sometimes, a fracture of a bone on a minor fall or a spine fracture without any history of trauma may lead to the diagnosis of multiple myeloma. Multiple myeloma is the second most common type of blood cancer after leukemia. Multiple myeloma is considered treatable but is generally incurable and hence may be called chronic.

The exact cause of multiple myeloma is not known, but certain factors can increase the risk of multiple myeloma:

• Increasing age: The risk of multiple myeloma increases after the age of 60 years.
• Male sex
• Black race
• Family history of multiple myeloma
• Personal history of a monoclonal gammopathy of undetermined significance (MGUS): Multiple myeloma can have a relatively benign condition called MGUS that is characterized by elevated levels of an abnormal protein called M protein, same as in multiple myeloma.

It’s important to remember that the outlook for everyone with multiple myeloma is different. Your treatment options and the general state depend on various factors. Most doctors divide multiple myeloma into four stages:

Smoldering stage: Myeloma that doesn’t present with active symptoms is called the “smoldering stage.” It may be undetectable in the blood in this stage. 

Stage 1: In this stage, a small number of myeloma cells appear in the blood and urine. The hemoglobin levels may drop slightly. Bone X-rays may look normal or show only one affected area.

Stage 2: A moderate number of myeloma cells are present. Hemoglobin levels drop further. Monoclonal immunoglobulin and blood calcium levels may increase. X-rays may show several areas of bone damage.

Stage 3: This is the final stage of multiple myeloma. A high number of myeloma cells are present. The hemoglobin level drops below 8.5 grams per deciliter. Blood calcium levels are high. There are multiple areas of bone destruction due to cancer on the X-ray.

Common signs and symptoms include:

• Pathological fractures (bone fracture without a trauma history)
• Bone pain
• Nausea
• Constipation
• Loss of appetite
• Loss of weight
• Fatigue
• Weakness
• Frequent infections
• numbness in the legs
• Excessive thirst
• Fractures
• Inability to concentrate
• Bleeding due to low platelet count

In the absence of symptoms (smoldering multiple myeloma):

No treatment is required at this stage. Regular follow-up is advised to monitor the progress of the disease.

In the presence of symptoms:

Treatment options for multiple myeloma depend on the stage and severity of the disease. A combination of more than one treatment modality may be advised. Treatment options include:

• Targeted therapy: Targeted drug treatment focuses on specific abnormal proteins within cancer cells. These drugs bind to these proteins and kill the cancer cells. They may be administered intravenously or orally.
• Biological therapy: They stimulate the immune system cells to identify and attack cancer cells. These medications are usually taken orally.
• Chemotherapy: Chemotherapy drugs kill fast-growing cells, including myeloma cells. They may be administered intravenously or orally.
• Corticosteroids: They suppress the immune system and reduce inflammation in the body. A corticosteroid may be administered orally or intravenously.
• Bone marrow transplant: A bone marrow transplant, also known as a stem cell transplant, is a minimally invasive procedure to replace the diseased bone marrow with healthy bone marrow.
• Radiation therapy: This treatment uses beams of radiation energy, such as X-rays, to target and kill myeloma cells.

The prognosis of multiple myeloma depends on age. Younger patients usually do better than older patients. Other underlying medical conditions may also affect the prognosis. Some may be asymptomatic for a long time, with a slow progression of cancer. Patients who respond well to initial treatment and experience complete remission (symptom-free periods) have a better prognosis. After treatment, regular follow-up testing and disease management care is required. Multiple myeloma is considered treatable cancer but is generally incurable and hence may be referred to as chronic.