Multiple Myeloma: Types of Treatment

Multiple myeloma is a cancer of the plasma cells.

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.  If you develop signs and symptoms or your multiple myeloma shows signs of progression, you and your doctor may decide to begin treatment.

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 abnormalities within cancer cells. The targeted drugs like monoclonal antibodies bind to specific proteins in cancer cells causing them to die. They may be administered intravenously or orally.
• Biological therapy: Biological therapy drugs involve using the body's immune system to fight against myeloma cells. 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: Corticosteroids, such as prednisone and dexamethasone, suppress the immune system and reduce inflammation in the body. Corticosteroid may be administered orally form 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.

Treatment of complications

multiple myeloma can cause a number of complications which also need treatment:

• Bone pain: Pain medications, radiation therapy or surgery may help reduce bone pain.
• Kidney complications: Patients with severe kidney damage may need dialysis.
• Infections: antibiotics may be prescribed to treat infections. vaccines to prevent infections, such as the flu and pneumonia may be administered.
• Bone loss: medications called bisphosphonates, can help prevent bone loss.
• Anemia: medications to increase red blood cell count may be prescribed 
• Secondary cancers due to the drugs used in chemotherapy also remains a concern and should be watched out for.

Multiple myeloma is a cancer of the plasma cells. The plasma cells are a type of white blood cells 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. Multiple myeloma causes cancer cells to accumulate in the bone marrow and replace healthy blood cells. The cancerous plasma cells multiply rapidly and do not function normally. 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. There may not be any symptoms initially or the symptoms may be generalized and non-specific, such as loss of appetite, bone pain, and fever. Multiple myeloma is the second most common type of blood cancer after leukemia.

The exact cause of multiple 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.
• Male sex
• Black race
• Family history of multiple myeloma.
• Personal history of a monoclonal gammopathy of undetermined significance (MGUS): Multiple myeloma can as a relatively benign condition called monoclonal gammopathy of undetermined significance (MGUS) which is characterised by elevated levels of abnormal protein called M protein, same as in multiple myeloma. 

Common signs and symptoms include:

• Bone pain
• Nausea
• Constipation
• Loss of appetite
• Loss of weight 
• Mental confusion
•  Fatigue
• Weakness
• Frequent infections
• numbness in the legs
• Excessive thirst
• Fractures