Download Multiple myeloma is the term used to describe myeloma

Myeloma
Myeloma is a type of cancer affecting plasma cells that occur in the bone marrow. Bone
marrow is a soft and spongy type substance found in larger bones. Bone marrow produces
three varieties of blood cells; they are red and white blood cells and platelets. Plasma cells
are another type of white blood cell in bone marrow. Plasma cells make antibodies
(immunoglobulins) to prevent and fight infection and build up immunity to disease. When a
person develops myeloma, plasma cells become malignant (cancerous) and become known
as myeloma cells. Myeloma cells produce abnormal antibodies called paraproteins.
Paraproteins do not fight infection adequately and actually reduce the production of normal
antibodies. Myeloma cells do not allow a sufficient quantity of normal plasma cells to be
produced in bone marrow.
Multiple myeloma is the term used to describe myeloma cells spreading from bone marrow
to the rest of the bone (hard part of bone) and damaging bone tissue. Many bones become
affected hence myeloma is referred as multiple myeloma. Over 200 Irish people are
diagnosed annually with myeloma.
Symptoms
Paraproteins show up in blood and urine tests and myeloma may show up in routine blood
tests before symptoms even occur. If myeloma is undiagnosed and is allowed develop it can
affect bones, blood and kidneys leading to symptoms. Bone symptoms of myeloma include
bone pain (particularly backache), bone fractures, brittle bones (osteoporosis), spinal cord
compression (an emergency situation), numbness and pins and needles. Blood problems
caused by myeloma include fatigue, infections, anaemia (low red blood cells) and bruising.
Kidneys problems caused by kidney problems include hypercalcaemia (high calcium levels
in blood due to destruction of bone cells), dehydration and thicker blood (caused by
paraproteins) which further reduces kidney function leading to further kidney problems.
Diagnosis
There is currently no programme to screen for myeloma in Ireland or any other country so
regular health checks are the only way to reduce risk from myeloma and other cancers.
Blood tests can help diagnose myeloma. Blood counts indicate calcium levels and levels of
normal proteins and paraproteins. Blood tests determine kidney function which is another
indicator of myeloma. Urine tests check if normal proteins and paraproteins are present. If
initial tests indicate that a person may have myeloma, further tests will then be done to
confirm diagnosis and determine the extent of the condition. This includes checking
immunoglobulin levels (antibodies for fighting infection). Protein electrophoresis of blood and
urine indicates the type of paraprotein. Another test is the serum free light chain test which
determines if certain minute amounts of abnormal proteins are present (eg) Beta-2
microglobulin.
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An X-ray indicates if myeloma cells are damaging bones. A bone marrow biopsy is when a
bone marrow sample is taken from the hipbone to determine if myeloma cells are present.
Other tests that help confirm myeloma diagnosis include an MRI scan, a CT scan and an
ultrasound.
Treatment
Treatment choices depend on age, general health, severity of myeloma and patient
preferences. Myeloma is currently an incurable disease that is chronic, relapsing and
remitting. Treatment aims to control the condition, prolong survival and maximise quality of
life. Treatment, if started in time allows bone marrow to recover and stop producing
abnormal plasma cells. This is known as remission and a person can have many years of no
symptoms.
Relapse (myeloma re-occurs) is a possibility; the reality is that most patients undergo
numerous remissions and relapses. A number of different treatment options are available
including
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Active monitoring
Chemotherapy
Biological therapy
High-dose therapy and stem cell transplant
Maintenance therapy
Treatment of symptoms
Treatment of relapsed myeloma
Pain control
Active Monitoring
When first diagnosed with myeloma, there may be little or no symptoms so doctors may
initially decide against treatment and simply monitor the myeloma until it develops further;
this is because there is no real benefit in treating myeloma when in the early stages.
Treatment will then start as soon as there is signs of organ damage (eg) kidney damage,
bone damage.
Chemotherapy
These are drugs that kill the abnormal proteins that cause myeloma. Chemotherapy is
generally central to the treatment for myeloma. Examples of drugs used include
cyclophosphamide, vincristine, melphalan, and adriamycin. The symptoms of chemotherapy
can be severe as chemotherapy drugs not only kill the abnormal cells; they also kill the
body’s normal cells.
Steroids are also given with chemotherapy prevent side-effects such as nausea, vomiting,
weight loss and fatigue. Steroids may help promote a feeling of wellbeing. Steroids
commonly prescribed with chemotherapy drugs include dexamethasone and prednisolone
(usually in tablet form). Side-effects from steroids include weight gain, stomach irritation,
brittle bones and high blood sugar levels.
Biological therapies
Work by stimulating the body´s own immune system to beat cancer. Drugs commonly used
for myeloma include velcade (bortezomib), lenalidomide and thalidomide.
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High-dose therapy with stem cell transplant
High-dose therapy and stem cell transplant can accelerate treatment response and increase
remission times. Stem cell transplants mean higher doses of chemotherapy can be given as
stem cell replacement therapy replaces red and white blood cells and platelets (which
chemotherapy damages). If cells are removed from the person getting treatment it referred
to as autologous transplant and if removed from a donor it referred to as allogeneic
transplant. Stem cells can be taken from bone marrow or blood.
Maintenance therapy
Maintenance treatment includes chemotherapy or transplant and helps prevent or slow the
re-occurrence of the myeloma. Drugs used for maintenance therapy include biological
therapies and steroids.
Symptom treatment
Bone symptoms can include bone pain (painkillers can be used) and brittle bones (can be
treated with drugs that strengthen bones like bisphosphonates or monoclonal antibodies).
Blood related symptoms include fatigue, anaemia, bruising or infections. Treatment for blood
related symptoms can include blood and/or platelet transfusions, erythropoietin,
plasmapheresis (if thinning the blood is needed), antibiotics (if infection becomes an issue
due to poor immune system), and growth factors (to increase white blood cells).
Kidney related issues include loss of kidney function and hypercalcaemia (high calcium
levels). If kidney problems become an issue the person must drink three litres of fluid daily
and avoid certain drugs known to affect kidney function including some over the counter
painkillers like ibuprofen (Nurofen®). Hypercalcaemia is treated by drinking sufficient fluids or
with medication such as bisphosphonates (biphosphonates such as alendronic acid and
risedronate reduce bone break-down). If kidney damage is severe the person may require
dialysis.
Advanced treatment
Advanced myeloma is when myeloma spreads from the initial cancerous area (called
secondaries). Unfortunately there is generally no cure for advanced myeloma. Treatment
aims to slow progression and improve quality of life. With proper treatment, a person with
advanced can live for many years with a decent quality of life; treatment options include
surgery, chemotherapy, radiotherapy and biological therapy.
Supportive therapy includes medication discussed earlier including painkillers and
bisphosphonates (for bone problems), blood transfusions, antibiotics, drugs for anaemia,
and growth factors. Many of these simply aim to prevent and treat side effects from
chemotherapy. A palliative care team often takes over care at this stage with the aim of
providing comfort to the patient and their family.
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Pain relief
Many people suffering from myeloma will need some type of pain killer at some stage; pain
can vary from mild to severe, depending on the extent of the condition and the amount of
bone damage done. Many different painkillers may be used for pain relief from simple
painkillers such as paracetamol to more potent painkillers like opioids (eg) morphine. Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and diclofenac are best
avoided to prevent potential negative effects on the kidneys (which kidney already likely to
be damaged due to myeloma). Nerve blocking drugs such as amitriptyline, carbamazepine,
gabapentin or pregabalin may be needed if neuropathic (nerve) pain is an issue.
Corticosteroids may be used relieve bone pain in the later stages of the condition.
Radiotherapy and chemotherapy may help ease pain as it reduces abnormal cells. Surgery
may be required for the likes of stabilisation of fractures and treatment of vertebral collapse.
Side effects
Side effects vary from person to person and drug to drug. Chemotherapy may cause severe
side effects including fatigue, nausea and vomiting, loss of appetite, diarrhoea, constipation,
and hair loss. Biological therapies in some cases can cause numbness or tingling in hands
and feet (often only temporary). Myeloma can cause kidney damage or failure. For a small
percentage the kidney damage can be permanent and the kidney function becomes so
impaired that dialysis (artificial removal of waste and water from blood) is required; this
usually means visiting your hospital for dialysis a few times a week.
Follow up care
Regular check-ups will be required after treatment is completed. At first, these check-ups will
be frequent but gradually they will reduce. Follow-up checks will continue for at least 5 years.
Tests that form part of follow-up check-ups include physical exams, blood and urine tests, Xrays and scans.
Causes and prevention
The exact cause of myeloma is still unknown. There are risk factors that may increase the
chance of developing myeloma. These include increasing age (myeloma is more common in
older adults, especially over 60’s), gender (it is more common in men than women), race (it
is more common in black people than white or Asian people), exposure to chemicals (petrol,
oil, benzene, pesticides, paints, rubber, hair dyes…. studies suggest that workers in
petroleum-type industries and those with many years exposure to hair dyes have more risk
of myeloma.), exposure to viruses (such as HIV, hepatitis, herpes virus), exposure to
radiation (especially dioxins), plasma cell conditions (eg. monoclonal gammopathy), other
conditions (autoimmune diseases, pernicious anaemia or ankylosing spondylitis) and family
history (if a person has a parent, sibling or child diagnosed with myeloma, their risk is
thought to increase 2 and 6 fold).
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For comprehensive and free health advice and information call in to Whelehans, log on to
www.whelehans.ie or dial 04493 34591. You can also e-mail queries to [email protected].