Multiple Myeloma

Multiple myeloma is the second most common type of blood cancer and afflicts more than 100 patients in Singapore a year. Find out more about multiple myeloma treatment here.

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What is Multiple Myeloma?

Multiple myeloma is a type of bone marrow cancer characterised by abnormal expansion of malignant plasma cells in the bone marrow. It is the second most common type of blood cancer and afflicts more than 100 patients in Singapore a year. Multiple myeloma has a rising incidence in Asia but the reason for that is still unknown. 

These tumours may keep the bone marrow from making enough healthy blood cells. Normally, the bone marrow makes stem cells (immature cells) that become three types of mature blood cells:
Red blood cells that carry oxygen and other substances to all tissues of the body
White blood cells that fight infection and disease
Platelets that form blood clots to help prevent bleeding

As the number of myeloma cells increases, fewer red blood cells, white blood cells and platelets are made. The myeloma cells also damage and weaken the bone.
 
In time, myeloma cells collect in the bone marrow. They may damage the solid part of the bone. Multiple myeloma occurs when when myeloma cells collect in several of your bones. This disease may also harm other tissues and organs, such as the kidneys.
 
Myeloma cells make antibodies called "M proteins". These proteins can collect in the blood, urine and organs.
 
Eventually, myeloma causes anaemia, lytic bone lesions which may cause bone pain or fractures, renal impairment and hypercalcaemia.
 

Who is At Risk of Multiple Myeloma?

Those who are aged 55 and above. The risk increases with age
Men are more susceptible to multiple myeloma
Those with a personal history of monoclonal gammopathy of undetermined significance (MGUS)
Those with a family history of multiple myeloma (the risk is higher if a close relative is a victim of the disease) 

Please speak to your doctor if you think that you may be at risk of developing multiple myeloma.
 

Signs and Symptoms of Multiple Myeloma

Bone pain, mostly in the back and the rib cage
Anaemia: this can cause fatigue, dizziness and shortness of breath
Hypercalcaemia: high levels of calcium in the blood may result in muscle weakness, increased thirst, nausea, loss of appetite, constipation as well as mental confusion
Kidney problems: damage to the kidneys will impair the body's ability to remove excess salt, fluid and waste, resulting in the swelling of the lower limbs and weakness
Recurrent infections and fevers

If you experience any of these symptoms, please consult a doctor.

Prevention of Multiple Myeloma

There is currently no way to prevent multiple myeloma. 
 

How Do You Diagnose Multiple Myeloma?

If you have a symptom that suggests multiple myeloma, your doctor must find out whether it is due to cancer or some other cause. Your doctor may ask about your personal and family medical history. You may also have one or more of the following tests:

Physical Exam

Your doctor checks general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

Blood Tests

Your doctor may order blood tests. The lab may check the level of many different proteins, including M protein and other immunoglobulins (antibodies), albumin and beta-2-microglublin, as multiple myeloma causes high levels of proteins in the blood. The lab may also do a complete blood count to check the number of white blood cells, red blood cells and platelets — this is because myeloma may cause anaemia and low levels of white blood cells and platelets. The lab may also check for high calcium levels or perform creatinine tests.

Urine Tests

The lab may test for Bence Jones protein, a type of M protein, in urine. The lab measures the amount of Bence Jones protein in urine collected over a 24-hour period. If the lab finds a high level of Bence Jones protein in your urine sample, doctors may monitor your kidneys as Bence Jones protein can clog the kidneys and damage them.

X-rays

This test is used to identify lytic lesions in the bones caused by myeloma. In addition, this test can also detect any weakened bone areas or fractures that may require surgery.

Magnetic Resonance Imaging (MRI)
A procedure that uses a magnetic field, radio waves and a computer to make a series of detailed pictures of areas inside the body. This procedure is called nuclear magnetic resonance imaging (MRI). An MRI may be used to find areas where the bone is damaged.

Biopsy 

The doctor may remove tissues to look for cancer cells. A biopsy is the only sure way to know whether myeloma cells are in your bone marrow. Before the sample is taken, local anaesthesia is used to numb the area to help reduce the pain. The doctor then removes some bone marrow from your hip bone or another large bone. A pathologist uses a microscope to check the tissue for myeloma cells. 

There are two ways the doctor can obtain bone marrow. Some patients may encounter both procedures during the same visit:    
Bone marrow aspiration: a thick, hollow needle is used to remove samples of the fluid part  of the bone marrow
Bone marrow biopsy: a thick, hollow needle is used to remove samples of the solid part  of the bone marrow

What are the Multiple Myeloma Treatment Options?

There are different treatments available for multiple myeloma depending on the stage of disease. Factors other than the stage of cancer that might have an impact on your treatment decision include your age, your overall health, and your own preferences. The three main types of treatment are:

1. Watchful Waiting

People with smouldering myeloma may be able to put off having cancer treatment. By delaying treatment, you can avoid the side effects of treatment until you have symptoms.

If you and your doctor agree that watchful waiting is a good idea, you may have regular check-ups (such as every three months) and receive treatment if symptoms occur.

Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. In some cases, it may reduce the chance to control myeloma before it gets worse.

You may decide against watchful waiting if you don’t want to live with untreated myeloma. If you choose watchful waiting but grow concerned later, please discuss it with your doctor. 

2. Induction Therapy

Many different types of drugs are used to treat myeloma. People often receive a combination of drugs, and many different combinations are used to treat myeloma.

Each type of drug kills cancer cells in a different way:
Chemotherapy: chemotherapy kills fast-growing myeloma cells, but the drug can also harm normal cells that divide rapidly
Targeted therapy: targeted therapies use drugs that block the growth of myeloma cells. The targeted therapy blocks the action of an abnormal protein that stimulates the growth of myeloma cells
Steroids: some steroids have antitumour effects. It is thought that steroids can trigger the death of myeloma cells. A steroid may be used alone or with other drugs to treat myeloma

You may receive the drugs orally or through a vein (IV). The treatment usually takes place in an outpatient part of the hospital, at the doctor’s office, or at home. Some people may need to stay in the hospital for treatment. 

3. Stem Cell Transplant

Many people with multiple myeloma may get a stem cell transplant. A stem cell transplant allows you to be treated with high doses of drugs. The high doses destroy both myeloma cells and normal blood cells in the bone marrow. After you receive high-dose treatment, you will receive healthy stem cells through a vein. New blood cells will then develop from the transplanted stem cells so they can replace the ones that were destroyed by treatment.

Stem cell transplants may take place in the hospital or in the outpatient setting. Patients will be assessed individually for suitability for either setting. Some people with myeloma may need two or more transplants.

Stem cells may come from you or from someone who donates their stem cells to you:
From you: an autologous stem cell transplant uses your own stem cells. Before you undergo the high-dose chemotherapy, your stem cells are removed. The cells may be treated to kill any myeloma cells present, before being frozen and stored. After you have received the high-dose chemotherapy, the stored stem cells will be thawed and returned to you
From a family member or another donor: an allogeneic stem cell transplant uses healthy stem cells from a donor. Your brother, sister, or parent may be the donor. The stem cells could also come from a donor who is not related. Blood tests will be used to ensure that the donor’s cells match your cells. Allogeneic stem cell transplants are under study for the treatment of multiple myeloma

There are two ways to get stem cells for people with myeloma. They usually come from the blood (peripheral blood stem cell transplant) or the bone marrow (bone marrow transplant).

After a stem cell transplant, you may stay in the hospital for several weeks or months. You will be at risk for infections because of the large doses of chemotherapy you received. In time, the transplanted cells will begin to produce healthy blood cells.



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