General Health

Myeloma (Myelomatosis): Symptoms, Causes, and Treatment

Healthy blood flow is crucial for the proper function of the heart, lungs, and other parts of the body.

Unfortunately, we tend to take our blood for granted and don’t even think about problems that could occur.

Myeloma is one of many issues that may affect our blood. What is myeloma, how to recognize it, who gets it? You’ll get answers to these and many other questions in this post.

What is myeloma?

Myeloma, or myelomatosis, is a type of cancer that begins in plasma cells in the bone marrow, i.e., white blood cells that produce antibodies.

Also known as multiple myeloma, Kahler disease, and plasma cell myeloma, this type of cancer is relatively uncommon. It belongs to the plasma cell neoplasm group of conditions. Other conditions from this group include extramedullary plasmacytoma. 

The American Cancer Society estimates that about 32,270 new myeloma cases will be diagnosed in the U.S. in 2020. The figures show 12,830 deaths will occur this year due to myelomatosis. The lifetime risk of getting multiple myeloma is one in 132 (0.76%).

Although myeloma is an uncommon type of cancer, it’s still the second most common blood cancer diagnosis right after non-Hodgkin lymphoma in the United States. It’s a cancer of B cells.

In order to understand myeloma as a disease, we need to define plasma cells, bone marrow, and antibodies. All these are frequently mentioned terms. However, most of us don’t know enough about them.

Bone marrow is a soft, sponge-like structure in the center of bones. It contains stem cells that are necessary for the production of blood cells. Stem cells constantly divide and produce new cells. Some of them remain as stem cells, but others go through maturing stages before they become mature blood cells. These include red blood cells, white blood cells, platelets. The human body makes millions of blood cells daily. 

Plasma cells are a type of white blood cells. White blood cells are an integral part of your immune system. In other words, they help the body combat infections. Plasma cells produce antibodies (immunoglobulins). Antibodies are proteins that bind to and help destroy viruses, bacteria, and other pathogens.

How does myeloma develop?

Myeloma develops when one abnormal plasma cell in bone marrow starts multiplying rapidly. Cancer cells don’t mature like normal cells in the body. That’s why they accumulate so fast.

Eventually, malignant plasma cells outnumber normal plasma cells in the bone marrow. The myeloma cells continue producing antibodies, just like healthy blood cells in the bone marrow. However, the body can’t use those antibodies because they are abnormal. The abnormal antibodies build up and cause further damage, such as kidney damage. 

The exact reason for the formation of one abnormal or cancerous cell is unknown. Various causes could play a role, including genetics.

What are the symptoms of myeloma?

In the early stages of the disease, a patient may not experience noticeable symptoms. In other words, they have asymptomatic myeloma.

As cancer progresses, signs and symptoms tend to occur. Every person is different, so symptoms of myeloma can vary too. 

The most common signs and symptoms of symptomatic myeloma include:

  • Anemia 

  • Bone pain, particularly in the chest or spine

  • Confusion or mental fogginess 

  • Constipation

  • Dizziness 

  • Excessive thirst

  • Fatigue

  • Frequent infections

  • Hypercalcemia (excessively high calcium levels)

  • Kidney problems

  • Loss of appetite 

  • Nausea

  • Swelling in legs

  • Weakness or numbness in legs

  • Weight loss

Studies show that symptoms of myeloma are nonspecific. About 73% of patients have anemia of unknown origin. Bone pain is present in 58% of patients and fatigue in 32%. Additionally, weight loss is a symptom of myeloma in 25% of patients, including impaired renal function.

Risk factors

The term risk factor refers to anything that increases your chance of developing a disease. Generally speaking, everyone can develop myeloma, but some people are more likely than others.

The most significant risk factors for myeloma include:

  • Age – the likelihood of developing myelomitis increases as you age. Most people diagnosed with this cancer are 65 and older.

  • Family history – similar to many diseases and cancers, myeloma may run in families. You are more likely to develop myeloma if your parent or sibling has it.

  • Gender – men have a higher risk of getting myeloma than women.

  • Having other plasma cell diseases – if you have some type of plasma cell disease, you may be more susceptible to myeloma. These diseases include monoclonal gammopathy of undetermined significance (MGUS) and solitary plasmacytoma.

  • Obesity – being overweight or obese puts you in a high-risk group of getting myeloma.

  • Race – multiple myeloma is two times more common in African Americans than in Caucasians. At this point, it’s not clear why that is

Myeloma is a multifactorial disease. It encompasses a wide variety of risk factors that span numerous life aspects. Further studies on this subject are necessary and highly anticipated. They would give us a more detailed insight into the disease and all factors that may contribute to its development.  

How is myeloma diagnosed?

In some cases, doctors diagnose myeloma accidentally. This happens when a person undergoes a blood test for a certain health condition. 

Regular checkups are important. Don’t underestimate them! Also, don’t ignore your symptoms. As soon as you notice something unusual, pains, aches, and other symptoms, you should see your doctor.

Based on the symptoms you provide, the doctor may suspect myeloma is the culprit. But in order to rule out other conditions and make an accurate diagnosis, they will order some tests. 

Diagnosis of myeloma usually includes the following tests:

  • Blood tests – may reveal the M protein (monoclonal protein) produced by myeloma cells. The blood test may show the presence of other abnormal protein called beta-2-microglobulin. Myeloma cells produce that protein, as well. The presence of this protein may give insight into the aggressiveness of cancer. Blood tests also examine blood cell counts, uric acid levels, calcium levels, and kidney function. 

  • Evaluation of bone marrow (biopsy) – the sample of bone marrow is inspected for myeloma cells. Healthcare providers rely on specialized tests such as fluorescence in situ hybridization (FISH) and bone marrow aspiration.

  • Imaging tests – X-ray, MRI, CT, or positron emission tomography (PET) scan detect bone-related problems that occur due to myeloma. 

  • Urine tests – urinalysis also looks for M proteins, i.e., Bence Jones proteins. 

The diagnosis of multiple myeloma requires the presence of one or more myeloma defining events (MDE).

In addition, diagnosis also requires evidence of either 10% or more clonal plasma cells on bone marrow biopsy or a biopsy-proven plasmacytoma. The MDEs include hypercalcemia, renal failure, bone lesions or lytic lesion, and anemia.

What happens when diagnostic tests indicate the presence of myeloma? The doctor can diagnose the condition and determine the stage. The stage indicates the severity and progression of the disease.

For example, stage I is usually the early phase of the disease. The cancer is less aggressive then. On the other hand, stage III is an aggressive disease. At this point, myeloma may affect kidneys, bones, and other organs. 

Some people may have smoldering myeloma, a precursor stage of this disease. 

Is myeloma treatable?

When people want to know if some disease is treatable, it means they want to know if it’s possible to cure it entirely. Treatable and curable are different things.

Treatable means manageable, and symptoms are controllable. That said, a curable disease is a disease from which a person can recover successfully. 

So now that we’ve defined context let’s proceed to answer the question.

Is myeloma curable? No. 

Is myeloma treatable? Yes, various treatment options are available to help myeloma patients manage their disease.

The presence of minimal residual disease is crucial for the treatment and monitoring of myeloma treatment.

Treatment of myeloma aims to alleviate pain, stabilize the condition, slow progression, and control the disease’s complications. 

Keep in mind that treatment may not be necessary if a patient experiences no symptoms. Even if you’re not receiving treatment, your doctor will monitor your condition regularly. The doctor will monitor you to detect signs that would indicate the disease is progressing. For this purpose, you may need to do blood tests and urinalysis often.

What happens when the treatment is necessary? The doctor will determine the right course based on the severity of myeloma and other factors. Standard treatment options are:

  • Biological therapy – uses the immune system of the body to fight multiple myeloma cells. These drugs strengthen the immune cells that detect and attack cancer cells. Biological therapy drugs include thalidomide (Thalomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst). They are available in the form of pills.

  • Bone marrow transplant – also known as stem cell transplant. The stem cell transplantation replaces diseased with healthy bone marrow. Before the transplant, a patient receives high doses of chemotherapy. The goal of chemotherapy here is to destroy the diseased bone marrow. Then, you receive stem cells that travel to bones and start rebuilding bone marrow. 

  • Chemotherapy – kills fast-growing cells, including myeloma cells. They are administered through a vein or taken in pill form.

  • Corticosteroids – regulate the immune system to manage inflammation. Drugs such as prednisone and dexamethasone are also active against myeloma cells.

  • Radiation therapy – focuses on X-rays and protons to damage myeloma cells and stop their growth.

  • Targeted therapy – focuses on specific abnormalities within cancer cells that allow them to survive. The most frequently used targeted drugs are bortezomib (Velcade), ixazomib (Ninlaro), and carfilzomib (Kyprolis). They are called proteasome inhibitors. These drugs block the activity of a substance in myeloma cells that breaks down proteins. As a result, myeloma cells die. The drugs are available in pill form but may also be administered through the vein in your arm. Besides these, other targeted therapies include monoclonal antibody drugs.

The exact combination of treatments depends on whether a patient is eligible for a marrow transplant. If a patient is eligible, the doctor may recommend different treatments, including targeted therapy, biological therapy, corticosteroids, and chemotherapy in some cases. A few months after the onset of treatment, the stem cells are collected.

For people who aren’t eligible for a bone marrow transplant, the treatment includes chemotherapy combined with targeted therapy, chemotherapy, or biological therapy.

Adequate systemic therapy could be helpful for people with this disease. Although it doesn’t cure cancer, modern treatment increased the 5-year survival rate for myeloma up to 75 years of age to over 50%. In 3-20% of multiple myeloma patients, remission can last for many years.

A great deal of myeloma treatment strives to prevent complications. You see, complications of myeloma can include:

Lifestyle and diet tips for people with multiple myeloma

A healthy lifestyle and proper nutrition are an essential part of myeloma treatment. The doctor advises patients about foods they should eat or lifestyle modifications to make. 

Why is this important? 

A well-balanced diet supplies the body with nutrients. The human body needs various nutrients to function properly and stay healthy, especially when fighting cancer. A healthy diet helps maintain your strength too. 

Lifestyle and diet tips for people with multiple myeloma include:

  • Maintain a healthy weight – the disease and treatment options may induce weight changes, and it’s important to maintain a healthy weight. You shouldn’t follow strict and fad diets. Just strive to choose healthy foods to avoid excess weight gain/loss. 

  • Eat small meals frequently – instead of one or two big meals, you may benefit more from small, frequent meals during the day. Why? Small and frequent meals supply the body with adequate calories, fiber, protein, and other nutrients to endure the treatment. Plus, smaller meals minimize nausea, a common treatment-related side effect. Strive to eat mini-meals every three hours or five to six meals a day.

  • Choose foods that are easy on your stomach – myeloma treatment drugs may have various side effects. Nausea is a common adverse reaction. Some foods may worsen nausea, especially those with strong flavors and odors. That’s why bland foods are essential. They don’t add to nausea and are easy on your stomach.

  • Get enough protein – it helps repair tissues and cells. This nutrient also promotes the recovery and maintenance of the immune system. Great sources of protein are lean meats, eggs, low-fat dairy.

  • Eat whole grains – they are a good source of fiber and carbs. These nutrients support energy levels. Enrich your diet with oatmeal, brown rice, whole wheat bread, whole grain pasta.

  • Fruits and vegetables – they are abundant in vitamins, minerals, and antioxidants that help the body fight cancer.

  • Healthy fat – not all fat is bad. Healthy sources of fat include olive oil, nuts, and seeds.

  • Avoid unhealthy fats – stay away from heavily refined and processed foods, trans fats, fried, greasy foods.

Other things you can do include:

Conclusion

This post focused on myeloma, an uncommon type of cancer. Although uncommon compared to other cancers, myeloma is one of the most prevalent blood diseases. A cure for myeloma doesn’t exist. Treatment aims to decrease the severity of symptoms and prevent complications. A healthy lifestyle is essential for treatment support.

Sources

  1. Key statistics about multiple myeloma, American Cancer Society https://www.cancer.org/cancer/multiple-myeloma/about/key-statistics.html
  2. Gerecke, C., Fuhrmann, S., Strifler, S., Schmidt-Hieber, M., Einsele, H., & Knop, S. (2016). The Diagnosis and Treatment of Multiple Myeloma. Deutsches Arzteblatt international113(27-28), 470–476. https://doi.org/10.3238/arztebl.2016.0470
  3. Sergentanis, T. N., Zagouri, F., Tsilimidos, G., Tsagianni, A., Tseliou, M., Dimopoulos, M. A., & Psaltopoulou, T. (2015). Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses. Clinical lymphoma, myeloma & leukemia15(10), 563–77.e773. https://doi.org/10.1016/j.clml.2015.06.003
  4. Rajkumar S. V. (2016). Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management. American journal of hematology91(7), 719–734. https://doi.org/10.1002/ajh.24402
  5. San-Miguel, J. F., & Mateos, M. V. (2011). Can multiple myeloma become a curable disease?. Haematologica96(9), 1246–1248. https://doi.org/10.3324/haematol.2011.051169
  6. Erectile dysfunction in myeloma. Everyday Health https://www.everydayhealth.com/multiple-myeloma/erectile-dysfunction-in-myeloma.aspx#:~:text=While%20ED%20can%20affect%20otherwise,away%20after%20successful%20cancer%20treatment.

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