Multiple Myeloma

Overview

In multiple myeloma, a type of white blood cell called a plasma cell multiplies unusually. Normally, they make antibodies that fight infections. However, in multiple myeloma, they release too much protein (called immunoglobulin) into your bones and blood. It builds up throughout your body and causes organ damage.

The plasma cells also crowd normal blood cells in your bones. They release chemicals that trigger other cells to dissolve bone. The weak areas of bone this creates are called lytic lesions.

As multiple myeloma gets worse, those plasma cells begin to spill out of your bone marrow and spread through your body. This causes more organ damage.

 

Symptoms

Early on, multiple myeloma may cause no symptoms. As time passes, you may have:

  • Bone pain
  • Weakness and fatigue
  • Weight loss

 

Causes

No one knows what causes multiple myeloma. However, you are more likely to get it if:

  • You’re older than 65
  • You’re African-American
  • You have a family member with it

If you have one these other plasma cell diseases, you may be more likely to get multiple myeloma:

  • Monoclonal gammopathy of undetermined significance (MGUS)
  • Solitary plasmacytoma

 

Diagnosis

Your doctor may test you for multiple myeloma if a blood test shows you have:

  • Too much calcium in your blood (your doctor may call it hypercalcemia)
  • Anemia (too few red blood cells)
  • Kidney problems
  • High protein levels in your blood, along with a low albumin level (your doctor may say you have a "globulin gap")

If your doctor thinks you have multiple myeloma, he may order blood tests:

  • A CBC, which stands for complete blood count. It measures the different kinds of cells in your blood.
  • Blood urea nitrogen, also known as BUN, and creatinine. These check how well your kidneys are working.

Other specialized blood and urine tests check for how much and what kinds of abnormal proteins your body is making.

After your test results come in, your doctor may want to do a bone marrow biopsy. He’ll put a needle into a bone, usually in your hip, to get a sample of bone marrow to check the number of plasma cells in it.

He may also want you to get X-rays. They can show spots of bone weakened by multiple myeloma. Sometimes you may also need a CT scan, MRI, or PET scan.

Multiple myeloma cases are usually graded as high, intermediate, or standard risk.

 

Treatment

If you do not have symptoms, your doctor may choose to watch you closely rather than start treatment right away.

If you do have symptoms, your doctor will work with you to come up with a treatment plan. It will aim to improve your quality of life by easing your symptoms and helping you get good nutrition.

People who are considered high-risk might want to look into a clinical trial for an existing or new treatment. Research is ongoing, including clinical trials to find more effective drugs and combinations.

Medications

Which drugs your doctor chooses depends on your age and how aggressive your cancer is.

Chemotherapy: Chemo drugs are most often used in combinations. The ones that treat multiple myeloma are:

  • Bendamustine (Treanda)
  • Cyclophosphamide (Cytoxan)
  • Doxorubicin (Adriamycin)
  • Etoposide (VP-16)
  • Liposomal doxorubicin (Doxil)
  • Melphalan (Alkeran, Evomela)
  • Vincristine (Oncovin)

 

Specialists


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