Multiple Myeloma is a malignant disease caused by an uncontrolled increase in plasma cells. Plasma cells constitute a subgroup of white blood cells, and their tasks are to produce proteins called antibodies. Under normal conditions, antibodies perform important tasks in the body's immune system fighting against various microbes. Since immunity to various microbes is required, various types of antibodies should be present in the blood. Malignant plasma cells that occur in multiple myeloma disease are called myeloma cells. Myeloma cells produce only one type (it is called monoclonal) and an abnormal antibody. These cells multiply especially in bone marrow and sometimes appear as tumors in the bones or other parts of the body. Great progress has been made in the treatment of multiple myeloma in recent years. Specialists of Department of Hematology of Memorial Şişli Hospital gave information about multiple myeloma disease and its treatment methods.
Symptoms of the disease
Multiple myeloma usually causes high sedimentation. Diagnosis of multiple myeloma sometimes reveals in a person with high sedimentation when its cause was searched. Sometimes, when the causes of some symptoms of the disease are investigated, it is possible to make a diagnosis. Late diagnosis can cause problems. Some symptoms of the disease include:
All blood cells are produced in the bone marrow and mature. Red blood cells (red blood cells, erythrocytes) carry oxygen through a substance called hemoglobin in them. Rareness of hemoglobin is called anemia (anemia). This condition can bring problems such as fatigue, weakness, dizziness, shortness of breath to the patient. In addition to red blood cells, there may also be a decrease in other blood cells in this disease. If white blood cells (white blood cells, leukocytes) decrease, predisposition to infections occurs; if blood cells called platelets decrease, bleeding may occur.
Normal plasma cells produce various antibodies to microbes, ensuring the body's resistance to infectious diseases. In myeloma patients, myeloma cells produce only one single antibody, we call it a “monoclonal protein”. In myeloma, this antibody is mostly in type of IgG, IgA or mild chain type. Level of monoclonal antibodies in the blood is measured and is also used in the follow-up of the disease. Since monoclonal antibody cannot prevent infections, infections can often occur in myeloma patients or infections can be severe. In addition, as mentioned above, if the leukocytes are also reduced, the risk of infection increases.
Multiple Myeloma causes damage to the bones in most patients. Myeloma cells increase both the activity of cells called osteoclasts and decrease the functioning of cells called osteoblasts forming bone tissue. In this way, myeloma cells cause bone thinning; and pain and fractures may occur in the bones. Even fractures and collapses in spinal bones can sometimes cause paralysis. Computed tomography and magnetic resonance tomography are used to examine the bones according to the patient's problems.
Antibodies consist of heavy and light chains. Myeloma cells produce free light chains in some patients, and these light chains can also block the kidneys and eventually lead to kidney failure. Level of free light chains in the blood and the number of light chains in the urine are measured by biochemical methods.
Complications of the disease
Multiple Myeloma, as mentioned above, can create problems caused by anemia, infections, weakening of bones, and damage to the kidneys. In addition, Multiple myeloma can lead to a disease called amyloidosis. There are several types of amyloidosis. The type of amyloidosis, that occurs when free mild chains created by abnormal plasma cells accumulate in various organs of the body, is called AL amyloidosis. In some patients, amyloidosis disease can also develop without Myeloma. AL amyloidosis can occur in any organ, but most often it causes damage to the kidneys, heart, or liver. The most common symptoms of AL amyloidosis are fatigue, weight loss, heart failure, shortness of breath, or edema (fluid collection in the feet). Although the diagnosis of AL amyloidosis is not easy to make, it is vital that the diagnosis is made on time and treatment begins without delay.
Diagnosis and treatment of the disease
Dr. International Myeloma Working Group IMWG in which Prof.Dr. Orhan Sezer, Head of Department of Hematology of our hospital participated in, stated in principles and details that can be applied in both the diagnosis and treatment of Multiple Myeloma disease in various international medical publications. The great achievements achieved in recent years in the treatment of multiple myeloma have positively and significantly influenced the life process in this disease. As large-scale research continues, new treatment protocols and new drugs also provide a constant source of hope for this disease.
At the diagnostic stage, some biochemical studies are performed in the blood and urine, and the condition of the bones and myeloma cells in the bone marrow are examined. Myeloma cells show different characteristics in different patients. Examining these properties of FISH (Fluorescence in situ hybridization) methods gives important information about how the disease can progress.
Treatment is carried out considering the patient's age, physical condition, organ functions and personal preferences. In recent years, some drugs collected under the name of “New drugs”, and stem cell transplantation (bone marrow transplantation) have led to much more successful results in this disease than before, and the life expectancy of patients has increased.
Multiple myeloma is the most common stem cell transplantation (bone marrow transplant) disease in the world. In the past, while stem cells were taken from the bone marrow, this method has now been gradually abandoned (but its name has remained the historical name). This is because stem cells are collected not from the bone marrow, but from the blood in a simple and easy way for the patient after special drug therapy, without the need for surgery. After several courses of chemotherapy, autologous stem cell transplantation is aimed at patients whose age and organ function are appropriate. After the stem cells are collected, high-dose treatment is performed, and the stem cells are given back to the patient intravenously. This treatment, which has a low risk of complications, significantly increases the response rate, response quality, and response time in Multiple Myeloma.
In the patients who cannot have a stem cell transplantation, treatment protocols are applied, including new drugs.
The response of myeloma to treatment is evaluated according to the quality of response. There are many details of this assessment, so in our brief introduction on this page, we touch on the most important points of the assessment:
Partial response: The amount of monoclonal protein in the blood drops below 50% of the initial value after treatment, and the amount of monoclonal protein in 24 hours urine drops below 90% of the initial value after treatment.
Better partial response: The amount of monoclonal protein in the blood drops below 10% of the initial value after treatment, and the amount of monoclonal protein in 24 hours urine drops below 100 mg after treatment.
Complete answer: Monoclonal protein in both blood and urine can no longer be seen even with immunization which is a sensitive method.
Usually, complete response significantly extends the control of the disease, and the time until the disease recurs even if it recurs.
If the disease recurs, there are effective drugs and combinations of drugs that can also be used in this case, in myeloma. Myeloma disease can be seen as a chronic disease in these cases, that its treatment will be started again when necessary. The aim is to prolong the life span and to maintain or improve the quality of life.
Multiple myeloma is a disease in which supportive treatment is important. Supportive therapy has great importance in bone diseases especially caused by Myeloma, in protection against infections and treatment of infections, in neuropathy, thrombosis (clots) prophylaxis, and in the treatment of various problems related to Multiple Myeloma.
Prepared by the Medical Editorial Board. Our health library contents have been prepared for informational purposes only and with the scientific content on the registration date. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.