Definition

Multiple myeloma is a rare blood cancer that affects a type of white blood cell called plasma cells. Plasma cells, also known as B cells, play a crucial role in the immune system by producing antibodies or immunoglobulins, which help the body recognize and fight infections.

In multiple myeloma, healthy plasma cells transform into abnormal and malignant cells, accumulating in the bone marrow and displacing healthy blood cells. Instead of producing beneficial antibodies, these cancerous cells produce abnormal proteins that can lead to complications. These changes can cause health problems that affect the kidneys and the body's ability to produce healthy white blood cells, red blood cells, and platelets.

Multiple myeloma is considered a rare disease, with an estimated incidence of about 7 out of 100,000 people each year. It accounts for approximately 10% of all blood cancers.

Causes

The exact cause of multiple myeloma is still unknown, but it is understood to originate from an abnormal plasma cell in the bone marrow. Typically, healthy cells undergo programmed cell death, but this process is disrupted in cancer cells, resulting in uncontrolled growth and proliferation.

As a result, abnormal plasma cells proliferate rapidly, disrupting the production of healthy blood cells in the bone marrow. These cancerous cells also produce dysfunctional antibodies that accumulate in the body, contributing to various disturbances such as kidney damage and an increased risk of bone problems.

Genetic mutations are suspected of transforming blood cells into abnormal ones, and disturbances within cells may promote malignant growth. Most multiple myeloma patients exhibit changes in specific chromosomes, suggesting a genetic component to the disease. Ongoing research is also exploring the potential role of environmental factors, such as radiation exposure or chemical exposure, in increasing the risk of multiple myeloma.

Risk factor

Factors that can increase the risk of multiple myeloma include:

• Increasing age, with most patients diagnosed in their mid-60s.
• Men are more likely to develop this disease than women.
• Black individuals are more likely to experience multiple myeloma than individuals of other races.
• Having family members, such as siblings or parents, who suffer from multiple myeloma can increase your risk of developing a similar condition.
• Working in agriculture, where there is frequent exposure to pesticides, benzene, or organic solvents, may elevate the risk.
• Chronic inflammatory diseases or infections affecting the bone marrow can increase the risk of multiple myeloma.
• A personal history of monoclonal gammopathy of undetermined significance (MGUS), a condition characterized by abnormal protein (M protein) in the bone marrow, is also a risk factor.

Symptoms

Multiple myeloma can cause various symptoms, but Bone pain is often the first noticeable symptom of multiple myeloma. Below are other complaints that may occur with multiple myeloma:

• Weakness and/or numbness in the limbs
• Bone pain, often the first noticeable symptom
• Increased susceptibility to bone fractures or compression of the spine
• Fatigue and weakness due to anemia (low red blood cell count), hindering engagement in activities
• Nausea, vomiting, constipation, or fever
• Loss of appetite and/or increased thirst
• Drastic unexplained weight loss
• Easy bruising or bleeding
• Confusion or cognitive difficulties
• Increased susceptibility to infections
• Nerve or kidney disorders

Diagnosis

The doctor will inquire about the patient's complaints, duration of symptoms, medical history, family health history, and any previous treatments. Following this, a physical examination will be conducted, which includes assessing vital signs such as blood pressure, respiratory rate, pulse, and body temperature. Subsequently, the doctor will conduct a thorough examination from head to toe to assess your condition.

Diagnostic tests may be conducted if the doctor suspects that your symptoms indicate an underlying disease warranting further investigation. Multiple myeloma is frequently discovered incidentally through the results of diagnostic tests. These tests may include:

• Complete blood count
• Calcium levels
• Uric acid levels
• Kidney function tests
• Urinalysis to detect specific proteins
• X-ray
• MRI
• CT scan
• PET scan

Management

If you're experiencing symptoms, various treatments are available to help alleviate pain, control disease complications, stabilize your condition, and slow down the progression of multiple myeloma. Some treatments that healthcare providers may offer for this disease include:

• Pain relievers to alleviate significant bone pain.
• Antibiotics may be prescribed for patients who frequently experience bacterial infections due to weakened immunity.
• High-dose steroids to reduce inflammation and combat cancer cells.
• Chemotherapy and radiation therapy kill cancer cells and reduce the number of abnormal plasma cells.
• Immunotherapy, stimulates the immune system to develop more cells to fight cancer.

In addition to the above treatments, stem cell transplantation therapy is another option. Stem cells, special cells found in the bone marrow, can generate new healthy plasma cells. This therapy involves replacing damaged or unhealthy stem cells with healthy ones from your body.

Complications

Multiple myeloma can lead to several complications, necessitating treatment for associated conditions. These complications may include:

• Severe kidney damage requiring dialysis.
• Bone weakening.
• Persistent anemia.
• Neuropathy or peripheral nerve damage, resulting in sensory disturbances in the limbs.

Prevention

Some cases of multiple myeloma are associated with avoidable risk factors. Current research is investigating whether treating high-risk multiple myeloma can prevent the disease from progressing.

However, it's essential to prioritize a healthy lifestyle by:

• Eating a balanced diet.
• Reducing intake of foods containing carcinogenic substances that can promote cancer cell growth.
• Staying hydrated by drinking at least 1 to 2 liters of water daily, unless contraindicated, such as in heart disease.
• Exercising regularly, aiming for at least two sessions per week with each lasting 30 minutes.
• Ensuring adequate sleep, aiming for 7 to 8 hours per night.
• Managing stress effectively.
• Undergoing annual health check-ups.

When to see a doctor?

If you have risk factors for multiple myeloma and experience signs and symptoms of the disease, it's essential to seek immediate medical attention from the nearest general practitioner.

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