What is Multiple Myeloma? Let's talk about this serious disease!

Have you ever heard of a disease called Multiple Myeloma? Maybe the name sounds a bit strange to you, or maybe you haven't heard of it at all. It's actually a rare, but serious cancer that affects our blood. It's important to be aware of it, because early detection can help you manage your symptoms and live your best life possible.

What is Multiple Myeloma?

Okay, let's see what this multiple myeloma is. Simply put, it's a cancer that develops in a type of cell called plasma cells in our blood.

Now you might be wondering, "What are these plasma cells?" These are a type of white blood cell in our body. To explain further, they are a very important part of our immune system , the system that protects us from disease. Sometimes these are also called B-cells . These plasma cells are what make antibodies , or immunoglobulins . These antibodies are what fight off germs, bacteria, and viruses that enter our bodies and protect us from getting sick. They are like little bodyguards in our bodies.

So, when multiple myeloma develops, these healthy, good plasma cells change for some reason and become abnormal cancer cells . Then these abnormal cells start dividing and multiplying rapidly, without control. The abnormal plasma cells that develop in this way also produce abnormal, useless antibodies. We call these M proteins .

These abnormal cells multiply and produce M proteins, which can cause problems. They can damage your bones and affect your kidney function. They can also interfere with the bone marrow's ability to produce healthy white blood cells, red blood cells, and platelets, which help blood clot.

Is this an incurable disease?

In fact, there is currently no cure for Multiple Myeloma. That is the sad truth. But don't worry , doctors can treat the side effects and symptoms of this disease. They can also slow down the spread of the disease.

Many people can have a period of symptom-free recovery after treatment. We call this a remission period. That is, after treatment, you can live normally without symptoms of multiple myeloma. For some people, this remission period lasts for a long time.

How common is Multiple Myeloma?

This is a really rare disease . Statistics show that about 7 out of 100,000 people are affected by this disease every year. In a country like America, it is estimated that about 100,000 people suffer from this disease. Although there is no exact data on how many people are affected in our country, this is considered a very rare disease.

Who is most likely to get this disease?

Multiple myeloma is more common in men than in women . It has also been found to affect certain ethnic groups more than others. For example, black people are twice as likely to develop the disease as white people.

In terms of age, it is most often diagnosed in people between the ages of 40 and 70. The average age at diagnosis is between 65 and 74. That means it tends to appear when you get a little older.

How does Multiple Myeloma affect the body?

Some people may not have any symptoms at first, but things like blood tests can show signs that they may develop multiple myeloma in the future.

For example, a bone marrow aspiration or biopsy can show abnormal plasma cells and genetic mutations. This could mean that you have a pre-cancerous condition called smoldering multiple myeloma (SMM) , which is a precursor to multiple myeloma. Blood and urine tests can also detect the M proteins that are produced by the abnormal plasma cells. This condition is called monoclonal gammopathy of undetermined significance (MGUS) . Doctors will monitor you closely for these.

The symptoms of multiple myeloma appear gradually over time. They may resemble the symptoms of other diseases. Here are the main conditions that can be caused by this disease and their causes:

• Anemia: A deficiency in your red blood cells. This happens because abnormal plasma cells fill the bone marrow, preventing it from producing healthy red blood cells.
• Bacterial infections, especially pneumonia: As well as red blood cells, abnormal plasma cells increase in number, crowding out healthy white blood cells that fight infection. This can make it easier for infections to develop.
• Thrombocytopenia: A low number of platelets in your blood. Platelets are cells that help your blood clot. Abnormal plasma cells can also interfere with the production of these platelets.
• Bone pain/bone fractures: Abnormal plasma cells destroy bone tissue, causing bones to become weak, painful, and easily broken. This is also called osteolytic lesions .
• Kidney problems/failure: Our kidneys are responsible for filtering out waste and toxins from our bodies. M proteins can interfere with the kidneys' filtering process and damage them.
• Amyloidosis: This is when abnormal proteins (amyloid proteins) are deposited in various organs of the body.
• Hypercalcemia: Excess calcium from damaged, weakened bones accumulates in the blood.
• Hyperviscosity syndrome: M proteins cause blood to thicken, which means the heart has to work harder to pump blood.
• Cryoglobulinemia: Multiple myeloma can sometimes cause proteins in the blood to clump together in the cold.

What are the symptoms of Multiple Myeloma?

Multiple myeloma can cause a variety of symptoms. But many people first experience bone pain , especially in the spine and ribs. Here are some other symptoms:

• Weakness and numbness in the limbs. If the bones in the spine are damaged, they can collapse and press on the spinal cord.
• Fatigue - This means feeling too tired to do daily tasks, feeling weak. These can be signs of anemia.
• Nausea and vomiting . This can be a sign of a condition called hypercalcemia.
• Loss of appetite and/or feeling more thirsty than usual. These can also be symptoms of hypercalcemia.
• Unexplained weight loss .
• Unexplained fever . This could be a sign of a bacterial infection.
• Easy bruising or bleeding . This means that the body is unable to make enough platelets due to abnormal plasma cells.
• Memory loss , inability to concentrate, feeling "foggy".

Remember, having one or two of these symptoms does not mean you have multiple myeloma. However, if these symptoms persist, it is best to see a doctor and get checked out.

What are the causes of Multiple Myeloma?

Doctors and researchers still don't know exactly what causes multiple myeloma, but there are some things they suspect and are researching:

• Genetic mutations: Research is being conducted to see if there is a link between mutations in certain genes ( oncogenes ) that control the growth of our cells and multiple myeloma. It has also been found that many people with this disease have missing parts of certain chromosomes.
• Environmental factors: Some studies have shown that exposure to radiation, pesticides, fertilizers, and chemicals like Agent Orange may also be involved.
• Having an inflammatory disease: For example, long-term inflammatory conditions such as heart disease, type 2 diabetes, and rheumatoid arthritis.
• Obesity: This means having too much body fat.

These are the things that are currently suspected. But none of these have yet been proven to be the cause.

How do doctors diagnose this disease?

A doctor follows several steps to diagnose multiple myeloma.

First, you will be given a physical examination . Your symptoms will be carefully examined. You will also be asked about your family medical history. Then, several tests may be done to confirm the diagnosis. The information obtained from all of this will determine the stage of the cancer, such as the size of the tumor and how far it has spread.

What tests are done for this?

Doctors perform a variety of tests to determine if you have multiple myeloma, and if so, whether it is in its early stages or has spread somewhat. Here are some of them:

• Complete Blood Count (CBC): This measures the number of red blood cells, white blood cells, and the amount of hemoglobin in your red blood cells.
• Blood chemistry test: This will check your creatinine level (which measures how well your kidneys are working), albumin protein level, calcium level, and lactate dehydrogenase (LDH) level. LDH can be a tumor marker.
• Quantitative immunoglobulin test: This blood test measures the levels of different types of antibodies in your blood.
• Electrophoresis: This test checks for the presence of M proteins in the blood.
• Urine tests: A 24-hour urine sample can be tested to see if there is a protein called Bence Jones protein , another marker of multiple myeloma.
• X-rays: X-rays are used to see if multiple myeloma has damaged the bones.
• CT Scan (Computed Tomography - CT scan): This is another test to look for bone damage.
• MRI scan (Magnetic Resonance Imaging - MRI): This uses a powerful magnet and radio waves to make detailed pictures of your bones and spine. It is used to look for things like plasmacytomas , which are tumors that form in clusters of abnormal plasma cells.
• PET scan (Positron Emission Tomography - PET scan): This is another type of scan used to detect plasmacytomas.
• Bone marrow biopsies: Doctors take a small sample of bone marrow and analyze it for the percentage of normal and abnormal plasma cells. They can also check for changes in DNA that can lead to cancer.

How are the stages of Multiple Myeloma determined?

Doctors determine the stage of multiple myeloma and other cancers by finding out how much the cancer has spread and how far it has spread. This stage is used to plan treatment. The process of determining the stage of multiple myeloma begins by classifying the disease into one of four categories:

1. MGUS (Monoclonal Gammopathy of Undetermined Significance): Blood tests show small amounts of M protein. About 1% - 2% of people with MGUS may develop multiple myeloma.

2. Solitary or isolated plasmacytomas: These are clusters of abnormal plasma cells that form singly, in one place.

3. SMM (Smoldering Multiple Myeloma): This is a pre-cancerous condition that precedes Multiple Myeloma. People with SMM may have mild symptoms, and show a small amount of M protein in the blood and an increase in plasma cells in the bone marrow.

4. Multiple Myeloma: This classification means that tests show multiple clusters of abnormal plasma cells, high levels of M protein in the blood or urine, and a high percentage of abnormal plasma cells in the bone marrow. These people often have anemia, hypercalcemia, kidney failure, and osteolytic lesions.

Doctors then use a system called the Revised International Staging System (R-ISS) to determine the stage of multiple myeloma. The R-ISS is based on levels of albumin, beta-2 microglobulin, and lactate dehydrogenase in the blood. It also takes into account tests for specific gene abnormalities.

What are the treatments for Multiple Myeloma?

Doctors treat multiple myeloma based on your symptoms and the extent of the disease. For example, people with MGUS usually don't need immediate treatment. But their doctor will monitor their health regularly. They can also create a treatment plan to take immediate action if symptoms develop.

If you have symptoms of multiple myeloma, doctors may use these treatments:

• Pain medications: Many people need these because they experience severe bone pain.
• Antibiotics: As the immune system weakens, infections become more likely. Your doctor may prescribe antibiotics to treat these infections.
• Steroids: Steroids, when given in high doses, can kill cancer cells and reduce inflammation.
• Chemotherapy: Chemotherapy is used to reduce the number of abnormal plasma cells.
• Immunotherapy: This treatment stimulates your immune system to make more cells that fight cancer.
• Radiation therapy: This treatment destroys cancer cells and shrinks bone tumors.
• Stem cell transplants: Stem cells are a type of specialized cell found in our bone marrow or blood. They can help make new, healthy plasma cells. Doctors usually recommend autologous stem cell transplants . This involves using healthy stem cells from your own body to replace damaged or unhealthy stem cells. Rarely, healthy stem cells can be obtained from another donor. This is called an allogenic stem cell transplant .

How long can you live with Multiple Myeloma?

Some people live with multiple myeloma for 10 years or more. As with many cancers, early detection and early treatment are key to long-term survival. For example, about 78% of people with a single plasmacytoma are alive five years after diagnosis. The overall five-year survival rate for people with multiple myeloma ranges from 40% to 82%. These figures are based on the R-ISS staging system mentioned earlier.

But remember, these numbers are averages. They don't take into account your age or overall health, which is personal. If you have multiple myeloma, your doctor can give you the best information about your condition.

Can this be prevented from happening?

No, there is currently no way to prevent multiple myeloma from developing. Researchers are trying to find ways to stop the pre-cancerous stage called SMM (Smoldering Multiple Myeloma) from becoming active multiple myeloma.

How do you take care of yourself?

Multiple myeloma affects everyone differently. For example, people with MGUS or SMM may not need immediate treatment. But they will need to see their doctor regularly for tests. If you are in remission from multiple myeloma, your doctor will schedule check-ups and tests based on your condition.

If you are living with Multiple Myeloma, there are several things you can do to maintain your overall health:

• Eat nutritious foods every day. Multiple myeloma can cause loss of appetite. So try to eat four to five small meals a day.
• If you are a smoker, try to quit.
• Give your body the rest it needs and sleep well.
• Protect yourself from infections. Ask your doctor about ways to prevent infections.
• Do some exercise, but ask your doctor first. He or she will tell you what kind of exercise is right for you.
• Pay attention to your mental health, too. It's normal to feel sad, anxious, and depressed when dealing with a condition like this. But if this sadness or anxiety lasts for more than two weeks, or interferes with your daily activities, talk to your doctor about it.
• If you're in remission , you may be happy that treatment is over. But you may also be worried that the cancer will come back. Talk to your doctor about your condition and what to expect going forward.

Multiple myeloma is a rare blood cancer. Although it cannot be cured, doctors can treat the associated conditions, symptoms, and control the spread of the disease. Some people live with the disease for years. Others are in remission. However, living with a cancer that doesn't go away and can come back is not easy. It means living with treatment and tests every day of your life. Doctors understand these challenges. If you need help learning to live with multiple myeloma, ask your doctor. They can tell you about helpful services and programs.

The most important thing we want to take home

Okay, so, the most important things you need to remember from what we've talked about are these:

• Multiple Myeloma is a rare blood cancer that develops in plasma cells .
• Although it cannot be completely cured, treatment can control symptoms, extend life expectancy, and improve quality of life .
• If you have symptoms like bone pain, severe fatigue, or frequent infections , see a doctor immediately.
• The earlier the diagnosis, the more likely it is that treatment will be successful.
• When living with this disease, it is very important to take good care of yourself, follow your doctor's advice, and stay mentally strong .

Don't worry, you're not alone. Medical science is advancing, and new treatments are coming out all the time. Your doctor and healthcare team are always ready to help you.

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