Multiple Myeloma | Symptoms, Types, Causes, Diagnosis & Treatment

Plasma cells are a type of white blood cell. They are found in bone marrow but can also form in the spleen, lymph nodes, and other sites. These cells normally transform into a type of lymphocyte called B cells, which produce antibodies and protect the organism against microbes and viruses. But what if these cells grow out of control? That is basically what multiple myeloma is.

You can see multiple myeloma as tumors formed in the bone marrow, but they can be different from other types of malignant growths or cancers. These tumors block the production of normal blood cells, which can lead to anemia, infections, and bleeding.

So multiple myeloma has various manifestations, and they depend on many factors at play. In this article, we’re looking at this disease and making it simple for patients and their caregivers to understand. After reading, you will know about the types of multiple myeloma, their signs and symptoms, treatment, and more.

What is multiple myeloma?

It is a type of hematologic cancer that affects the bone marrow and can affect the body’s ability to make new blood cells. Multiple myeloma is a type of cancer that develops in plasma cells. As a type of cancer that is found in the blood, multiple myeloma is not always apparent in the same way as solid cancers.

There are sometimes tumors forming in the bone marrow, but not necessarily so. And still, there are alterations in how blood cells are formed, and patients experience different alterations. That’s why multiple myeloma can cause various symptoms, including fatigue, fever, anemia, bleeding, spinal cord compression syndromes, pain in bones or joints, weakness, weight loss, and much more.

Multiple myeloma symptoms

The most common symptoms of multiple myeloma include bone pain, fatigue, and bleeding.

• Pain is most noticeable in your bones, and you may experience symptoms of bone damage. It is described as bone pain, which is dull and sustained for an extended period in a wide area that is difficult to pinpoint.
• Fatigue is a common symptom in multiple myeloma, as the disease often causes anemia, which makes you feel tired easily. It can also be described as muscle weakness or a sensation of feeling unwell or malaise.
• Blood tests are used to detect multiple myeloma. These tests measure the levels of t cells, red blood cells, platelets, and creatinine in your blood. Abnormal levels of these substances in your blood test can indicate the presence of multiple myeloma. When platelets are low, the most common symptom is bleeding

Signs of multiple myeloma

The difference between signs and symptoms is that the patient feels symptoms, and signs are something a doctor can measure in their clinical practice. The most important signs of multiple myeloma include the following:

• Pathologic fractures: In other words, fractures because your bone is weakened and has reduced mineral density. With an otherwise healthy bone, you wouldn’t have fractured.
• Spinal cord compression: When a pathologic fracture occurs in the vertebrae, these structures collapse and create compression in the spinal cord. It is also possible that the bone marrow mass grows very large and also causes compression.
• Anemia: This is a reduction in the hemoglobin levels of the blood. Anemia is characteristic of multiple myeloma because the abnormal growth of plasma cells takes the space reserved for other blood cells. They are not produced as effectively, and patients would experience a reduction in their blood cell count.

Types of multiple myeloma

There are different types of multiple myeloma, which are also considered stages:

1. MGUS (monoclonal gammopathy of uncertain significance): It is characterized by the presence of an abnormal protein produced by the abnormal cells in the blood marrow and then released to the blood. The protein is known as protein M, but it is also known as paraprotein or myeloma protein.
2. SMM (smoldering multiple myeloma): This is an intermediate stage between MGUS and active multiple myeloma. Patients will also have protein M, but the levels of this protein are higher. Another feature is the number of abnormal cells in the bone marrow, which is much higher than MGUS. Still, the patient remains asymptomatic.
3. Solitary plasmacytoma: This one is similar to SMM because it is an intermediate stage between MGUS and active myeloma. The difference is that in solitary plasmacytoma, an actual mass or tumor of abnormal cells is clearly visible and growing in the vertebrae.
4. Symptomatic or active multiple myeloma: When SMM or solitary plasmacytoma turns into the actual disease, we call it symptomatic or active multiple myeloma.

Causes of multiple myeloma

Why are plasma cells produced uncontrollably in multiple myeloma? There are different causes or explanations for this disease:

• • Genetics: Multiple myeloma will be more prevalent in patients with a first-degree relative who had the disease, especially if that’s your identical twin. There are oncogenes associated with the development of multiple myeloma, especially one known as c-myc. Other genes are involved in the disease’s development, including K-ras, N-ras, and TP53.
  • Environmental causes: The environment you live or work in can increase your chance of multiple myeloma. If you’re continuously exposed to chemicals used in the agricultural, petrochemical, or food industry, the opportunity of multiple myeloma goes up.
  • Radiation: Some studies reported that survivors of the Nagasaki atomic bomb have an increased prevalence of multiple myeloma compared to the rest of the population.
  • Chronic inflammation: If you have chronic inflammatory diseases such as inflammatory bowel disease or an autoimmune disorder such as arthritis, the risk of multiple myeloma is higher. It is thought that ongoing inflammation and antigenic stimulation could trigger abnormal cell growth.
  • Infection with the human herpesvirus 8: Being infected with this virus can increase your risk of multiple myeloma. It doesn’t mean that herpesvirus 8 causes multiple myeloma directly, and it only happens under some circumstances.

Is multiple myeloma a lethal or dangerous disease?

Multiple myeloma is a malignant disease that can cause a wide range of symptoms that we will review thoroughly in this article and can also result in death if not treated. However, many people with multiple myeloma live long, happy lives.

However, this depends on different factors, including your age and some disease features, including the level of C-reactive protein, beta-2-microglobulin, and blood calcium levels. Another sign of bad prognosis is having an actual tumor mass in the vertebrae, Bence Jones proteinemia, or kidney impairment with a creatinine level lower than 2 mg/dL.

One of the main problems with multiple myeloma is how the disease affects the immune system. That is what makes multiple myeloma more dangerous, and infections are a common cause of death in these patients, especially during the first months after the diagnosis is made.

What diagnostic tests will the doctor order

Multiple myeloma alterations are sometimes found incidentally in a routine medical test. In other cases, it is found in active multiple myeloma when patients already have signs and symptoms. If your doctor suspects you have multiple myeloma, they would likely order these tests:

• • A complete blood test: This is made to examine cells under a microscope, including plasma cells, white blood cells, red blood cells, and platelets, to see if they are damaged or abnormal. The doctor will also look at the shape and structure of the cells.
  • Urine tests: In the urine, a molecule known as Bence Jones protein could be found in patients with bad prognoses.
  • Myeloma protein levels: As mentioned above, abnormal plasma cells produce a specific protein we can detect in the blood. These proteins can be detected by immunoglobulin analysis or any other method.
  • Radiography: It is important to determine if there is a visible mass in the vertebrae. It is also essential to rule out or diagnose skeletal lesions and pathological fractures.
  • Aspiration and biopsy: This is the definitive diagnostic method and the only way to confirm if you have multiple myeloma or not. An aspiration sample is taken from the bone marrow, and the cells are examined under the microscope to see the differences from the normal tissue.
  • Cytogenetic analysis: The doctor will also use a chromosome analysis to check for genetic markers, which may indicate multiple myeloma and worsen the prognosis.

Non-surgical treatment of multiple myeloma

If you have been diagnosed with multiple myeloma, there are many treatment options that do not involve surgical procedures. Non-surgical treatment of multiple myeloma can help shrink tumors and prolong life, preventing or reducing the need for surgery.

These treatments can include:

• • Chemotherapy, which can help shrink the tumor and kill off cancer cells. It is a systemic treatment with many side effects, but it is effective when the disease is in an advanced stage.
  • Radiation, which can kill cancer cells limited to a small space of the body. It doesn’t have the same side effects as chemotherapy, but localized side effects on the skin and soft tissues are sometimes painful and difficult to handle
  • Another option is immunotherapy, which uses your own immune system to kill cancer cells. Immunotherapy can also be combined with other treatments, such as chemotherapy.

Surgical treatment of multiple myeloma

Sometimes patients can’t undergo surgery, or the disease is very advanced, and the prognosis is poor after surgery, with a very high chance of infections during the hospital stay. But some patients with multiple myeloma are recommended a type of surgical treatment that may contribute to better disease control.

The main surgical treatments contemplated in patients with multiple myeloma include:

• • Bone marrow transplantation: It is perhaps one of the only ways to revert the disease, but it is a very complex procedure that not all patients may survive. Thus, different tests will be made to ensure this procedure is suitable and safe for you before considering the option. There are different forms of bone marrow transplantation, including autologous transplantation.
  • Surgical care: Multiple myeloma can cause pathological fractures and spinal cord compressions, which require surgical care to improve the patient’s quality of life.

Alternative treatment for multiple myeloma

Multiple myeloma is currently incurable when it reaches an advanced stage. Common treatments include chemotherapy, radiation, and surgery, but each of these treatments may be accompanied by significant side effects.

This is where alternative treatments and herbal remedies enter to boost the patient’s immune system, effectively beating back the disease. Alternative treatments include herbs such as echinacea, ginseng, and green tea. Other alternative therapies include acupuncture, relaxation techniques, and massage.

While these alternative treatments and herbal remedies may promise great things, there is no conclusive evidence that they really work in treating multiple myeloma. Studies suggest that few patients actually benefit from these treatments.

What alternative treatments do is coadjuvating the actual medical treatment. In other words, they can help you feel better sometimes and may sometimes improve how your body reacts to medical treatment.

Prevention of multiple myeloma

Multiple myeloma most often affects older adults, although younger people can also be affected. It is rare, but it is important to know the causes and symptoms to look for. It is also essential to run tests frequently to detect multiple myeloma before the disease reaches a late stage.

One way of preventing the morbidity and mortality in multiple myeloma is getting an early diagnosis, which is achieved by screening for this and other diseases as a part of your annual visits with your doctor, depending on your risk factors.

Besides secondary prevention, there’s no way to reduce the incidence of multiple myeloma. Current studies are looking for options to prevent the disease, especially in patients with a high risk, and routine residential ultraviolet exposure appears to have a protective effect that requires further confirmation.

Conclusion

Multiple myeloma is a type of cancer that grows in the blood cells, more specifically in plasma cells, which are meant to become B cells and produce antibodies. But these abnormal plasma cells do not transform into B cells and keep on growing and taking up space in the bone marrow. Other blood cells in the bone marrow are affected, and patients suffer from a depletion of platelets, red blood cells, and other blood elements.

Multiple myeloma has different stages, including two asymptomatic stages in which the only sign is a protein in the blood and other alterations. Thus, before signs and symptoms show up, it is recommended to run screening tests if you’re at risk of this disease.