Multiple myeloma is classified as cancer within the plasma cells. Normal plasma cells are located in the bone marrow and are essential for the immune system. Several different types of cells make up the immune system. These cells work together fighting off diseases and infections. Lymph cells or lymphocytes are one of the main kinds of white blood cells located in the immune system. This also includes B cells and T cells. Lymphocytes are found throughout the body including in the bone marrow, the bloodstream, lymph nodes, and intestines.
When there is an infection, the B cells respond. The cells then mature and transform into plasma cells. Plasma cells produce antibodies also referred to as immunoglobulins. This is partly how the body attacks and kills germs. The majority of plasma cells are located in the bone marrow. This is the soft tissue found inside of the bones. Normal bone marrow also contains other types of blood cells including platelets, white cells, and red cells.
In most instances, when plasma cells are cancerous they start growing out of control. This is classified as multiple myeloma. An abnormal antibody or protein is produced by these plasma cells. This is referred to under numerous different names including M-protein, monoclonal protein, monoclonal immunoglobulin, paraprotein, an M-spike. Abnormal plasma cells are also found in many other types of plasma cell disorders. These disorders are not considered active multiple myeloma because the criteria are not met.
• Solitary plasmacytoma
• (SMM) Smoldering multiple myeloma
• Light chain amyloidosis
• (MGUS) Monoclonal gammopathy of uncertain significance
Symptoms of multiple myeloma do not generally appear until the disease is advanced. For this reason, a diagnosis is not usually made until the disease has already spread. Decreased numbers of blood cells can lead to a reduced ability to fight off infections, excessive bleeding, and anemia. When M protein builds up in the urine and blood, organs including the kidneys can sustain damage. Damage to the bones can result in pain and osteolytic lesions. These are weakened spots located on the bones.
The risk of fractures increases due to bone destruction often resulting in hypercalcemia. This condition is classified as higher levels of calcium within the blood.
Smoldering Multiple Myeloma
(SMM) or smoldering multiple myeloma is early myeloma with no symptoms present. The individual will not experience any problems. Individuals with this disease will have some of the symptoms of multiple myeloma including:
• Bone marrow containing a large number of plasma cells.
• High levels of monoclonal protein or immunoglobulin in the blood.
• High levels of light chains in the urine. These are small protein segments also referred to as Bence Jones protein.
These individuals will have normal kidney function, normal calcium levels, normal blood counts, no damage to the organs or bones, and no signs or symptoms of amyloidosis. Individuals with this condition do not need immediate treatment. This is because months or years can be required for the disease to become symptomatic or active myeloma. This disease can be so slow in some people that it never develops into active myeloma.
Active research is currently being conducted for SMM. Certain types of SMM have a much higher risk of becoming active myeloma than others. Studies are being conducted to determine if SMM should be classified as active myeloma or if treatment needs to begin sooner. Individuals diagnosed with SMM are closely watched for any signs or symptoms of myeloma.
Causes of Multiple Myeloma
The causes of this disease include anything interfering with the immune system including exposure to atomic radiation or toxic chemicals. Viruses and infections caused by cancer have also been found to trigger or cause multiple myeloma. Specific toxic chemicals have been identified as the cause of multiple myeloma symptoms including:
• Dioxins including what has been found in Agent Orange
• Cleaning products
• Engine exhaust
• Agricultural chemicals including pesticides and defoliants
Numerous viruses have been identified as possible triggers including:
• AIDS and HIV
• Several different herpes viruses
• Simian virus 40. This was a Sabin polio vaccine containing contaminants used from 1955 until 1963.
Roughly five to seven percent of all people diagnosed with multiple myeloma have a close relative receiving a diagnosis of either myeloma or MGUS in the past. Anyone with a close family member diagnosed with either MGUS or MM including a father, mother, sister, brother, daughter, or son should tell their primary care doctor so it can be included in their permanent medical record. This enables the physician to look for early signs and symptoms and order testing when deemed necessary.
Anyone diagnosed with this disease should inform their family so they can tell their primary physicians. A lot of advancements have been made by researchers in understanding the development of multiple myeloma. At this time the exact cause remains unknown. All cancers including multiple myeloma are heterogeneous. This means every case is considered unique. Multiple myeloma is caused by genetic mutations different for every individual.
The identification of specific mutations is now known to be genetic risk factors. Despite this, multiple myeloma is not believed to be a hereditary disease. Multiple myeloma is more common in men, individuals above the age of 45, and African Americans. It is important to understand there is no proof these factors cause multiple myeloma. New studi1es consistently reveal new findings to help the medical community identify the risk factors of the disease and help find a cure.
In comparison to the other ethnicities, there are twice as many cases of multiple myeloma in the Black community. In comparison to white patients, this disease results in twice as many deaths in Black patients. The conditions linked to the development of this disease including MGUS are much more common among Black patients.
Approximately 70 percent of all individuals with multiple myeloma experience bone or back pain, persistent or recurrent infections, and fatigue. Anyone experiencing the following symptoms should talk to their doctor.
• Unexplained or recurring infections including urinary tract infections, sinus infections and pneumonia
• Recurrent or persistent pain in the bones or back
• Worsening or persistent fatigue
• Shortness of breath
• Swelling of the arms or legs
Plasma cells can overgrow in the bone marrow resulting in blood-forming cells being crowded out. This can result in a low blood count or anemia. Anemia is classified as not enough red blood cells. The symptoms are often fatigue and weakness. Multiple myeloma can also result in low levels of platelets within the blood referred to as thrombocytopenia. This can result in increased bruising and bleeding. Leukopenia is another condition linked to multiple myeloma.
Leukopenia can result in an insufficient supply of white blood cells. The individual may then be unable to fight off infections. Interference from myeloma cells can also prevent bones from remaining strong. Bones must constantly be reformed to ensure they remain strong. Two different types of cells are responsible for keeping bones strong and healthy. Old bone is broken down by osteoclasts. New bone is then laid down by osteoblasts.
A substance is produced by myeloma cells telling osteoclasts to work harder to dissolve the bone. This means there is no new bone to take the place of the broken down bone. Bones then become weaker and easily broken. One of the major issues for individuals with multiple myeloma is fractured bones. When bone breakdown increases calcium levels can be raised within the blood. Issues due to high calcium levels are a sign of multiple myeloma.
When plasma cells are abnormal, protecting the body from infections is impossible because antibodies to attack the germs are not being produced by normal plasma cells. Once normal plasma cells are forced out by myeloma cells, the antibody produced by the myeloma cells is incapable of fighting off infections. This is because myeloma cells are simply numerous copies of the same plasma cell.
Myeloma cells also produce an antibody often harmful to the kidneys. The result is kidney damage. In some cases, this leads to kidney failure.
There are several different types of treatments for multiple myeloma. The right treatment is dependent on the symptoms experienced by the individual in addition to other factors. In the early stages, there are often no symptoms. Doctors monitor this condition carefully with active surveillance. When symptoms are present, they can be treated with targeted therapy or chemotherapy.
In specific circumstances, other treatments are recommended including surgery, interventional radiology, and radiation therapy.
The other treatments for multiple myeloma include:
Interventional Radiology: Interventional radiology is beneficial to help eliminate pain during treatment.
Chemotherapy: Chemotherapy is usually provided along with certain drugs to fight multiple myeloma and help prevent a recurrence.
Radiation Therapy: Radiation therapy often becomes necessary when there is plasma cell growth within the bone marrow resulting in pain and bone damage.
Targeted Therapy: This type of therapy can be used by itself or with other therapies for the treatment of multiple myeloma.
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