Overview
What is Multiple myeloma?
Within the bone is the bone marrow. Usually, the bone marrow is composed of fat cells and cells that produce normal cells. One of the cells within the bone marrow is called a Plasma cell and the function of the normal plasma cell is to produce antibodies to fight infections.
When excess abnormal plasma cells are produced, they could produce abnormal extra abnormal proteins. The immunity is lowered since the antibodies are abnormal, and patients are at higher risk of acquiring infections. When these abnormal proteins stick to the kidneys it could lead to kidney damage.
Similarly these abnormal plasma cells interact with the bone which leads to bone damage and high calcium.
Plasma cells in excess within the bone marrow lead to crowding of the bone marrow space, suppressing normal cell production and leading to anemia.
Symptoms
When the bone are affected by myeloma, majority of the patients could have bone pain. When the bone is thin due to myeloma, patients are prone for bone fractures.
If the patient is Anemic, they could have fatigue and if the hemoglobin is very low they could have difficulty with breathing and some patients may have blurring of vision.
If the Calcium is high, they could have altered sensorium and kidney damage.
Some patients may have infections, weight loss, abnormal skin sensation.
Diagnosis
The diagnosis is based on few criteria.
Blood tests, urine test, imaging studies of the bones, bone marrow tests would be required for the diagnosis and staging.
Staging of Multiple Myeloma.
Unlike other cancers, Myeloma has only 3 stages. The newer staging system is called Revised International Staging System.
Is Multiple Myeloma Curable?
No. For Smouldering myeloma treatment may not be required. Close follow up is required. Studies are underway to see if for a subset of smouldering myeloma if treatment could be beneficial.
Multiple Myeloma is treatable and some of the complications reversed to normal. Survival can be improved with treatment.
Treatment
Hydration is a major part of the newly diagnosed Myeloma patients. Precautions and treatment is taken to prevent Kidney damage. If the calcium is high, medications are used to lower calcium.
Various drug combinations are used to treat Myeloma. It may include combinations of the following sets. Steroids, Immunomudulating drugs, Proteasome inhibitors, monoclonal antibodies , bisphosphonates, targeted treatments, chemotherapy drugs and others. The combinations are decided upon based on the patients age, affordability and other factors.
After few months of myeloma treatment and if the patients have responded well, they may require a autologous stem cell transplantation to improve the survival chances. After transplantation these patient may require maintenance treatment for few years, to delay the myeloma for relapsing.
Can the patients be off treatment?
Yes, once the course of the treatment is over and the disease is under good control, patients can go off myeloma treatment and followed up by periodic check ups.
What is the Myeloma relapses or does not respond to the initial treatment?
Myeloma drugs that has not been used in the past, or if the relapse is after few years, the same drug can be considered or newer treatment options can be considered.
Newer treatment modalities that is applicable can be considered.
Second autologous stem cell transplantation, Allogenic Stem cell transplantations, CART cell therapy, clinical trials and other newer treatment options.
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