What is Multiple Myeloma ?
In normal healthy adults, these normal plasma cells produce antibody that helps us to fight infection.
In Myeloma, these plasma cells
- have turned cancerous, and
- they produce a large quantity of one toxic antibody called paraprotein or
M protein.
Signs and Symptoms of Multiple Myeloma
Multiple Myeloma may affects many parts of the body as shown below :
Body Part |
Effect |
Symptoms |
Bone Marrow |
Anaemia |
Lethargy |
Bone |
Weak bones bones that fracture easily High blood Calcium level |
Bone pain, weak bone Vague abdominal pain or discomfort, Constipation |
Kidneys |
Kidney failure Occasionally may require dialysis treatment |
Nausea, poor appetite |
Nerves |
Peripheral neuropathy |
Numbness and weakness of the limbs |
Immune system |
Low antibody level |
Frequent infection |
Tests to diagnose Multiple Myeoma
Blood tests :
Full blood count
Blood biochemistry : to determine - renal function
- calcium level etc
Antibody level
Protein study
Urine test :
This is sometimes done to determine
if you are excreting an abnormal protein in your urine.
Classification of MM
By the type of abnormal antibody or paraprotein
that your body is producing.
Example :
if you are producing an IgG paraprotein,
the type of Multiple Myeloma is an IgG subtype.
The Durie-Salmon Staging
Stage |
Criteria |
I |
All of the following: · Haemoglobin level >10g/dL · Calcium level : normal or < 3 mmol/L · Bone X-ray : normal bone structure or Solitary bone plasmacytoma only · Low M Protein Production Rate (IgG<5g/dL; IgA <3g/dL; Bence-Jones Protein <4g/24H) |
II |
· Fitting neither stage I nor stage III |
III |
One or more of the following: · Haemoglobin level < 8.5g/dL · Calcium level > 3 mmol/L · Advanced lytic bone lesions · High M Protein Production Rate · (IgG >7g/dL; IgA >5g/dL; Bence-Jones Protein > 12g/24H) |
How does your Doctor decide what treatment you should receive ?
1. Disease-related factors
v The type of Myeloma
v The extent and stage of the disease
v Presence of any related complications
such as renal failure or bony fracture
v A new disease or a recurrence of Myeloma
2. Patient-related factors
v Health status, including presence of any co-existing medical conditions
v Lifestyle and quality of life issues
v Your fitness to undergo stem cell transplantation
should you need one in the future
v Your expectation, whether to try to achieve a sustained disease remission or to
control the disease
Supportive care
These are therapies that your doctor may prescribe to reduce discomfort and manage complications associated with the disease.
Example :
v Pain killer
v Antibiotics
v Growth factor
v Red blood cell hormone / stimulants called erythropoietin
v Blood transfusion
v Medications to lower blood calcium level and help to build bone faster
called biphosphonates
v Radiation treatment
v Medication to reduce the severity of nerve damage
Plasma Cell : a type of white blood cell
Fracture of arm bone, Lytic bone lesions
How is Multiple Myeloma Diagnosed ?
Multiple Myeloma is sometimes difficult to diagnose
~ as there is no one single test or symptom that can point to the diagnosis.
Many patients go to their doctor because
~ they feel tired,
~ have vague low back ache, a bony fracture that has happened easily or
~ when they have developed renal failure ‘all of a sudden’.
Tests to diagnose Multiple Myeloma
Radiological Imaging Methods :
X-Rays
CT scan or MRI
( if there is a suspicion of nerve compression or spine fracture)
Whole body PET/CT scan – occasionally done
Bone Marrow Examination: click to link
This is necessary to determine the presence and the severity of plasma cell infiltration in your bone marrow.
Staging of MM
There are two widely accepted staging systems :
~The Durie-Salmon Staging System – the older staging system
~The International Staging System (ISS)
This is used more widely now, and it gives a better information on projected survival and a more useful guide in the treatment and decision-making process.
The International Staging System (ISS)
Stage |
Criteria |
I |
B2M < 3.5 mg/L and Albumin > 35g/L |
II |
B2M < 3.5 mg/L and Albumin < 35g/L Or B2M 3.5 - 5.5 mg/L |
III |
B2M ≥ 5.5 mg/L
|
Multiple Myeloma Affecting the Kidneys & the Skull
Treatment for MM
Monitoring of Disease after Treatment
It is important that
> you communicate with your doctor for any problems related to your treatment
> you undertand that treatment will take weeks to months to assess the response
to treatment
> to be compliant to your treatment and follow-up