What is Multiple Myeloma?

MM is a malignancy of plasma cells which live in the Bone Marrow. They are an important part of the Immune system, and manufacture infection-fighting proteins called Immunoglobulins. When plasma cells become malignant, they grow excessively, creating local and systemic problems. Since they are present in the bone marrow, they occupy the marrow throughout the body. This occupation crowds out normal cells, causing anemia, low platelet counts and decreases the number of normal white cells, thus decreasing the ability to fight infection. As the condition worsens and grows, it can dissolve the surrounding bone, and weaken it, causing fractures. As the bone dissolves, the blood calcium levels rises to abnormal levels.

Meanwhile, the excessive plasma cells secrete an abnormal amount of Immunoglobulins, which can clog up circulation. This can result in kidney failure, among other things.

Multiple Myeloma progresses through a number of stages. There is no screening test that is routinely done, but there are clues that a vigilant physician can pick up. Initially, there is a mismatch of the protein  (albumin and globulin) levels, and a special test called a SPEP and IEP is done to verify that there is a preponderance of one kind of protein fraction (Monoclonality).  If that is all there is, a condition called Monoclonal Gammopathy of Unknown Significance (MGUS) is diagnosed. This does not need treatment, but needs to be checked annually for progression to Multiple Myeloma.

Plain X-rays of the bones are done to look for weak spots, corroborative evidence of the presence of Multiple Myeloma. Other telltale signs are the presence of low numbers of red blood cells (anemia) and platelets. A bone marrow biopsy is done, which quantifies the percentage of plasma cells. If it is more than 15 %, it confirms the presence of Multiple Myeloma. If less than that, there is the pre-myeloma stage of smoldering myeloma. The bone marrow sample provides other valuable information. The marrow is sent for analysis of chromosome abnormalities. Particular abnormalities confer worse prognosis.

 Not all Multiple Myeloma patients need to be treated at initial diagnosis.  Measurements of abnormal Immunoglobulin levels, Calcium, kidney function, and abnormal blood cell counts will dictate need for therapy. It is a disease that is seen more in the elderly population, and extent of treatment is dictated by the age and physical condition of the patient. The disease cannot be eradicated by routine chemotherapy, and a bone marrow transplant is considered in the younger, more robust patient. Chemotherapy is given to decrease the tumor burden i.e. volume of tumor, followed by a bone marrow transplant. In patients who are not transplant candidates, the goal of chemotherapy is to induce a remission, and make it last as long as possible. There are many new drugs to help in this endeavor.

Radiation Therapy is used to strengthen bones that have developed spot breaks. It is also helpful in pain management of diseased bones.

Supportive therapy will include blood transfusions, Epo injections to improve blood counts, antibiotics for infections, even dialysis to improve clogged kidneys. Calcium loweing drugs are administerd to lower high calcium levels.

With serial chemotherapy and good supportive care, patients can continue to function well for several years.