Multiple Myeloma Treatment in India

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About Multiple Myeloma

Multiple myeloma is the second most common type of blood cancer. Also known as Myeloma, it starts in the plasma cells of the bone marrow. Plasma cells are short lived antibody (protein) producing cells, derived from a type of white blood cell (B-Lymphocyte). They make different forms of proteins (antibody) that helps fight infection. Malignant transformation of plasma cells results in defective and abnormal single protein formation called monoclonal or M protein. When plasma cells become cancerous and grow out of control, they produce a tumor called plasmacytoma. If someone has only a single plasma cell tumor, the disease is called solitary plasmacytoma or if someone has more than one plasmacytoma, it is called multiple myeloma.

Risk Factors:

There is no exact cause known for the disease. However there are few risk factors associated with increased risk of multiple myeloma, these include:

Age factor: More common in elder people.

Gender: Males are more likely to get multiple myeloma than female.

Family History: If someone is having family history of multiple myeloma, he or she is 4 times more likely to develop multiple myeloma compared to others.

Though not proved, but People who have suffered from some kind of injury are also prone to get multiple myeloma.

Few other plasma cell diseases like solitary plasmacytoma or Monoclonoal gamopathy of unknown significance are associated with high risk for developing multiple myeloma.

Symptoms:

Plasmacytoma in the bones results in weak bone (osteoporosis) which can cause bone pain as well as bones become more prone to get fractured.
It also results in lytic lesion in the bone or spine which further causes pain in back extending to legs.
Increased calcium level which results in kidney problem.
Thirst, frequent urination, feeling drowsy, weakness.
Due to accumulation of abnormal cells in bone marrow, there is reduction in normal RBC, Platelets and WBC counts which causes anemia, weakness and more prone to other infections.

Diagnosis:

Blood tests: As discussed above due to abnormal plasma cell overgrowth other blood counts get reduced. CBC helps to know the level of RBC, Platelets and WBC. Kidney function tests and serum calcium help to assess the renal insufficiency.
Serum and urine electrophoresis: Abnormal protein produced by plasma cells known as monoclonal protein or M protein can be found in blood. This test helps to measure the abnormal Immunoglobulin produced by clonal plasma cells. Immunoglobulin consists of two light and two heavy protein chains. In multiple myeloma these light chains are sometime secreted in the urine, also called Bence - Jones protein which is evaluated through urine electrophoresis.
B-2 microgobulin: It is another light chain protein which helps to assess the prognosis rather than diagnosis.
Quantitative Immunoglobulin levels helps to assess the abnormal levels of specific Immunoglobulin. In multiple myeloma IgG paraprotien is the most common.
Free light chain assay i.e. Kappa and Lambda produced by malignant cells help to assess their ratio. Any abnormality in their ratio suggests Myeloma.
Bone marrow Biopsy: Increased percentage of plasma cells (at least 10%) in the bone marrow helps to diagnose multiple myeloma.
Imaging: MM x-rays show distinct, round (lytic) areas of bone erosion; generalized thinning of the bones or fractures at the time of diagnosis. The bones most commonly involved are the vertebrae, the ribs, the pelvic bones, and the bones of the thigh and upper arm. Other imaging tests may be done for better assessment of extent of disease. These may include magnetic resonance imaging, computerized tomography, or positron emission tomography.