Multiple myeloma, Cancer of plasma cells, Bence Jones proteins, Paraprotein

Description :   Multiple myeloma (MM) is a cancer of plasma cells- also known as white blood cells- in the bone

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What is multiple myeloma?

Multiple myeloma (MM) is a cancer of plasma cells- also known as white blood cells- in the bone marrow.  Healthy plasma cells produce antibodies which help to fight infections in the body.  In MM, these cells become cancerous, growing out of control to accumulate in the bone marrow.  This leads to bone pain, inadequate number of healthy blood cells- white blood cells and red blood cells- and fractures.  In addition, these cancerous plasma cells produce a large amount of abnormal proteins instead of helpful antibodies which damage the kidneys.

MM accounts for 10% of all blood cancers.  In the United States, the American Cancer Society estimates that in the year 2020 around 32,000 new cases of MM will be diagnosed.  Furthermore, around 12,800 deaths from MM are expected to occur in the year 2020.  African Americans are most commonly affected by MM than whites or Hispanics.  Men are more commonly affected than women.  The peak age of people diagnosed with MM are 68 years for men and 70 years for women.

The treatment plan depends on the severity of your signs and symptoms.  There are several treatment options available such as non-chemotherapy drugs, standard chemotherapy drugs, bone marrow (stem cell) transplantation and corticosteroids.

What are the causes of multiple myeloma?

The exact cause of MM is still unknown but there are several factors which may increase your risk of developing this condition and these include:

• Family history: Having a parent or sibling affected by MM increases your risk of developing it.
• Occupational or environmental causes: People working in the agricultural, petrochemical and food industry are at increased risk of developing MM.  Farmers who use insecticides and herbicides are at risk.  In addition, people who are exposed to benzene or other organic solvents are also at risk.
• Radiation: It was reported that atomic-bomb survivors were at increased risk of developing MM.  29 out of 109,000 survivors of the atomic bombing of Nagasaki during World War 2 died of MM between the 1950 and 1976.
• Race: Black people are more at risk of developing MM than other races.
• Sex: Males are more at risk of developing MM than females
• Age: As your age increases, your risk of developing MM increases as most people diagnosed with MM are above the age of 60 years.

The bone marrow produces blood cells such as white blood cells and red blood cells.  MM begins when 1 white blood cells becomes abnormal which multiplies very quickly.  These abnormal cells do not mature and accumulate within the bone marrow which will impair the production of healthy blood cells.  White blood cells normally produce antibodies to help your body fight infections.  However, these cancerous cells produce abnormal proteins which accumulate in the body and get clogged in the kidneys, causing kidney damage.  In addition, your bones become weaker and are predisposed to fractures.

What are the signs and symptoms of multiple myeloma?

In early stages of the disease, there may not be any signs and symptoms.  However, as the disease progresses, the following signs and symptoms may become apparent:

• Bone pain in the back or chest
• Nausea
• vomiting
• Fatigue
• Constipation
• Loss of appetite
• Weight loss
• Frequent and recurrent infections
• Confusion
• Excessive thirst
• Frequent urination
• Numbness in your legs
• Fractures of the vertebrae (bones of the spine)
• Coma
• Paleness
• Blurred vision
• Bleeding from nose and mouth
• Muscle weakness

There are other diseases or conditions which may resemble MM and these include:

• Malignant (primary) lymphoma of bone
• Monoclonal Gammapathies of Undertermined Significance (MGUS)
• Metastatic bone disease
• Waldenstrom Macroglobulinemia

Making a diagnosis

To make a diagnosis, your doctor will first take a detailed history from you to know more about your symptoms.  After the history taking, your doctor will perform a thorough physical examination to look for signs of MM.  Your doctor will order some tests to confirm the diagnosis and determine the severity of MM.  These tests include:

• Complete blood count (CBC): A CBC is done to determine whether there is presence of anaemia (low red blood cell count), low platelet count or leukopenia (low white blood cell count).
• Erythrocyte sedimentation rate (ESR): ESR is a marker of inflammation in the body and is typically raised in MM
• Coagulation studies: This study is often abnormal in people with MM and causes bleeding problems.
• Blood and urine test for Monoclonal protein: The cancerous plasma cells produces an abnormal protein called monoclonal (M) protein which is also known as paraprotein or Bence Jones protein.  These are found in the blood and urine of almost all people with MM which confirms the    Read more