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What is Multiple Myeloma?

 

Multiple myeloma is one of several diseases that fall under the category of plasma cell dyscrasia - an abnormality of the plasma cell. The plasma cell is part of the immune system that is responsible for forming antibodies against foreign organisms and substances that invade the body. The disease process occurs when one of these cells escapes from the control of the master immune system and behaves erratically by forming antibodies and dividing into numerous cells that the body does not need.

When the plasma cell becomes independent of the immune system, it does not realize that the protein it is forming is not needed, resulting in production of large amounts of this protein. Also, myeloma cells reside in the bone marrow. The space used by these cells takes up the space used for red blood cells, white blood cells, and platelets, interfering with the manufacturing process and causing low blood counts. As the myeloma cells continue to divide out of control, the space within the bone marrow narrows. The myeloma cells then form a chemical that destroys the bone to create more space. This bone destruction results in the bone pain, bone fractures, and increased calcium in the blood. In the meantime, the body tries to rid itself of the excess protein through the kidneys. This excess protein can directly damage the kidneys or the kidneys could be overwhelmed by the large amount of protein. Either can result in kidney failure.

In early stages of multiple myeloma, the symptoms may be vague; including low energy level, flu-like symptoms, back pain, and/or bone pain. These symptoms, if unexplained and unresolved for 8-12 weeks, may increase suspicion and prompt further testing. In rare cases multiple myeloma has been found incidentally during routine blood work. In more advanced disease, pathologic bone fractures (fractures occurring without specific injury) may occur due to bone damage. Also, confusion, nausea, vomiting, and weakness may result from high levels of calcium in the blood or kidney. The diagnosis of multiple myeloma can be confirmed with tests such as myeloma typing (serum and urine), serum protein electrophoresis, and bone marrow biopsy, although additional tests will be needed to determine the extent of disease.

The treatment for multiple myeloma depends on the patient’s specific situation. However, in general, it can be divided into three phases with supportive therapy through all phases:

Induction Phase Induction Phase - The efforts and treatment are focused on reducing the amount of disease. Often this includes different types of chemotherapy and, possibly, radiation therapy.

Maintenance Phase - Currently, there is no single standard or accepted approach to care. However, biologic therapy, immune therapy, or bone marrow transplantation may have a role. Maintenance Phase - Currently, there is no single standard or accepted approach to care. However, biologic therapy, immune therapy, or bone marrow transplantation may have a role.

Supportive Therapy - Supportive therapy focuses on managing the disease with growth factors, bisphosphonates (to stabilize bones), immunoglobulins, and/or antibiotics when the underlying disease cannot be controlled. Supportive Therapy - Supportive therapy focuses on managing the disease with growth factors, bisphosphonates (to stabilize bones), immunoglobulins, and/or antibiotics when the underlying disease cannot be controlled.

Salvage Therapy Salvage Therapy - Salvage therapy is used for treatment of patients in whom all known effective therapy with acceptable toxicity has failed.

 

Further readings:

New treatment regimens;

 
 
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