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Introduction to Myeloma: Diagnosis, Treatment, Risk Factors and Prevalence

Multiple myeloma is a complex cancer of plasma cells arising from the bone marrow, often leading to anemia, bone pain, and kidney issues. While its exact causes remain unknown, factors like radiation exposure and genetics may play a role. Currently, multiple myeloma is not curable, but advancements in early detection, autologous stem cell transplants, and novel drugs have significantly improved survival rates, now averaging 8 years. This article explores the symptoms, diagnosis, treatment options, and the importance of early intervention in enhancing patient outcomes.

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Introduction to Myeloma: Diagnosis, Treatment, Risk Factors and Prevalence

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  1. Alan Bryce, MD Staff Oncologist, Mayo Clinic Arizona Introduction to Myeloma:Diagnosis, Treatment, Risk Factorsand Prevalence Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida

  2. Multiple Myeloma - Background • The Bone Marrow (blood factory) makes 3 kinds of cells: • White Blood Cells …immune system • Red Blood Cells (Hemoglobin) …carry oxygen • Platelets …clotting • There are several kinds of white cells in the marrow • usually 1-3% of them are PLASMA CELLS • plasma cells make good proteins – antibodies or “immunoglobulins” which help fight infection

  3. Multiple Myeloma - Introduction • Myeloma is a cancer of the Plasma Cells • They grow out of control in the bone marrow (at least 10% and as high as nearly 100%) • This results in many problems including: • Low hemoglobin (anemia) and platelets • Elevated abnormal immunoglobulins (proteins) • Bone pain and fractures • Infections (partly due to low normal immunoglobulins) • Kidney problems • Other complications…

  4. Asymp- tomatic Myeloma Spectrum of Myeloma Aggressive Myeloma Normal plasma cell MGUS Active Myeloma Monoclonal gammopathy of unknown significance

  5. How do plasma cells become “evil”?

  6. Multiple Myeloma – Causes? • The cause of myeloma is still unknown • Some have suggested: • Radiation- Nuclear Bomb Survivors • Chemicals (benzenes), herbicides and insecticides- The “Myeloma Belt” • Genetics or even viruses • Familial Myeloma – still rare • However, nothing is conclusive, and it is likely a combination of many factors…

  7. Multiple Myeloma • Unfortunately, MM is not a curable disease (yet!!) • Historically most people did not live for much more than 2 years… • However, the average survival is now at least 8 years • This has been a result of three key developments: 1. Early Detection 2. Autologous Stem Cell Transplant 3. Novel Drugs (thalidomide, bortezomib, lenalidomide)

  8. Multiple Myeloma - Epidemiology • Incidence • It is a rare condition, occurring in about 4 people per 100,000 (1% of all cancers) • About 2100 new cases this year in Canada • It is more common in men than women • It is more common in the black population • Average age of diagnosis is 65 • Less than 10% of cases occur in patients <50 • Less than 2% of cases occur in patients <40

  9. Myeloma rate in Arizona among race groups, 1995-2009

  10. Common Symptoms • Not all patients will have all of these symptoms • Fatigue • Mostly due to low hemoglobin (anemia) • Also due to disease itself • Other factors contribute to this (psychological, chemo & other drugs, infections…) • Lack of Appetite • Infections • Due to weakened immune system

  11. Common Symptoms contd. • Bone Symptoms • The abnormal protein causes an imbalance in bone production leading to bone thinning • This bone loss can lead to osteoporosis, bone pain and bone fractures • Most common location is the spine • High Calcium levels • Often happens when first diagnosed (calcium released by damaged bones) • Can result in thirst, nausea, vomiting, frequent urination, confusion and even coma

  12. Common Symptoms contd. • Impaired Kidney Function • The abnormal protein and the high calcium can damage the kidneys • About ½ of patients have some degree of kidney damage • Some have severe damage and require dialysis • Neurological symptoms • Bone fractures may compress nerves and cause symptoms • Easy bruising & bleeding occurs in some

  13. Diagnosis of Myeloma The diagnosis of Myeloma is made as a result of several tests: • Blood Counts (CBC – white, red, platelets) • Blood and urine tests for immune proteins 3. Bone Marrow tests (aspirate and biopsy) 4. X-rays 5. Other blood tests

  14. Myeloma Treatment • Principles of therapy • 1. Stop the production of the abnormal plasma cells (chemo) • 2. Strengthen the bone and prevent fractures • 3. Increase the hemoglobin count and reduce fatigue • 4. Reduce risk of infections • 5. Promote well being and quality of life

  15. Treatment with Chemotherapy • Goal is to reduce the number of plasma cells and the proteins they produce • Timing is important as it may be possible to wait & watch • It is not “curative” but may put the disease into remission • Must be tailored to individual based on disease factors (type, severity, organs involved) and patient factors (age, general health…) • Stem Cell Transplant is a common treatment option

  16. Conclusions • New Treatments for myeloma have improved survival • Myeloma is usually preceded by many years of MGUS • Screening and early detection can allow therapy to begin before organ damage develops • Bone Marrow transplant and Clinical Trials should be considered when appropriate

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