What is multiple myeloma?

Written by: Dr Santhosh Narat
Edited by: Cal Murphy

Cancer can strike almost anywhere in the body – even our blood can turn against us. Multiple myeloma is a common type of blood cancer. How does this disease affect our bodies and can it be treated? We turned to esteemed haematologist Dr Santhosh Narat for answers.

What is myeloma?

Myeloma (or multiple myeloma) is form of blood-related cancer originating from the plasma cells. They represent about 2% of all cancers. It is more commonly seen in the older population.


What are plasma cells?

Plasma cells are involved in the production of antibodies that fight infection. They are produced in the bone marrow, the red spongy tissues seen in the middle of long bones and hip bones.


What happens in myeloma?

In myeloma, during the formation of plasma cells, unexpected changes in DNA occur. These are called mutations. These abnormal plasma cells make their own copies or clones which multiply faster than the normal plasma cells and they eventually replace the normal bone marrow cells. They also spread to other parts of the body – mostly to the bones. This accumulation in focal areas of the bone causes localised destruction.

The antibodies produced by these aberrant clone of plasma cells are called paraproteins. They are abnormal in that they do not fulfil any of the normal functions of antibodies. In fact, production of normal disease-fighting antibodies are compromised in favour of the abnormal paraproteins.


What are the signs of multiple myeloma?

The symptoms of myeloma are related to the build-up of plasma cells in the bones and paraproteins in the blood.

Bone pain is the most common symptom associated with this condition. About 70% of patients report bone pain at the time of diagnosis. It can affect the lower back, rib cage or shoulders. The pain is described as a dull ache and frequently gets worse on moving. Spontaneous fracture of long bones is another presentation.

Frequent infections are common in myeloma. This results from underproduction of protective antibodies and general suppression of immunity due to myeloma. A protracted chest infection can be the presenting symptom.

The paraproteins secreted by the plasma cells are filtered in the kidney, causing damage to kidney tissue.

Swollen ankles can be a sign of kidney problems in myeloma. Kidney disease in myeloma may not cause any symptoms. It is often detected when blood tests are performed by a GP or in the hospital for other reasons.

Patients may also report shortness of breath, profound tiredness or itching which could often be due to anaemia.

High blood calcium can result from the release of calcium locked in the bones by myeloma cells. Patients often report excessive thirst, fatigue, headaches, blurred vision, red eyes, abdominal pain or in severe it can cause acute confusion. Similar symptoms are reported when the blood contains high levels of paraprotein.

Some patients can present with unexplained fatigue due to anaemia or high levels of paraprotein or calcium in the blood. Spontaneous bleeding or bruising can be a symptom of low platelet production in the bone marrow.


Is myeloma curable?

Although not a curable condition, there are effective treatments that can control the disease, preventing and managing complications, thereby prolonging and improving quality of life. Modern treatments can successfully control symptoms. Combinations of biological agents with fewer side-effects are increasingly used for rapid control of the myeloma, followed by maintenance treatments. A holistic approach includes improved pain control, and nutritional and psychological support.


How does myeloma behave?

The natural history of myeloma is characterised by periods of active disease requiring treatment followed by periods of remission or stable disease during which patient is generally symptom-free from the effects of the condition. Myeloma tends to come back in most patients, warranting further treatment but the intervals may vary.


What is the life expectancy with myeloma?

With the arrival of more targeted treatments, life expectancy with myeloma is steadily improving. The latest statistics suggests that the average life expectancy is around 5.5 years. The long-term survival has particularly improved in the younger age group under the age of 50. In fact, survival over 10 years is increasingly becoming the norm. The newer combined treatments are expected to improve the survival in the years to come.

By Dr Santhosh Narat

Dr Santhosh Narat is an esteemed haematologist based at Worthing and Sussex NHS Foundation Trust Hospital. Working across hospitals in London and Sussex, Dr Narat's main areas of clinical interest are haematological oncology (myeloma, lymphoma, leukemia), general haematology (anaemia, white cell, platelet disorders), thrombosis and bleeding disorders, thrombophilia screening, bood transfusions, and venesections for haemochromatosis.

Dr Narat completed his specialist training in Haematology in the UK in the North London hospitals such as St Mary's, the Royal Free and Hammersmith and has been working as a consultant in the NHS since 2005. On top of his clinical commitments he is responsible for Specialist Registrar training and  mentoring junior doctors and haematological specialist nurses in an educational and clinical supervisory role .He is also the principal investigator conducting a number of NHS-run clinical trials researching haematological malignancies, helping to make advances in his field. He provides cutting edge treatment to his patients and keeps abreast of changes by regularly attending national and international Haematology conferences and regular annual appraisals. He is the recipient of a Clinical Excellence Award from the WSH NHS Foundation Trust.

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