A Family Doctor's Tale - MYELOMA

DOC I HAVE MYELOMA

Multiple myeloma is a cancer affecting patients 50 years and above. It is sad because patients who have been working so hard and on the way to enjoying their retirement are striked down by the disease. One notable case was a good friend of mine who was so fit and healthy. 
He suddenly had breathing problem and went for a complete checkup only to be diagnosed as a multiple myeloma patient. He fought the illness for four years before finally succumbing to it.

Multiple myeloma is cancer of the bone marrow which occurs from the uncontrolled growth of plasma cells, a form of immune-protective white blood cells.Normally plasma cells make antibodies to fight infections.
The disease is called multiple myeloma because myeloma cells can occur in multiple bone marrow sites in your body.

Common multiple myeloma symptoms include:
1.Bone pain.
2.Presence of abnormal proteins — which can be produced by myeloma cells — in your blood or urine. These proteins — which are antibodies or parts of antibodies — are called monoclonal, or M, proteins. Often discovered during a routine exam, monoclonal proteins may indicate multiple myeloma, but also can indicate other conditions.
3.High level of calcium in your blood. This can occur when calcium from affected bones dissolves into your blood.
If you have a high calcium level in your blood, you may experience signs and symptoms such as:
2.Excessive thirst and urination
3.Constipation
4.Nausea
5.Loss of appetite
6.Mental confusion
7.Anemia can occur as myeloma cells replace oxygen-carrying red blood cells in your bone marrow, which may lead to another 8.fatigue.

Although the exact cause isn't known, doctors do know that multiple myeloma begins with one abnormal plasma cell in your bone marrow . This abnormal cell then starts to multiply.
Because abnormal cells don't mature and then die as normal cells do, they accumulate slowly reducing the number of healthy cells. 
Because myeloma cells may circulate in low numbers in your blood, they can populate other bone marrow sites in your body, even far from where they began. Uncontrolled plasma cell growth can damage bones and surrounding tissue.

Factors that may increase your risk of multiple myeloma include:
1Age. The majority of people who develop multiple myeloma are older than 50, with most diagnosed around age 70. Few cases occur in people younger than 40.
2.Sex. Men are more likely to develop the disease than are women.
Race. Blacks are about twice as likely to develop multiple myeloma as are whites.
3.History of a monoclonal gammopathy of undetermined significance. Every year 1 percent of the people with MGUS in the United States develop multiple myeloma.
4.Obesity. Your risk of multiple myeloma is increased if you're overweight or obese.
5.exposure to radiation and working in petroleum-related industries.

Multiple myeloma can be diagnosed before you ever have symptoms — through blood and urine tests.
Blood and urine tests
A blood test called serum protein electrophoresis separates your blood proteins and can detect the presence of M proteins, called an "M spike," in your blood. Parts of M proteins may also be detected in a test of your urine — when found in urine, they're referred to as Bence Jones proteins.
 Your doctor may also conduct other blood tests to check for beta2-microglobulin — another protein produced by myeloma cells — or to measure the percent of plasma cells in your bone marrow.
Other tests include:
Imaging. X-rays of your skeleton can show whether your bones have any thinned-out areas, common in multiple myeloma. If a closer view of your bones is necessary, your doctor may use magnetic resonance imaging (MRI) or computerized tomography (CT) scanning.
Bone marrow examination. Your doctor may also conduct a bone marrow examination by using a needle to remove a small sample of bone marrow tissue. The sample is then examined under a microscope to check for myeloma cells. 

Staging and classification These tests can help confirm whether you have multiple myeloma or another condition. If tests indicate you have multiple myeloma, the results from these tests allow your doctor to classify your disease as stage 1, stage 2 or stage 3. People with stage 3 myeloma are more likely to have one or more signs of advanced disease, including greater numbers of myeloma cells and kidney failure. Screening and diagnosis

Multiple myeloma can result in several complications:
Impaired immunity. Myeloma cells inhibit the production of antibodies needed for normal immunity. Having multiple myeloma may make you more likely to develop infections, such as pneumonia, sinusitis, bladder or kidney infection, skin infections and shingles.
Bone problems. Multiple myeloma also can affect your bones, leading to erosion of bone mass and fractures. The condition may cause compression of your spinal cord. Signs of this medical emergency include weakness, or even paralysis, in your legs.
Impaired kidney function. Multiple myeloma may cause problems with kidney function, including kidney failure. Higher calcium levels in the blood related to eroding bones can interfere with your kidneys' ability to filter your blood's waste. The proteins produced by the myeloma cells can cause similar problems, especially if you become dehydrated.
Anemia. As cancerous cells crowd out normal blood cells, multiple myeloma can also cause anemia and other blood problems.
Standard treatments for myeloma Though there's no cure for multiple myeloma, with good treatment results you can usually return to near-normal activity. The appropriate multiple myeloma treatment depends on your needs, medical status and general health. You may also wish to consider approved clinical trials as an option.

Standard treatment options include:
1.Chemotherapy. Chemotherapy involves using medicines — taken orally as a pill or given through an intravenous (IV) injection — to kill myeloma cells. Chemotherapy is often given in cycles over a period of months, followed by a rest period. Often chemotherapy is discontinued during what is called a plateau phase or remission, during which your M protein level remains stable. You may need chemotherapy again if your M protein level begins to rise. Common chemotherapy drugs used to treat myeloma are melphalan (Alkeran), cyclophosphamide (Cytoxan), vincristine (Oncovin), doxorubicin (Adriamycin) and liposomal doxorubicin (Doxil).
2.Corticosteroids. Corticosteroids such as prednisone and dexamethasone (Decadron) have been used for decades to treat multiple myeloma. They are typically given as pills. Some research suggests that high doses of steroids may not be needed, and that lower doses may be safer and more effective.
3.Stem cell transplantation. This treatment involves using high-dose chemotherapy — usually high doses of melphalan — along with transfusion of previously collected immature blood cells (stem cells) to replace diseased or damaged marrow. The stem cells can come from you or from a donor, and they may be from either blood or bone marrow.
4.Thalidomide (Thalomid). Thalidomide, a drug originally used as a sedative and to treat morning sickness in the 1950s, was removed from the market after it was found to cause severe birth defects. However, the drug received approval from the Food and Drug Administration (FDA) again in 1998, first as a treatment for skin lesions caused by leprosy. Thalidomide is currently FDA-approved in conjunction with the corticosteroid called dexamethasone for the treatment of newly diagnosed cases of multiple myeloma. This drug is given orally.
5.Bortezomib (Velcade). Velcade was the first approved drug in a new class of medications called proteasome inhibitors. It is administered intravenously. It works by blocking the action of proteasomes, which causes cancer cells to die. One study showed that bortezomib had more than twice the response rate of a commonly used drug, dexamethasone. Bortezomib is approved by the FDA for use in a treatment for people with multiple myeloma who have received at least one prior therapy.
6.Lenalidomide (Revlimid). Lenalidomide is chemically similar to thalidomide, but appears to be more potent and cause fewer side effects. It is given orally. Lenalidomide is FDA-approved for use in combination with dexamethasone as a treatment for people who have received at least one prior therapy for multiple myeloma.
Radiation therapy. This treatment uses high-energy penetrating waves to damage myeloma cells and stop their growth. Radiation therapy may be used to target myeloma cells in a specific area — for instance, to more quickly shrink a tumor that's causing pain or destroying a bone.

Initial therapy for myeloma The initial chemotherapy used to treat multiple myeloma depends on whether you're considered a candidate for stem cell transplantation. Factors such as the risk of your disease progressing, your age and your general health play a part in determining whether stem cell transplantation may be right for you.
If you're considered a candidate for stem cell transplantation: Your initial therapy will likely exclude melphalan because this drug can have a toxic effect on stem cells, making it impossible to collect enough of them. You may begin treatment with the most common initial myeloma therapy in the United States, thalidomide plus dexamethasone. Or your doctor may instead recommend a newer regimen, lenalidomide plus low-dose dexamethasone.
Your stem cells will likely be collected after you've undergone three to four months of treatment with these initial agents. Your doctor may recommend undergoing the stem cell transplant soon after your cells are collected or delaying the transplant until after a relapse, if it occurs. Your age and your personal preference are important factors that will help your doctor make his or her recommendation.
If you're not considered a candidate for stem cell transplantation: Your initial therapy is likely to be a combination of melphalan, prednisone and thalidomide (MPT). If the side effects are intolerable, melphalan plus prednisone is another option (MP). This type of therapy is typically given for about 12 to 18 months.
Treatments for relapsed or treatment-resistant multiple myeloma Most people who are treated for multiple myeloma eventually experience a relapse of the disease. And in some cases, none of the currently available, first-line therapies slow the cancer cells from multiplying. If you experience a relapse of multiple myeloma, your doctor may recommend repeating another course of the treatment that initially helped you. Another option is trying one or more of the other treatments typically used as first-line therapy, either alone or in combination.
Research on a number of promising new treatment options is ongoing, and these drugs offer important options for those with multiple myeloma. Talk to your doctor about what clinical trials may be available to you.
Treating complications Because multiple myeloma can cause a number of complications, you may also need treatment for those specific conditions. For example:
Back pain. Taking pain medication or wearing a back brace can help relieve the back pain you might experience with multiple myeloma.

1.Kidney complications. People with severe kidney damage may need dialysis.
Infections. Antibiotics may be necessary to help treat infections or to help reduce your risk of them.
2.Bone loss. You may take medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), which bind to the surface of your bones and help prevent bone loss. Treatment with these drugs is associated with the risk of harm to the jawbone. If you're taking these medications, don't have dental procedures done without consulting your doctor first.
3.Anemia. If you have persistent anemia, your doctor may prescribe erythropoietin injections. Erythropoietin is a naturally occurring hormone made in the kidneys that stimulates the production of red blood cells. Research suggests that the use of erythropoietin may increase the risk of blood clots in some people with myeloma.