Dr Melanie: All about myeloma
UK survival rates for this blood cancer are increasing faster than for any other type of cancer.
ultiple myeloma is the second most common blood cancer, with around 5,500 new cases a year – one in 50 UK cancers. It affects plasma cells, which form part of our immune system and are produced inside bone marrow. The cause isn’t known, although genetic and environmental factors may be involved; it’s more common in people aged over 60 years, men, and people of Afro-Caribbean origin.
Plasma cells produce immune proteins called immunoglobulins, but sometimes produce abnormal proteins (monoclonal gammopathy of unknown significance – MGUS). MGUS is much more common than myeloma and can be detected and monitored with blood tests, but only 1% of people with MGUS go on to develop myeloma each year.
These are often vague at first, such as fatigue or backache. But as plasma cells take over the bone marrow, it makes fewer red and white blood cells, so you’ll become anaemic (pale, perhaps breathless) and more prone to infections. Platelets (clotting cells) are also reduced, so you may develop unusual bruising/ bleeding, or blood may become more ‘sticky’.
The plasma cells invade surrounding bone, too, particularly the spine, skull, ribs and hips, producing a dull ache, worse on movement. Weakened bones may suddenly break, producing severe pain; a fractured spinal vertebra may press on the spinal cord, producing leg weakness/numbness and bladder/bowel difficulties (an emergency). The damaged bones release extra calcium, which can cause excessive thirst, nausea, frequent urination, constipation or confusion, and/or lead to gradual kidney failure with fatigue, swollen ankles/hands, nausea, itching, reduced appetite and weight loss. Other complications can include dizziness, heart failure or strokes.
You’ll need to see the specialist haematology ‘team’; Myeloma UK also has a useful information pack for people newly diagnosed (call 0800 980 3332 or download it at myeloma.org.uk).
Treatment depends on your age, and whether you’ve been diagnosed from an abnormal blood test, or have already developed
symptoms. Myeloma can also grumble on for some time, with only mild symptoms, or good and bad patches, although it will relapse eventually, and can’t currently be cured.
If you have symptoms, treatment to control the disease by targeting plasma cells may include combinations of chemotherapy, steroids, thalidomide and bortezomib. It can destroy healthy bone marrow cells too, but it may be possible to replace these with your own stem cells, collected before treatment (autologous stem cell transplant), or donated cells from a relative or anonymous donor. Other new treatments have been approved by NICE, the National Institute for Health and Care Excellence, so the outlook has improved significantly.
You’ll also need treatment for other symptoms, such as pain, anaemia and kidney failure. Bisphosphonate drugs (used for osteoporosis) can also help to treat bone damage, raised calcium levels and fractures, for example in the spine; radiotherapy can also reduce bone pain. Over the course of your treatment you may need blood transfusions or plasma exchange (to remove/replace ‘sticky’ blood components).
These treatment advances over the past 10 years have significantly prolonged survival, especially for younger people. Myeloma UK can provide advice and support at every stage of the disease.
Mid/lower back pain is a common symptom of myeloma