Dr Melanie: All about myeloma

UK sur­vival rates for this blood can­cer are in­creas­ing faster than for any other type of can­cer.

Woman's Weekly (UK) - - Contents -

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.

MSymp­toms

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.

Treat­ment

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

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