Multiple Myeloma Treatment in Delhi, India

Multiple myeloma is a type of cancer. It occurs in specific white blood cells known as plasma cells. These plasma cells make antibodies that help in fighting infections. They do that by recognizing and attacking germs that cause infection. In multiple myeloma, large amounts of cancer-forming plasma cells accumulate in the bone marrow. It results in crowding out healthy blood cells.

Associated Anatomy of Multiple Myeloma

White blood cells

Multiple Myeloma Causes

The exact cause of multiple myeloma is not clear. However, some studies have shown that specific changes in DNA can cause plasma cells to grow excessively and become cancer-forming cells. Such genes in DNA responsible for such cell growth and cell division are called oncogenes. Studies have also shown that some cells in the bone marrow produce a chemical substance known as interleukin 6 (IL 6), which is an essential factor in the development of multiple myeloma.

Multiple Myeloma Symptoms

People with multiple myeloma do not usually notice any signs or symptoms at the early stage of the disease. They also vary from person to person. The most common signs and symptoms include -

• Nausea
• Bone pain
• Fatigue
• Loss of appetite or weight loss
• Frequent infections
• Stomach upset
• Problems with urination and other kidney-related issues
• Dizziness
• Severe thirst

Multiple Myeloma Diagnosis

There are varieties of tests that are usually done to confirm the diagnosis of multiple myeloma.

Blood and Urine Tests

These tests are usually done to check the levels of M protein produced by plasma cells. They are also used for checking the levels of calcium, uric acids, the total number of blood cells, kidney function, etc.

Bone marrow biopsy is done to confirm the diagnosis and check how the cells grow.

Imaging Tests

CT, MRI, X-ray, etc., are sometimes done to check bone damage.

Stages of Multiple Myeloma

Once the cancer diagnosis is confirmed, staging is done to establish the spread of cancer. The staging of multiple myeloma depends on four factors. Amount of albumin in the blood Amount of LDH Amount of beta 2 microglobulin Gene-specific abnormalities in the plasma cells

Stage 1

Albumin greater than 3.5 Beta 2 microglobulin in less than 3.5 LDH levels are normal Genetic abnormalities are low risk

Stage 2

neither stage 1 or stage 3

Stage 3

Beta 2 microglobulin levels are 5.5 or greater LDH levels are high Genetic abnormalities are high risk.

Multiple Myeloma Treatment

The treatment for multiple myeloma depends on the condition of the patients and signs and symptoms. Doctors assign the risk and stage of cancer and then determine the planned course.

Chemotherapy

In Chemotherapy, Doctors will give an aggressive form of medicine to help kill all the cancerous cells. They are usually given in high doses.

Targeted Therapy

In Targeted Therapy, These medicines target specific functions of the multiple myeloma cells that prevent them from growing.

Biological Therapy

In Biological Therapy, These medicines help improve the immune system, which will attack the myeloma cells.

Stem Cell Transplant

The depleting bone marrow is replaced with healthy bone marrow cells, which will develop into normal plasma cells.

Radiation Therapy

In Radiation Therapy, Uses radiation to damage cancer cells and reduce their growth.

Corticosteroids

This medicine balances the immune system and reduces inflammation.

Risk Factors of Multiple Myeloma

Even though the exact cause is not known, a few risk factors are responsible for multiple myeloma:

• Age greater than 65 years Gender - More typical in men than women If you are overweight or obese.
• Hereditary - more common if you have a family member with multiple myeloma
• Contact with certain chemical substances in a factory, petroleum industry, etc.
• Exposure to radiation
• History of Monoclonal Gammopathy of Undetermined Significance (MGUS) - This condition causes plasma cells to produce specific proteins. In some cases, MGUS can develop into multiple myeloma.

Prevention of Multiple Myeloma

Currently, there are no ways to prevent multiple myeloma. A few factors can be avoided to reduce cancer risk, such as being overweight and radiation exposure. However, there are no definitive methods or therapies that can completely prevent the occurrence of multiple myeloma.

Complications of Multiple Myeloma

A few possible complications of multiple myeloma may include -

• Frequent infections
• Bone problems (bone pain, reduced density of bones, and bone fractures)
• Low red blood cell count (causes anemia)
• Reduced kidney functions

Epidemiology of Multiple Myeloma

Multiple myeloma is a relatively rare cancer. It occurs at a rate of 0.7 per one lakh people. In India, an estimated 6,800 new cases occur every year. It is slightly more common in males than in females. In India, the median age is slightly lower compared to the USA, which is 52-61 years. The incidence of multiple myeloma also increases with age. More than 75 % of patients are between 55 to 85 years of age. Only a few cases occurred in patients below 20 years of age. In the USA, it is more common in African Americans. The annual percentage change of multiple myeloma in the last decade is minimal. It indicates newer and better treatment modalities.

Prognosis of Multiple Myeloma

The prognosis of multiple myeloma depends on the stage and other risk factors. One of the most critical factors affecting the prognosis is when the diagnosis is made. If it is late, then the prognosis is not so good. For the people who were diagnosed earlier, the survival rate is around 71 %. For those who were diagnosed at the last stages, the survival rate is around 48%. About 50 % of people who were diagnosed were alive after five years.

Natural Progression of Multiple Myeloma

It starts with abnormalities in plasma cells. This can naturally progress into multiple myeloma in a few years without treatment. Approximately 20 % of people die from the disease after a few years.

Pathophysiology of Multiple Myeloma

Multiple myeloma occurs due to the proliferation of plasma cells in the bone marrow. This increased rate of division of plasma cells causes an increase in M proteins. It causes the destruction of bone, bone marrow, and normal stem cells.

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