This Bone Marrow Cancer Causes Your Plasma Cells To Go Crazy

This Bone Marrow Cancer Causes Your Plasma Cells To Go Crazy - When there is an infection, the body responds with its plasma cells producing antibodies (immunoglobulins) to combat the microorganisms. These cells are produced in the bone marrow, a spongy tissue in the centre of some bones like the hip and thigh bones.

Plasma cells are normally produced in a controlled manner. However, large numbers of abnormal plasma cells are produced in the malignant condition known as multiple myeloma.

These cancer cells fill up the bone marrow and interfere with the production of other healthy cells, i.e. red and white blood cells, and platelets.

Multiple myeloma involves many bones, including the spine, pelvis, ribs and spine.

The exact cause of this blood cancer is unknown. However, it has a close association with monoclonal gammopathy of unknown significance (MGUS), a condition in which there are excess numbers of immunoglobulins.

About one in every 100 persons with MGUS develops multiple myeloma annually.

Other risk factors include increased age and being male.

Features in multiple myeloma

There may be no symptoms in the early stages, which may be diagnosed on routine blood or urine examination.

Multiple myeloma presents in several ways.

There may be anaemia due to decreased production of red blood cells. The features of anaemia include tiredness and breathlessness. Anaemia can also occur because of treatment.

Infections may occur repeatedly and/or may be prolonged because of interference with the body’s immune system.

Interference with platelet production leads to bruising and bleeding from the nose and gums, and heavy periods for women.

There may be pain in the affected bones – usually the back, hips or ribs – with a persistent dull ache that may be aggravated by movement. The weakened bones, usually the back and ribs, may fracture.

Spinal fractures cause collapse of the spine and/or compression of the spinal cord.

The former causes pain, and the latter, pins-and-needles sensation, numbness, weakness in the lower limbs, and sometimes, affects bladder and/or bowel control.

The release of excess calcium from the affected bones raises blood calcium levels (hypercalcaemia), which leads to increased thirst, passing urine often, constipation, confusion and drowsiness.

The kidneys can be damaged by the abnormal cells, hypercalcaemia or medicines used in treatment. Ultimately, kidney failure will result and its features include swollen ankles, feet or hands; tiredness; poor appetite; weight loss; itchiness; and breathlessness.

Sometimes, the blood may become thick (hyperviscosity), which leads to headaches, blurred vision, bleeding from the nose or gums, and breathlessness.

Investigating multiple myeloma

It is not easy to diagnose multiple myeloma because there are no symptoms in the early stages.

After taking a history and performing a physical examination, investigations will help in its diagnosis. Some of these tests may be done initially by the family doctor, but at some stage, a referral will be made to a general physician or a specialist in blood conditions (haematologist).

The blood tests include a full blood count, erythrocyte sedimentation rate, plasma viscosity, blood calcium measurement, liver and kidney function tests, and measurement of the proteins produced by the abnormal plasma cells.

The abnormal proteins, called Bence Jones proteins, are collected over a 24-hour period to measure its quantity and to assess kidney function.

X-rays of the bones of the limbs, skull, spine and pelvis will be done to assess any damage.

Computerized tomography (CT) scans and magnetic resonance imaging (MRI) may also be done.

The diagnosis of multiple myeloma is confirmed by a bone marrow biopsy in which a marrow sample is obtained by inserting a needle into a bone, usually the pelvis, under local anaesthesia.

A microscopic examination of the sample is then carried out.

Management of multiple myeloma

Multiple myeloma usually cannot be cured, i.e. further treatment is needed when it recurs (relapse).

Treatment is usually managed by a team of specialists led by a haematologist or general physician. The objectives of management are to control the condition, and to prevent and treat its complications.

Treatment may not be prescribed in the early stages, but there will be monitoring to detect when problems arise.

The initial treatment may be intensive or non-intensive.

The former is more toxic and is usually prescribed for younger and fitter patients. It involves higher doses and is followed by stem cell transplant.

Both treatments involve consuming anti-myeloma medicines.

These usually include a chemotherapeutic medicine, steroids, and either bortezomib or thalidomide (or its analogue, lenalidomide).

Chemotherapeutic medicines destroy the myeloma cells. Oral melphalan and cyclophosphamide are commonly prescribed.

They are usually well tolerated with mild side effects, e.g. nausea, vomiting, increased infections and hair loss.

Steroids increase the effectiveness of the chemotherapy and help destroy the myeloma cells. Oral prednisolone and dexamethasone are commonly prescribed.

Their side effects include indigestion, increased appetite and mood changes.

Bortezomib destroys the myeloma cells by causing protein to increase in the cells. It is administered by injection.

The side effects include nausea, tiredness, diarrhoea, and numbness or tingling sensations in the hands and feet.

Thalidomide destroys the myeloma cells. It is taken orally and the side effects include constipation, rashes and numbness, tingling sensation in the hands and feet, increased risk of infection and blood clot formation (blood-thinning medicines may be given to prevent this). It cannot be prescribed in pregnant women as it can cause birth defects.

Lenalidomide has similar effects.

Patients on intensive treatment will be prescribed a higher dose of chemotherapy as an in-patient, to potentially destroy larger number of myeloma cells with the objective of achieving a longer period when the condition is inactive.

As the high doses also affect healthy bone marrow, a stem cell transplant will be needed for recovery of the bone marrow after the treatment.

The stem cells are usually taken from the patient prior to treatment; sometimes, they are taken from a sibling or an unrelated donor.

The choice of treatment is influenced by disease factors like type of myeloma, extent of the condition, complications of the condition and recurrence, and individual factors like health status, fitness, expectations and lifestyle.

It would be useful to discuss these matters, and the pros and cons of particular treatments with the doctors before commencing treatment.

Having a list of questions for clarification would be helpful.

A recurrence is treated in a similar manner as initial treatment.

In general, non-intensive treatment is preferred and additional medicines may be prescribed.

The complications and symptoms are treated with various modalities, i.e. painkillers, and even radiotherapy for pain relief; blood transfusions or erythropoietin to increase the haemoglobin; bisphosphonates to prevent bone damage; dialysis for kidney failure; surgery to repair damaged bones or treat spinal cord compression; and plasma exchange for hyperviscosity.

There may be offers of participation in clinical trials that compare new treatments with existing ones.

It is crucial to remember with such offers that there is no guarantee that new treatments are more effective than existing ones.