Our body has many different types of cells like the red blood cells, the white blood cells and many more. One particular type of cells is the plasma cells and Multiple Myeloma is a very important disease associated with these cells. It is the most common primary malignant arising in bone of adults. Multiple myeloma is actually a malignant proliferation of plasma cell. However, what causes this disease is still not known.
The normal function of plasma cells is to produce immunoglobulins. The immunoglobulins have many heavy and light chains. The defect in multiple myeloma is that the plasma cells produce such immunoglobulins which have single heavy and light chain type. Most of the malignant plasma cells are present in the bone marrow and few in the blood. In some cases, only light chain immunoglobulins are produced and this usually appears in urine. These are known as Bence Jones proteins.
When the plasma cells turn malignant they start producing a chemical known as ‘cytokine’. Now, this stimulates those bone cells which are involved in bone absorption. Such cells are known as osteoclasts. So this ultimately results in net bone absorption. The patient gets severe bone pain and fractures. Since, calcium is being mobilized from the bone, its level in the blood increases. The bone marrow gets filled with plasma cells and hence patient becomes anemic. These patients commonly complain of weakness and fatigue. The proteins which are being produced might deposit in the kidney and this can eventually lead to kidney failure.
The diagnosis of Multiple Myeloma is often based on finding malignant plasma cells in the bone marrow. The marrow can have up to 20% of these malignant cells. The bone lesions seen on X-ray are also quite significant. The proteins produced in this disease can find their way into the urine and thus can be detected in it. Few other investigations which can help in diagnosing this disease are the kidney function tests, blood calcium and albumin levels. All the blood cells counts are low because the marrow in filled with these malignant cells.
Various treatment options are available for this disease. Chemotherapy is often done using a drug – melphalan. The drug is given orally to old and weak patients while it’s given into the veins in the young ones. Relapses can however occur and these do not respond very well to this drug. Radiotherapy is given for localized bone pain, which doesn’t responds to pain killers. The calcium levels are sky high in multiple myeloma and to treat this, bisphosphonates are used. Of course these treatment methods do not cure the disease. Bone marrow transplants are often done and these can actually prolong life and cure the disease. Thalidomide is also used sometimes for treating this condition though it’s teratogenic (can damage the growing fetus). One latest drug which is still under trail is ‘bortezomib’.
This prognosis of this disease is not very good. People receiving the usual treatment might survive for 40 months on an average. However few lucky ones might be able to live for 10 years with the standard drugs and chemotherapy. Stem cell transplant, if successful is the only thing that can prolong the life of such patients.
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