What is mutliple myeloma and how it affects your whole body

It is a malignant plasma cell disease that typically affects older individuals more than 70 years old. In particular, it is a malignancy of the bone marrow, a soft substance found in some bones. It could affect the spine, brain, pelvis, and ribs, among other body parts. Because the patients first exhibit no clear indications or symptoms, it is extremely difficult to identify.

 

Pasma cells in Mutiple Myeloma

 

 

Clinical manifestations of multiple myeloma

 

We will try to list the most common sign and symptoms of this disease.

Generalized bone disease that mainly affects vertebra, ribs, skull and sternum etc.

·      Persistent and continuous back pain that does not go away with the use of routine painkillers.

 

Myeloma cells affecting spine

 

·      Punched out lytic bone lesions

·      Pathological fractures

·      Hypercalcemia of malignancy due to release of calcium by weakened bones in the blood that in turn causes other symptoms like lethargy, dehydration, confusion and weakness.

 

 

·      Normocytic normochromic anaemia due to reduced production of erythropoietin as the result of kidney damage.

·      Primary amyloidosis, which damages the endothelium of the blood vessels.

·      Peripheral neuropathy, which can cause numbness, pins and needles, or tingling owing to the build-up of amyloid in the skin's soft tissues or can cause carpal tunnel syndrome by affecting the median nerve in your hands.

·      Radiculopathy that includes impingement of origins of nerve roots from the spinal cord owing to the vertebral fractures.

·      Renal failure, which includes proteinuria, where Para proteins, such as Bence-Jones proteins, exceed the body's capacity to reabsorb them.

·      Kidney stones due to excessive light chain proteins like lambda and kappa or due to increased calcium contents in your blood.

·      Recurrent infections due to immunosuppression of other immunoglobulin.

·      Shortness of breath, headache and general fatigue due to hyper viscosity syndrome as M proteins are everywhere in the body.

 

Hperviscosity syndrome

 

·      Local tumours that may appear as local masses.

 

Pathophysiology of multiple myeloma

 

Osteoblasts, osteoclasts, and stromal cells that support blood synthesis can be found in your bone. Multiple myeloma, as its name implies, is a malignancy of the myeloid tissue that also goes by the name monocolonal plasmacytoma since it comprises more than 10% of plasma cells that come from the same colony.

These plasma cells or cancer cells emit cytokines that promote cell development and migration to the site of the damaged area. This leads to a poor chain of events, such as a reduction in osteoblast formation and an increase in osteoclast activity, as well as the proliferation of malignant cells.

 

Multiple myeloma cells

 

Additionally, it could result in more para proteins being produced, which are short, light-chain proteins that can easily flow through the kidney tubules, causing injury to the kidneys and proteinuria. But none of these proteins is albumin; rather, they are all globulin in origin. This malignancy affects your humoral immunity because it is a B-lymphocyte cancer.

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Investigations for multiple myeloma

 

·      Blood test to check for weak blood, higher levels of calcium

·      Renal function tests like increase in urea and creatinine and BUN

·       Serum alkaline phosphatase will be within normal range.

 

 

·      Urine dipstick is usually normal so it does not hep to diagnose this condition.

·      Urine immuno electrophoresis detects Bence-Jones proteins. 

 

 

·      Bone examination includes aspiration of bone marrow that shows abundant plasma cells.

·      X-ray of bone shows thinning of bones or osteoporosis.

·      CT scan of bone shows lesion of bones and other soft tissues.

 

Early onset of multiple myeloma seen in skull

 

 

Diagnosis of multiple myeloma

 

It really depends upon presence of these four factors like

·      Hypercalcemia

·      Renal failure

·      Anaemia

·      Bone lesion 

 

 

 

Complications of multiple myeloma

 

·      Complications of multiple myeloma includes renal tubular acidosis and dehydration due to high calcium in the body.

·      Mostly people may develop leukaemia later (ALL).

·      Acute renal failure

·      Presence of immature red blood cells and immature white blood cells in the blood

 

Treatment of multiple myeloma

 

Chemotherapy, steroids, thalidomide, or bortezomib are all used in its treatment. But be mindful of their side effects, which may include hair loss, neuropathy, or in the case of thalidomide, blood clot development. Your doctor will give you additional medications to treat these issues because they work well at killing myeloma cells.

 

treatment of multiple meyeloma

 

 

            Autologous stem cell transplant in which you will be your own donor.

Painkillers

Radiotherapy is used further for bone pains

Use of certain special medicines like bisphosphonates

Blood transfusion

Surgery in case of oncological emergency or pathological fractures

Dialysis along with plasma exchange in the case of renal failure