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multiple myeloma

Multiple Myeloma

What is Multiple myeloma?

Multiple myeloma is type of a blood cancer; fundamentally it is a cancer which forms in a type of white blood cell known as plasma cell. Normally the plasma cells are found in the bone marrow, which makes antibodies that fight against the infections in your body known as immune system of the body. Our immune system is made up of several types of cells that work to fight against the infections and other diseases.

In multiple myeloma, plasma cells become cancerous and start growing uncontrollably in the bone marrow and crowd out healthy blood cells. Rather producing antibodies, the cancer cells produce abnormal proteins known by several other names, including monoclonal immunoglobulin, monoclonal protein (M-protein), M-spike, or paraprotein.
It is seen multiple myeloma affects more men than women. It affects twice as many people who are black as it does people who are of other races. Mostly it diagnosed of age group between 40 to 70.
Other Plasma Cell Disorders
Multiple myeloma is one of type that can cause problems with patient plasma cells. Others include:
• Monoclonal gammopathy- This condition is known as when your plasma cells make too many copies of one antibody.
• Solitary plasmacytoma- It is most like multiple myeloma, but it causes a single unusual plasma cell growth rather than many of them. This can happen inside or outside a bone.
• Light chain amyloidosis- Causes unusual plasma cells in bone marrow.
• Waldenstrom macroglobulinemia- This is a type of both monoclonal gammopathy and non-Hodgkin’s lymphoma, a cancer of lymph system.

Multiple Myeloma Causes and Risk Factors

Experts are not sure about the exact cause of multiple myeloma. But it is mostly seen people in age group above 60 and (older people), Africans and Africans Americans. Some potential causes they are exploring include:
• Genetic Mutations
• Environmental Factors- Had contact with chemicals used in rubber manufacturing, woodworking, firefighting or in herbicides
• Having an inflammatory disease or condition- Disease include Type 2 diabetes, rheumatoid arthritis.
• Overweight or Obese
• Radiation Exposer

Symptoms of Multiple myeloma

Earlier patient might not notice any symptoms. But over the time it may be shown as:
• Bone pain, especially in spine or chest
• Nausea
• Constipation
• Loss of appetite
• Mental fogginess or confusion
• Fatigue
• Frequent infection
• Weight loss
• Weakness or numbness in your legs
• Excessive thirst
• Bruising or bleeding more easily

Multiple Myeloma complications

• Bone problems- Bone can become so weak, leading to fractures.
• Blood problems- Body might get anemic. Causes tiredness, pale and heart problems. Person might also have low platelets level, which makes harder for the blood to clot.
• Infections- When person has myeloma that body is not able to produce healthy antibodies to fight against the infections. Leading weak immune system.
• Kidney damage- Myeloma restricts the proper functioning of the kidneys. They don’t filter the way they should. Might lead to kidney failure.
Multiple Myeloma Diagnosis
When a patient visits to a doctor having above mentioned complains and symptoms related with multiple myeloma. Then the doctor may ask about the patient’s family medical history. He may do some physical examination and advice several blood tests and other tests to confirm a diagnosis. Sometimes doctor diagnose multiple myeloma accidentally during a blood test for some other medical condition of the patient.
Test and procedures used to diagnose multiple myeloma include.
• CBC
• Blood chemistry test
• Quantitative immunoglobulin test
• Electrophoresis test
• Urine test
• Scan like- X rays, CT scan, MRI, PET scan
• Bone marrow biopsy

Once cancer is diagnosed, then doctor check the stage. Staging provides important information about the cancer spread in the body and anticipated response to treatment.

Treatment of multiple myeloma

Treatment of multiple myeloma depends on patient’s symptoms, stage of the cancer and patient’s overall health. In many cases it has seen that team of doctors will work with the patient to find best treatment plan for that particular patient. The goal of treatment is to eliminate the myeloma cells, control tumor growth, control pain, and allow patients to have an active healthy life. While there is no complete cure for multiple myeloma, but it can be managed successfully in many patients for years.
Treatment overview for people with smoldering multiple myeloma:
this is the early stage of myeloma and no symptoms, called smoldering multiple myeloma or SMM. This can closely monitored by the doctor through checkups. The process is called active surveillance or watchful waiting. If doctor find any evidence of bone thinning or osteoporosis, periodic infusions of bisphosphonates to reverse this process may be recommended. Doctors follows clinical protocols which used to evaluate whether using targeted therapy or immunotherapy can prevent or delay myeloma from developing into a disease that requires treatment. Active treatment start only after symptoms appears.
Treatment overview for patients with symptoms
Patients with symptomatic myeloma include both treatments to control the disease spread as well as supportive care to improve quality of life.

Different phases of treatment –

• Induction therapy for rapid control of cancer and to relieve symptoms.
• Consolidation for more chemotherapy or a bone marrow transplant.
• Maintenance therapy over a prolonged period to prevent the recurrence of cancer
Mediational therapies
• Chemotherapy
• Targeted therapy
• Immunomodulatory drugs
• Steroids
• Bone- modifying drugs
• Immunotherapy
Bone marrow transplant
Radiation therapy

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Best multiple myeloma treatment in India

Best multiple myeloma treatment in India

Multiple myeloma is cancer of the plasma cells (a type of white blood cells) of the bone marrow. Plasma cells are protein-making cells that generally produce the different kinds of antibodies for our immune system. In multiple myeloma, the plasma cells become malicious and cancerous. These myeloma cells stop making different forms of protein in response to the immune system’s needs and instead start to produce a single abnormal type of protein sometimes termed a monoclonal or M protein. Multiple myeloma plasma cell populations accumulate in the bone marrow, and these collections of cells called plasmacytomas can erode the hard outer shell or cortex of the bone that normally surrounds the marrow. These weakened bones show thinning of the bone, as seen in nonmalignant osteoporosis or what appear to be punched out or lytic bone lesions. People often refer to multiple myeloma simply as myeloma (also termed Kahler’s disease after the physician who first described this cancer). The disease usually occurs in people past middle age.

In India, there are large number of options available for Best multiple myeloma treatment in India.

However, rarely it can occur in a child.
One type of myeloma-related plasma cell neoplasm is called a monoclonal gammopathy of undetermined significance (MGUS). In MGUS, medical professionals only find low levels of M protein and people have no symptoms; MGUS infrequently develops into multiple myeloma.

Plasma cell neoplasm is another name for multiple myeloma. Causes of multiple myeloma
What triggers plasma cells into malicious multiple myeloma is unknown. The cancerous
myeloma plasma cells proliferate and crowd out normal plasma cells and can corrode areas of bones. The proteins produced in large amounts can cause many of the symptoms of the disease by making the blood more viscous and depositing the proteins in organs that can interfere with the functions of the kidneys, nerves, and immune system.

Causes of multiple myeloma are not known exactly. But patients more likely to get affected
• older than 65 years
• people of African-American origin
• overweight or obese people
• family member with it

Stages of multiple myeloma

There are four stages of multiple myeloma. While many health care professionals use different staging, these are various stages cited by many clinicians:

• Smoldering: multiple myeloma with no symptoms
• Stage I: early disease with little anemia, relatively small amount of M protein and no
• bone damage
• Stage II: more anemia and M protein as well as bone damage
• Stage III: still more M protein, anemia, as well as signs of kidney damage
Because staging criteria differ according to different groups, some clinicians simply define the individual’s multiple myeloma without assigning a stage and simply estimate a prognosis for their patient.

Symptoms of multiple myeloma

Patients with myeloma may be asymptomatic with an unexplained increase in protein in the
blood. With more advanced disease, some myeloma patients may have weakness due to anemia caused by inadequate production of red blood cells, with bone pain due to the bone damage, and as the abnormal M protein can accumulate and damage the kidneys resulting in patient’s unexplained kidney damage and decreased kidney function. Multiple myeloma cancer cells may be in or outside the bone marrow.

The following symptoms and signs of multiple myeloma – 

• Anemia
• Bleeding
• Nerve damage
• Bone tenderness or pain, including back pain
• Enlarged tongue
• Skin lesions (rash)
• Infections Weakness, fatigue or tiredness
• Kidney failure and/or other end-organ damage• Spinal cord compression •
• Loss of appetite and weight loss
• Leg swelling
• Hypocalcaemia
• Diagnosis of multiple myeloma
• First sign of multiple myeloma is found when a routine blood test shows an abnormal amount of protein in the bloodstream or an unusual stickiness of red blood cells causing them to stack up almost like coins, an unusual formation for red blood cells. The health care professional will do a history and physical exam, looking for signs and symptoms of multiple myeloma. If multiple myeloma is suspected, several studies help confirm the diagnosis.

They include a bone marrow aspiration and biopsy most commonly from the large bones of the pelvis. Cells obtained from the marrow are studied by a pathologist to determine if there is one (plasmacytoma) or more (multiple myeloma) abnormal types or numbers of cells
• Medical professionals also study a sample of the bone marrow aspirate for more detailed
• Characteristics such as the presence or absence of abnormal numbers or types of chromosomes (DNA) by what is called cytogenetic testing.

Bone marrow biopsy can assess the concentrations of cells in the marrow and the presence of abnormal invasive growth of cellular elements.
• Blood testing and urine testing by several methods can determine levels and types of
National Comprehensive Cancer Network (NCCN) recommended that health care professionals use a serum free light chain assay and fluorescence in situ hybridization (FISH) test to further
• Monoclonal protein produced and if there is kidney damage.

Identify multiple myeloma in patients

X-ray studies to identify skeletal lesions and MRI for spinal cord lesions in multiple myeloma.

Medical treatment for multiple myeloma

The therapy is decided based upon the patient’s condition and the cancer management team,
made with the patient’s input. The choices for treatment(s) often include combinations of drugs, some of which medical professionals give as pills and others by intravenous injection.

These include drugs that affect or modulate the immune system, steroids, and some oral or injectable chemotherapy drugs. These are usually used in combinations.
There may be a role for high-dose chemotherapy followed by the administration of bone marrow called a stem cell transplant. Numerous factors come into play in determining whether to do such a transplant. Other medical treatments may include steroids, bisphosphonate therapy, blood or platelet transfusions, plasmapheresis, and other combination therapy depending on the
individual patient’s disease stage.

Radiation therapy may treat painful areas of bone damage. Surgeons can surgically repair broken bones in many cases.

There are many drugs used to treat multiple myeloma. Medical professionals often use the
following drugs in combination with dexamethasone,

• Bortezomib Velcade — protease inhibitor
• Lenalidomide (Revlimid) — immune cell modulation
• Melphalan (Alkeran) — alkylating agent that is toxic to myeloma cells
• Carfilzomib (Kyprolis) — protease inhibitor that is FDA approved usually for patients
• who have failed a previous treatment
• Daratumumab (Darzalex) — monoclonal antibody that may damage or kill multiple
• Myeloma cells (and others) that have CD38 protein on their surface
• Elotuzumab (Empliciti) — a compound that activates the body’s natural killer cells to
• Destroy multiple myeloma cells, usually in combination with Revlimid and Decadron
• Ninlaro (Ixazomib) — This proteasome inhibitor, in combination with Revlimid and
• Dexamethasone, improves the survival rates of some patients with multiple myeloma.

Hospitals offer best multiple myeloma treatment in India, the charges for autologous stem cell transplant ranges between USD 15000 to USD 21000 depending on the status of the disease and individual’s response to the treatment provided at the hospitals.

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