Multiple Myeloma

Multiple myeloma, a malign blood disease, occurs with bone pain, fatigue, weight loss, weakness and anemia, headache, blurred vision, bleeding, shortness of breath, swelling in different parts of the body. With the diagnosis of myeloma, it is necessary to complete jaw-related pre-interventions and avoid damaging approaches to the jawbone, especially because drugs that prevent bone damage harm the jawbone. During the course of treatment, the teeth should be brushed regularly until the physicians say otherwise.

What is multiple myeloma?

Multiple myeloma is a malign blood disease. It is a disease that occurs when uncontrolled proliferation of a blood cell called plasma cell accumulates in various tissues, primarily bone marrow. During healthy life, multiple successive genetic defects develop in the blood cell for reasons that cannot be fully identified. These defects lead to the formation of myeloma cells. Plasma cells that cause multiple myeloma release various molecules. These molecules enable multiple myeloma cells to survive and proliferate and spread. Multiple myeloma cells are closely associated with bone marrow nest cells. It makes the cells in the nest release molecules that will increase its survival. In other words, the myeloma cell "takes care of itself."

Normal plasma cells produce proteins called antibodies. The role of these proteins is biological warfare against infections. Plasma cells that make up multiple myeloma often also produce protein. However, this protein is deficient compared to actual antibodies. It is therefore called abnormal protein and is not effective against infections.

 

At what age and how often is it observed?

The probability of occurrence increases with advancing age.  Indeed, the mean age at the time of diagnosis is 65 years. However, it is also encountered at younger ages. In the United States, multiple myeloma has been reported in 4 out of 100 000 people each year.

 

What are the symptoms?

Bone pain: It is the most common complaint. Continuous, increasingly severe back or lower back pain and sometimes pain in the arm or leg. Some molecules released from multiple myeloma cells suppress bone formation on the one hand and increase bone decomposition and destruction. Excessive bone decomposition can lead to bone fractures. Spine fractures can cause spinal compression. Loss of strength and paralysis may develop in varying degrees in limbs.

Fatigue, weight loss, weakness and anemia symptoms can be observed.

Infections due to immunosuppression: Plasma cells that make up myeloma cannot produce normal antibodies. Therefore, there is a tendency for infections in patients. Uncontrolled pneumonia, severe sinusitis, prolonged urinary tract infections, skin infections occur as signs of immune deficiency.

Symptoms of renal failure; Drinking too much water, frequent and abundant urination or progressive decrease in the amount of urine, unconsciousness disorders associated with high urea in the blood may develop anorexia, weakness, nausea, vomiting.

Symptoms such as headache, blurred vision, hemorrhages, impaired consciousness, shortness of breath may occur due to the presence of abnormal protein in the blood.

Swelling in different parts of the body is a condition in which myeloma cells accumulate in different organs and form a tumoral mass, which is called a plasmacytoma.

 

What causes multiple myeloma? Is it related to diet?

There is no clear relationship between disease and cause. More commonly, it is observed in African Americans, people over 50, males, overweight people, people exposed to radiation, petroleum workers, and people exposed to insecticides.

 

Is it possible to diagnose multiple myeloma early?

Diagnosis and treatment of multiple myeloma is performed by hematology-oncology specialists. However, treatment is not performed in the early stage of myeloma, when there are no symptoms. Because, there is no difference in survival rates between the patients who are treated with current treatment options and those who are not. Following the diagnosis of multiple myeloma, staging is carried out to determine the spread of the disease to determine the tumor burden or biological behavior. Myeloma patients diagnosed as early stage are closely monitored without treatment. If the disease causes complaints, that is, it becomes symptomatic the treatment is started.

 

How is it diagnosed?

Bone marrow biopsy: The diagnosis of multiple myeloma is made by demonstrating plasma cell increase in bone marrow examination. Rarely, "plasmacytoma" is diagnosed by demonstrating myeloma plasma cells in a biopsy performed due to swelling in any organ of the patient's body.

Genetic defect investigation tests: It is necessary to demonstrate the genetic defects in patients with multiple myeloma. Genetic defects are informative about the course of the disease. Nowadays, treatment choices based on these genetic deficiencies have started to be considered.

Investigation of bone damage: Bone damage is investigated radiologically in every myeloma patient. Tests showing organ and tissue damage in organs such as kidney, liver, heart are performed.

 

What should myeloma patients pay attention to?

Although myeloma is a blood disease, it has the ability to damage many organs. The majority of people living in Turkey will request the doctor to withhold information from the patient. This is the biggest problem faced by physicians in our country. Relatives of the patient want to learn the details of each step of the patient and to consult the physician day and night. However, they request that the information be withheld from the patient.

Patients should get acquainted with their diseases and be aware of possible complications.
 
Oral and dental health control: With the diagnosis of myeloma, it is necessary to complete jaw-related pre-interventions and avoid damaging approaches to the jawbone, especially because drugs that prevent bone damage harm the jawbone. During the course of treatment, the teeth should be brushed regularly until the physicians say otherwise.
 
Carbohydrate-poor nutrition: Cortisone is one of the indispensable drugs in the treatment of myeloma. Cortisone use can increase blood sugar. Furthermore, drug doses are regulated taking into account body weight. Therefore, patients gaining more weight means being exposed to more drugs. Moreover, patients with bone damage are at increased risk of bone fractures if their body weight increases.
 
Salt-poor nutrition:  Cortisone use can lead to fluid retention. It may cause overloading, which is more pronounced in patients with hypertension.

Patients can eat uncooked but well-washed foods as long as physicians approve.
 
If approved by physicians, taking plenty of fluid will replace the fluid lost through the kidneys.
 
To the extent that their bodies allow, patients should be mobile and try to perform their own chores. The house should be rearranged according to the patient's needs. Less items reduce the possibility of bumps and falls. Patients should not climb stairs or stools. Loss of balance can lead to falls and serious bone fractures. Sudden behavior that may lead to impacts should be avoided.

 

What are the treatment options?

Treatment of multiple myeloma has undergone a major revolution in the last 10 years. Drugs with different mechanisms of action that prolong survival times are also available and licensed in our country.

Treatment is selected according to the patient's age (over or under 65 years) and body strength associated with comorbidities. Drug doses are reduced as age increases.

Tumor eliminating drugs: The first approach is to give a high dose of chemotherapy if the patient is younger than 65 years and can physically endure this treatment, in order to further reduce the tumor burden after 3-4 cycles of treatment that reduce the tumor burden. High-dose chemotherapy is not selective when removing tumors. It also kills healthy blood cells, which means that the blood-producing bone marrow becomes non-functional. Therefore, the cells that will constitute the bone marrow are first collected from the blood with the help of a special device called apheresis device. Then high dose chemotherapy is administered. The stored blood cells (stem cells) are intravenously returned to the patient to regenerate the bone marrow. This form of treatment is called autologous stem cell transplant or bone marrow transplant with its former name. For patients older than 65 years or those who cannot endure high-dose chemotherapy, medication therapy is administered.

Bone damage prevention drugs: Medications for the prevention of bone damage are also used in the treatment of patients with myeloma.

 

How can they cope with nausea, vomiting, loss of appetite?

The side effects of most drugs used in myeloma are acceptable. The general recommendation is to eat frequently, in smaller portions.