A Body on Shaky Foundations: Myeloma Explained

Higher levels of M protein in the blood are a key defining feature of multiple myeloma, which negatively impacts one’s bones, organs, and blood cell production. The condition represents 1% of all cancer cases. In India, it makes up 1.23% of the cancer population.

How does multiple myeloma develop?

In multiple myeloma, also known as Kahler’s disease, plasma cells undergo mutations and become cancerous. As a result, they multiply uncontrollably and rapidly, outnumbering the healthy plasma cells vital for immune function. These malignant cells begin to release an abnormal antibody known as the M protein. The average age at which individuals are diagnosed typically ranges from 65-70, with only a fraction of the cases (about 2%) being diagnosed in individuals under 40.

Causes and risk factors of multiple myeloma

While researchers haven’t yet identified the exact cause of multiple myeloma, several potential explanations have been proposed:

• Family history

Individuals with a close relative, such as a parent or sibling, diagnosed with multiple myeloma or another blood cancer may have a higher risk. This suggests that certain inherited genetic factors can play a role.

• Ageing

The risk of multiple myeloma increases significantly with age. Most cases are diagnosed in people over the age of 60, with it being very rare in those under 40.

• Exposure to radiation

Long-term or high-level exposure to ionising radiation, such as that used in certain medical treatments or encountered in industrial settings, may increase the risk of multiple myeloma.

• Chemical exposure

Prolonged exposure to harmful substances such as benzene, herbicides, and pesticides has been associated with a higher risk of developing blood cancers, including multiple myeloma.

• Obesity

Being overweight or obese has been linked to a number of cancers, including multiple myeloma. Excess body fat can affect hormone levels and immune function, potentially influencing cancer risk.

“Multiple myeloma causes punched-out lesions in the bones, leaving them brittle and painful. These lesions are partially reversible, and bone strength can gradually improve over time with appropriate treatment,” says Dr Vineet Govinda Gupta, MBBS, MD and DM, a cancer specialist based in Delhi.

Are there different types of multiple myeloma?

Multiple myeloma can be classified into four types:

1. Monoclonal gammopathy of undetermined significance (MGUS): Small amounts of M protein are detected in blood tests, with 1%-2% of cases progressing to multiple myeloma.

Key features:

• M protein is present in low levels.
• Bone marrow contains fewer than 10% plasma cells.
• No symptoms or damage to bones, kidneys, or blood counts.
• Considered a benign condition, but requires monitoring.

2. Solitary plasmacytoma: A single group of abnormal plasma cells is present.

Key features:

• Only one tumour or lesion is present.
• Minimal or no M protein in the blood or urine.
• Other bones and bone marrow are unaffected.
• Common in younger patients compared to multiple myeloma.

3. Smouldering multiple myeloma (SMM): A precancerous condition characterised by mild symptoms, low M protein levels in the blood, and more plasma cells in the bone marrow.

Key features:

• M protein is present in moderate amounts.
• Bone marrow contains 10–60% plasma cells.
• No evidence of CRAB symptoms (calcium elevation, renal impairment, anaemia, bone lesions).
• May take years to develop into active myeloma.

4. Multiple myeloma: Characterised by multiple clusters of abnormal plasma cells, high M protein levels, and elevated plasma cell counts in bone marrow. Symptoms often include anaemia, hypercalcaemia, kidney failure, and bone lesions.

Key features:

• High M protein levels in the blood or urine.
• More than 60% plasma cells in the bone marrow (in some cases).
• Presence of CRAB symptoms:

C – Hypercalcaemia (high calcium levels, leading to nausea, thirst, confusion)

R – Renal (kidney) dysfunction

A – Anaemia (fatigue, breathlessness)

B – Bone lesions or fractures

Symptoms of multiple myeloma

Early on, multiple myeloma is hard to diagnose due to its mild symptoms. Among its various symptoms, bone pain is often the most noticeable. Other prominent symptoms of multiple myeloma include:

• A feeling of weakness or numbness in the arms and legs, which can be due to weak spinal segments pressing on the spine
• Excessive fatigue and exhaustion, impacting routine activities
• Nausea, weight loss, or reduced appetite
• Experiencing excessive thirst
• Recurring or persistent fever or infections
• Serious bleeding, even with minor injuries
• Feeling drowsy, confused, or dizzy

What does medical treatment entail?

The diagnosis of multiple myeloma involves several steps, with the medical team guiding each procedure. The doctor will begin by examining your symptoms, enquiring about your medical history, and then perform a physical examination. Additional diagnostic and imaging tests may be necessary to confirm multiple myeloma and gauge its progress. The stage, tumour size, location, and risk level will determine the most appropriate treatment. If multiple myeloma is detected during routine check-ups without any symptoms, a careful wait-and-watch approach may be recommended instead of immediate treatment.

Life with multiple myeloma

While one cannot entirely prevent multiple myeloma, adopting these strategies can strengthen your body, whether you're at high risk or have already been diagnosed with the condition:

• A healthy diet is essential to support the body during this journey. Consult a nutritionist for a plan tailored for you.
• Seek assistance for overcoming substance abuse, if needed.
• Ensure adequate sleep and follow exercise routines as advised by your doctor.
• Take protective measures to guard against infections.
• Prioritise both mental and physical well-being by seeking appropriate support.

Frequently Asked Questions

1.  What is usually the first symptom of multiple myeloma?

Bone pain is the first and most common symptom usually observed in people with multiple myeloma.

2. What are the common risk factors of multiple myeloma?

Here are some factors that could potentially increase the risk of developing multiple myeloma:

• Age over 65 years
• Higher risk in biological males compared to females
• A close family member with multiple myeloma
• Obesity

3. How can one identify the warning signs of multiple myeloma?

Early warning signs of multiple myeloma include bone pain, especially in the back, weakness, numbness or tingling in the limbs, fatigue, brittle bones prone to fractures, recurrent fevers and infections, frequent nosebleeds, bruising, and bleeding gums.

4. Can multiple myeloma be cured?

Although multiple myeloma cannot be completely cured, various invasive and non-invasive treatments aim to alleviate symptoms, slow disease progression, and prevent associated complications.

5. Can stress cause multiple myeloma?

While stress is not a direct cause of multiple myeloma, chronic stress can harm overall immunity and health, particularly when dealing with such a condition.