A Body on Shaky Foundations: How Multiple Myeloma Impacts Bones & Organs

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.

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.

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

• Certain genetic abnormalities that occur with age may lead to multiple myeloma.
• Exposure to certain chemicals, fertilisers, or radiation could lead to the development of multiple myeloma.
• Living with an inflammatory disease or other plasma cell disorders

“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.

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

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

The diagnosis of multiple myeloma involves several steps, with the medical team guiding each procedure. The doctor will begin by examining your symptoms, enquire 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.

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.

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

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.

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

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.