Myeloma

Your bone marrow is a spongy tissue at the centre of your larger bones that makes all your body’s blood cells including red cells, white cells and platelets. Plasma cells are a type of white blood cell.

Myeloma starts when abnormal plasma cells are created that quickly multiply and cluster. They leave less room for your normal blood cells to develop in your bone marrow, that keep you healthy.

Normal plasma cells are part of your immune system and they make a number of antibodies to help your body fight infections. Abnormal myeloma plasma cells produce an aberrant antibody that has no useful function, called paraprotein and this is found in the blood of most people with myeloma.

Myeloma is also known as multiple myeloma as it affects multiple places in your body where bone marrow is found such as in the bones of your spine, skull, pelvis, ribs, arms, legs and the areas around your shoulders and hips.

Myeloma is unlike many cancers as it does not exist as a lump or tumour. Instead, it damages your bones and affects the production of your healthy blood cells.

You may not have any symptoms in the early stages of myeloma and it is often only picked up following a routine blood or urine test.

Over time, myeloma can affect your body in several ways with most symptoms being caused by the build-up of the abnormal plasma cells and the reduction of other blood cells in the bone marrow, and the presence of paraprotein in your body.

Symptoms can include:

• bone pain or tenderness often in your spine and long bones (arms and legs)
• weak bones that break and fracture easily
• tiredness and feeling weak with shortness of breath, caused by a lack of red blood cells (anaemia)
• repeated infections due to a lack of normal plasma and other white blood cells
• kidney damage
• unusual bleeding and bruising due to a lack of platelets (thrombocytopenia)
• thirsty, feeling sick, confusion, drowsiness, and frequent urination because of high levels of calcium in your blood (hypercalcaemia).

If you are concerned you may have myeloma cancer symptoms you should see a doctor. Initially, they will examine you and ask about your symptoms, medical history and overall health. They will provide screening to diagnose myeloma cancer which is a series of tests that may include blood tests to check for certain antibodies and proteins, urine and bone marrow tests and X-rays or scans of your bones to diagnose myeloma cancer. If they suspect myeloma, they will refer you to haematologist for further tests and scans including X-rays, CT scans, MRI scans, and a biopsy sample of bone marrow.

Myeloma cancer is given stage numbers based on the results of your tests that refer to how far the disease has progressed. Stages of myeloma help doctors decide on the best course of treatment.

The stages of myeloma are:

• Smouldering - non-active disorder with no symptoms
• Stage 1 - early myeloma with no symptoms
• Stage 2 - progressing myeloma that is causing multiple symptoms
• Stage 3 - myeloma is in multiple parts of the body and experiencing complex symptoms.

There is no cure for myeloma cancer but treatment aims to get myeloma under control.

Myeloma cancer treatment will be based on the stage you are given. If you have smouldering myeloma with no problems you may not need immediate treatment.

The main treatments for myeloma are:

• Chemotherapy- medicines that kill myeloma cells
• Steroids - help destroy myeloma cells and make chemotherapy more effective
• Other types of anti-myeloma drugs - help kill myeloma cells

You often have a combination of these drugs as they work well together for the treatment of myeloma cancer.

You will usually be given your specific drug combination over a number of weeks, which may or may not be followed by a rest period and this constitutes one cycle of treatment. Your initial course of treatment will usually last four to six months during which you can expect to have a series of treatment cycles.

If you are fit enough, you may have high-dose therapy to help destroy a larger number of myeloma cells and give you a longer period of remission. Stem cell transplant is used to allow your bone marrow to recover. Your stem cells are usually collected from you before you are admitted for the high-dose treatment.

When there is no sign of active myeloma in your body, it is known as being in remission. However, if it returns, called a relapse, further treatment is needed that is similar to your initial treatment.

You may also need treatment to help relieve some of the problems caused by myeloma including:

• painkillers
• radiotherapy – to relieve bone pain
• bisphosphonate medicine – to prevent bone damage and reduce blood calcium levels
• blood transfusions or erythropoietin medication – to increase your red blood cell count and treat anaemia
• surgery – to treat or strengthen damaged bones or spinal cord compression
• dialysis – if you develop kidney failure
• plasma exchange – replacement of the liquid that makes up your blood if you have unusually thick blood.