Myeloma is a cancer that forms in a type of white blood cell called a plasma cell that helps the body recognize and attack germs. An abnormal plasma cell, also called a myeloma cell, will multiply and divide creating more abnormal plasma cells. These myeloma cells collect in bone barrow and begin to damage the solid part of the bone. When myeloma cells affect several bones in the body, the disease is called multiple myeloma.
Multiple myeloma can cause other problems such as bone fractures and legions, damage to kidneys and other organs, suppression of the immune system and anemia. Symptoms of multiple myeloma can vary and may not be apparent in the early stages of the disease. When signs and symptoms do appear, they can include: bone pain, especially in the spine or chest; nausea; constipation; loss of appetite; mental fogginess or confusion; fatigue; frequent infections; unexplained weight loss; weakness or numbness in the legs; excessive thirst.
Treatment for multiple myeloma isn’t always necessary for people who aren’t experiencing any signs or symptoms. For people with multiple myeloma who require treatment, many treatments are available to help control the disease. To determine the best course of treatment, blood and urine tests, bone marrow biopsies and imaging test such as an X-ray, MRI, CT or PET may be performed.
Chemotherapy: Chemotherapy is a systemic treatment that travels throughout the body and kills cancer cells. Chemotherapy combines drugs that can be taken orally or intravenously, typically administered on a three to four–week cycle. One course of treatment can require four to six cycles. It is sometimes combined with other drugs, like steroids or immunomodulatory drugs.
Corticosteroids (Steroids): Steroids can be used at all stages of the disease. At high doses, steroids work to destroy multiple myeloma cells. They also decrease inflammation and can reduce nausea, a common chemotherapy side effect.
Proteasome inhibitors: These drugs are widely used for multiple myeloma and at all stages of the disease. Proteasomes are protein complexes that support cell survival and proliferation. Inhibitors block typical proteasome function, which causes cancer cells to die. Inhibitors can be administered orally or by infusion.
Nuclear export inhibitor: XPO1 protein regulates the transport of proteins and multiple RNA species. Inhibitors block XP01, which causes cancer cell death.
Immunomodulatory drugs (IMiDs): IMiDs are a class of immunotherapy drugs that stimulate the immune system, prevent cancer cell growth, and kill myeloma cells. They are orally taken.
Monoclonal Antibodies: This treatment uses genetically–engineered antibodies to target and attack the surface proteins of myeloma cells. Monoclonal antibodies kill cancer cells and support the body’s immune response to do the same. It is given intravenously.
Bispecific T–cell engager (BiTE): BITEs are engineered proteins injected into the body. These proteins bind the immune cells (T cells) to the BCMA protein on the myeloma cells, which prompts the immune system to attack.
CAR T–CELL (Chimeric Antigen Receptor T–cell) THERAPY is a type of immunotherapy that requires removal and genetic alteration of the patient’s T cells. Once these modified cells are infused back into the patient’s bloodstream, they seek and attack cancer cells.
BCMA-Targeting Drugs: BCMA is a surface protein found in nearly all cases of MM. In BCMA-targeted therapy, the patient’s T cells are collected and modified to recognize BCMA on the surface of the myeloma cells and to kill those cells.
STEM CELL TRANSPLANT
This type of therapy replaces a patient’s damaged stem cells with healthy stem cells. A myeloma patient typically receives a high dose of chemotherapy to kill existing cancer cells before receiving new, healthy blood–forming stem cells. There are two types:
– Autologous Transplants: The patient’s own stem cells are harvested and stored until ready for transplant. Some doctors may recommend a second autologous transplant six to 12 months later.
– Allogenic Transplants: The patient receives stem cells from a donor, usually a close relative with a closely matched cell type. This type of transplant is riskier but may be more effective at fighting cancer. Allogenic transplants are not considered a standard treatment. Autologous transplants are more common.
EXTERNAL BEAM RADIATION
This treatment may be used to relieve bone pain and prevent further bone damage. It is also a common treatment for solitary plasmacytomas (plasma cell tumors). Radiation relieves multiple myeloma symptoms rather than treating the disease itself.
Surgery is not a standard treatment for multiple myeloma. It is sometimes used to remove solitary plasmacytomas and can help repair and support disease–weakened bones.