Multiple Myeloma (MM) in India
- Multiple Myeloma (MM) is a type of cancer that originates in plasma cells, a type of white blood cell responsible for producing antibodies that help fight infections. In MM, abnormal plasma cells grow uncontrollably in the bone marroww, crowding out normal blood cells and leading to various systemic issues. This cancer is considered relatively rare but serious, primarily affecting older adults.
Pathophysiology
MM is characterized by the malignant transformation of plasma cells, which begin to proliferate uncontrollably. This leads to:
1. Excessive production of monoclonal proteins (M proteins):
- These abnormal immunoglobulins can accumulate in the blood and organs, causing various complications.
2. Bone Marrow Suppression:
- The overgrowth of cancerous plasma cells disrupts normal blood cell production, resulting in anemia, leukopenia, and thrombocytopenia.
3. Bone Destruction:
- Myeloma cells release substances that activate osteoclasts (cells that break down bone), leading to bone resorption, lytic lesions, and fractures.
Etiology
The exact cause of MM is unknown, but several risk factors have been identified:
1. Age:
- The majority of patients are typically over 65 years old.
3. Gender:
- Males are affected slightly more frequently than females..
2. Race:
- African Americans have a higher incidence compared to other ethnic groups.
4. Genetic factors:
- Some cases may be linked to specific genetic abnormalities, such as translocations involving chromosomes 14 and 4.
Symptoms
The presentation of MM can be highly variable, but common symptoms include:
1. Bone pain:
- Most commonly in the spine and ribs, due to bone lesions.
3. Fatigue and weakness:
- Due to anemia.
2. Increased susceptibility to infections:
- Due to a weakened immune system.
4. Hypercalcemia:
- Bone breakdown releases calcium into the blood, leading to nausea, confusion, and kidney dysfunction.
Diagnosis
Diagnosis of MM typically involves several tests to confirm the presence of abnormal plasma cells and associated complications:
1. Blood Tests:
- Elevated levels of monoclonal proteins (M proteins), calcium, creatinine, and reduced hemoglobin.
2. Urine Tests:
- The presence of Bence Jones proteins (light chain immunoglobulins) in the urine.
3. Bone Marrow Biopsy:
- To detect an increased number of abnormal plasma cells.
4. Imaging:
- X-rays, CT scans, or MRI to identify bone lesions or fractures.
5. Cytogenetic and Molecular Testing
- To identify genetic abnormalities that may affect prognosis and treatment decisions.
Staging
Multiple myeloma is staged using the Revised International Staging System (R-ISS), which includes the following factors:
1. Serum β2-microglobulin levels
2. Serum albumin levels
3. Lactate dehydrogenase (LDH) levels
4. ICytogenetic abnormalities
Treatment
The treatment of MM depends on the stage, patient health, and specific genetic factors but generally includes:
1. Chemotherapy:
- Using drugs like melphalan, cyclophosphamide, or newer agents like bortezomib, lenalidomide, or carfilzomib.
2. Corticosteroids:
- : Drugs like dexamethasone or prednisone are often used alongside chemotherapy.
3. Targeted Therapy:
- Drugs such as proteasome inhibitors (bortezomib) and immunomodulatory drugs (lenalidomide) target specific aspects of myeloma cell survival.
3. Immunotherapy:
- Monoclonal antibodies like daratumumab target cancerous plasma cells.
4. Stem Cell Transplantation
- Autologous stem cell transplants can be used after high-dose chemotherapy to restore bone marroww function.
Complications
1. Infections:
- Due to immunosuppression, patients are more prone to serious infections.
2. Renal failure:
- Drugs such as proteasome inhibitors (bortezomib) and immunomodulatory drugs (lenalidomide) target specific aspects of myeloma cell survival.
3. Anemia:
- Resulting in chronic fatigue and weakness.
4. Peripheral Neuropathy
- Caused by the disease itself or side effects of certain treatments (like bortezomib).
Departments
Blood Cancer
Sickle cell Anaemia
Allogeneic Transplant
Haploidentical Transplant
Syngeneic Transplant
Related Hospitals
Indraprastha Apollo Hospitals (Jasola, Delhi)
