Multiple Myeloma

• Bony pain, particularly the backbone and ribs
• Anaemia can cause tiredness, shortness of breath especially on exertion
• Bone fractures with minimal to no trauma 
• Recurrent or frequent infections 
  
• Kidney damage
• Unexplained weight loss
• Increased thirst, constipation, mental confusion due to high calcium levels
  

• Eating a diet rich in fruits and vegetables
• Quitting or not starting smoking
• Limiting alcohol consumption
• Regular exercise

• Age – Myeloma is more common in people over the age of 55 and increases with age such that over the age of 80 years up to 5% of patients may have myeloma.
• Gender – Males are slightly more likely to develop myeloma compared to females.
• Repeated exposure to toxic elements such as agricultural chemicals or pesticides, and petrochemicals are thought to increase the risk of Myeloma.
• Exposure to DNA damaging ionising radiation or chemotherapeutic agents
• Obesity is a common risk factor for several forms of cancers, including Myeloma

How is multiple myeloma diagnosed?

• Clinical examination: Your doctor will check for any myeloma related complications and assess baseline functional capacity of different organ systems.
• Blood tests: To test blood cell, kidney and liver function assessments. Blood tests required for measurement of M protein, subtyping and quantification as well as investigations required for staging like beta-2 microglobulin, to assess the extent of complications or organ function effects like kidney, calcium level etc will be performed.
• Bone marrow aspiration and biopsy: Bone marrow samples are usually taken by inserting a needle into the flat part of the hip bone to extract the samples. These are then examined in the laboratory for the presence of cancer cells. It will also help quantify the percentage of the cancer cells in the marrow and help with prognostication by seeking the genetic change that the cancer cells harbour.
• Imaging tests: Imaging tests including X-Rays or CT scan, MRI scans of the back bones and PET scans may be used to look for extent of the bone destruction caused by myeloma in the body. 

How is multiple myeloma treated?

• Induction Phase: with the aim to reduce the amount of cancer cells in the bone marrow
• Consolidation Phase: with the aim of further deepen the response after induction therapy using treatments like an autologous haematopoietic stem cell transplant 
• Maintenance Phase

• Corticosteroids: Steroids can regulate the immune system and can control inflammation in the body. They are also very active against myeloma cells.
• Chemotherapy: There are many chemotherapy drugs that are used to eradicate myeloma cancer cells and prevent their growth. There are different group of chemotherapy drugs used to treat myeloma: proteasome inhibitors, alkylators, immunomodulatory drugs etc. 
• Immunotherapy: Immunotherapy harnesses the power of your immune system to control myeloma. For example, monoclonal antibodies like daratumumab target a specific protein on the surface of cancerous plasma cells and make it easier for the immune cells to identify and kill them. 
• Haematopoietic Stem Cell Transplantation: Stem cell Transplantation involves the substitution of diseased bone marrow with healthy bone marrow stem cells. In most cases, the patient’s healthy stem cells are transplanted. Healthy blood-forming stem cells are collected from the patient by a process called apheresis and is stored in advance of the transplantation. During transplantation, high doses of chemotherapy drugs are then given to destroy the diseased bone marrow. This isfollowed by reinfusion of previously collected stem cells back into the blood which then home in on the bone marrow and start producing all blood and immune cells
• Radiation therapy: Radiation therapy or radiotherapy uses high-energy radiation (rays or particles) to kill or damage cancer cells. It is usually used to shrink localised collection of cancerous plasma cells that form a tumor and is commonly used in combination with chemoimmunotherapy.