What is Multiple Myeloma
Multiple myeloma is the second most common hematologic neoplasm worldwide. It is a malignant tumor (cancer) that originates in the bone marrow and results from the proliferation of neoplastic clonal plasma cells, meaning cells that mutate and become abnormal.
The clonal plasma cells that accumulate in the bone marrow are responsible for producing a large quantity of abnormal antibodies. Because they cannot perform their protective functions, these antibodies form a cluster of disordered proteins, called monoclonal proteins or M proteins.
The expansion of multiple myeloma causes decalcification and lesions in the bones, leading to pain and eventually even fractures in advanced cases. Kidney failure and recurrent infections can also occur as a result of the disease.
Approximately 7,000 new cases of multiple myeloma are diagnosed in Brazil each year. The disease most commonly affects men and women over 60 years of age.
Symptoms and signs of multiple myeloma
Some patients may not present any symptoms, especially if the clonal plasma cells infiltrate the bone marrow in small quantities and the production of M component is low. However, when there is a higher infiltration of plasma cells and increased production of M protein, the patient may experience the following symptoms:
- Extreme fatigue
- Weakness
- Paleness
- Unexplained weight loss
- Decreased kidney function
- Swelling in the legs
- Excessive thirst
- Loss of appetite
- Constipation
- Frequent infections
Bone pain without apparent cause is among the most common symptoms. Spontaneous bone fractures (without a history of trauma) are less common but can also occur in patients with multiple myeloma.
Diagnosis
Due to being asymptomatic in some cases, multiple myeloma can be discovered by chance during routine examinations. The most common is a blood test, which can reveal the presence of anemia and hyperproteinemia (increased proteins in the blood).
Imaging tests such as X-rays, CT scans, and MRI are essential in the evaluation of multiple myeloma, identifying the characteristic lytic lesions of bone disease.
Bone marrow biopsy and bone marrow aspiration, in which a fragment of the pelvic bone is removed for laboratory analysis, are essential for confirming the diagnosis. The goal of these tests is to identify and quantify the clonal plasma cells present to define and characterize multiple myeloma.
Other essential complementary diagnostic procedures are protein electrophoresis, protein immunofixation, and free light chain assay (FreeLite), performed through blood and urine samples, to identify and quantify the involved M protein.
Multiple myeloma treatment
In the treatment of multiple myeloma, medications are used to destroy, control, or inhibit the growth of cancerous cells.
Some of the options include proteasome inhibitors (which target cancer cells with less impact on healthy ones), immunomodulators, monoclonal antibodies, and corticosteroids. Autologous stem cell transplantation is an important tool for disease control, usually indicated for patients under 70 years of age.
Lastly, attention should be given to supportive treatment, addressing physical symptoms that may impair the patient’s quality of life and health perception. The use of bisphosphonates helps maintain strong bones by inhibiting osteoclast-mediated bone resorption, reducing bone pain, hypercalcemia, and fracture incidence.
