Recently, there has been an increased focus on multiple myeloma and a growing interest among Kenyans in understanding what multiple myeloma is.
Dr Malkit Riyat, a consultant haematologist at the Aga Khan University Hospital, says multiple myeloma is a type of blood cancer that develops from plasma cells in the bone marrow.
Bone marrow is found in various body parts, including the spine, skull, shoulders, ribs, and pelvis.
Dr Riyat explains that the term “multiple myeloma” is used because this type of cancer affects multiple bones in the body.
“There are different types of cells in the bone marrow, one of which is called plasma cells. They are part of the immune system and help fight infections. When a person has cancer, these abnormal plasma cells spread throughout the bone marrow and there is not enough space to make enough normal blood cells,” explains Dr Riyat.
Signs and symptoms of myeloma
Myeloma can cause bone pain, such as back pain, neck pain, pelvic pain, and hip pain. It can also cause symptoms such as constipation due to high calcium levels, kidney failure, anaemia, frequent and difficult-to-conquer infections such as chest infections and urinary tract infections, as well as fatigue and shortness of breath.
“These symptoms occur because myeloma patients have a weakened immune system," he says.
Dr Riyat explains that, like other cancers, the exact causes of myeloma are not known.
However, high levels of radiation and exposure to certain chemicals and viruses, such as HIV/Aids, have been linked to an increased risk of myeloma. In addition, myeloma is not usually inherited, so it is rare for more than one family member to be affected.
“We do not know what causes multiple myeloma. However, patients with the disease may have specific genetic mutations that can be identified through specialised tests that examine the chromosomes. It is important to note that all patients with multiple myeloma have a pre-existing condition known as monoclonal gammopathy of undetermined significance (MGUS),” says Dr Riyat.
He goes on to say that, among patients with MGUS, some will go on to develop myeloma.
MGUS is a condition in which an atypical protein is found in the blood. The protein is called a monoclonal protein, or M protein. This protein is made in the soft, blood-producing tissue at the centre of the bones. This blood-producing tissue is called the bone marrow.
Dr Riyat says that the diagnosis of multiple myeloma is usually straightforward and nine out of ten cases are detected immediately. However, the challenge is to get the patient to the right doctor who suspects multiple myeloma and knows which tests to perform. If a patient has MGUS, there is a chance that they will develop myeloma.
“Sometimes patients come in late and are examined and diagnosed with all sorts of conditions before the final diagnosis is made,” he says.
Tests to diagnose myeloma
There are several blood and urine tests used to diagnose myeloma. The main blood test measures the amount and type of paraprotein in the blood. Paraprotein is an abnormal antibody produced by myeloma cells. Urine tests can check for the presence of Bence Jones protein, which is paraprotein, in the urine.
X-rays: X-rays are usually taken of the head, spine, ribs, hips, legs and arms to check for bone damage caused by myeloma cells.
CT scans: A CT scan produces three-dimensional images to look at a part of the body in more detail or to look for areas of bone damage that may not be visible on an X-ray.
Treatment to control myeloma
“We combine three or four drugs that a patient should take for eight to nine months if they don’t go for a bone marrow transplant. If they go for a transplant, we can stop the treatment after three to four months and do the transplant,” says Dr Riyat.
Initial treatment usually involves a combination of chemotherapy, thalidomide and steroids. Bisphosphonate drugs are used to reduce bone pain and prevent further bone weakness or damage caused by myeloma cells. They also prevent dangerous increases in blood calcium levels. In addition, radiotherapy (also known as radiotherapy), which uses X-rays to kill or damage cancer cells, can be used to relieve some of the symptoms of multiple myeloma, such as bone pain.
“The drugs can cost about Sh100,000 per month for up to eight months, which is close to Sh1 million,” says Dr Riyat.
Besides drugs, Dr Riyat says a bone marrow transplant is another form of myeloma treatment. It does not cure the disease, but it keeps it at bay for a much longer period than drugs.
Patients do not need a donor for the transplant, as they use their own bone marrow.
“In India, it costs an average of $20,000 (Sh2.6 million) to $25,000 (Sh3.2 million),” he says.
After treatment, Dr Riyat notes that many patients live healthily for about eight to ten years, and some beyond that.
“Before the treatment was available, patients would die within three to four years of diagnosis,” he says.
Dr Riyat, who says the condition is more common in men than women, has treated about 200 patients over the past 15 to 20 years.
At his clinic, he sees about ten patients a year. That is, at most, two patients in a month.
He adds that multiple myeloma is usually a disease of the elderly—people over the age of 60. However, he says that some patients are diagnosed in their 40s, but rarely in their 30s. The disease is also very rare in children.
“Because all cases are referred to specialists, some doctors may never see a case in their career,” he says.
“Treatment for myeloma is improving all the time and can help control the disease, manage symptoms, and improve quality of life, but it is not currently curable. When myeloma is under control, people usually return to good health, which can last for several months or years before further treatment is needed,” says Dr Riyat.
Myeloma cells typically remain in the bone marrow, unlike leukaemia, which is a cancer of immature blood cells that circulate in the bloodstream. The problems caused by myeloma cells and the treatments used for myeloma differ from those used for leukaemia.
