Research Paper on Diagnosis and Treatment of Multiple Myeloma

Introduction

A plasma cell is a white blood cells that secret antibody which acts against the antigen. It is found in the bone marrow, (Knapp 1987). However, these plasma cells can mutate to give rise to cancer and or malignancies which include but not limited to leukemia and multiple myeloma, (Drayson 2006). Multiple myeloma (MM) actually is a blood cancer closely related to leukemia and lymphoma. MM develops from a premalignant condition which is recognized as monoclonal gammopathy of underdetermined significance (MGUS). MMC is rapidly becoming a fatal disease and its treatment which started in the 1960s with a median survival of 2-3 years has not presented any promising results of cure. However, incidence of multiple myeloma (MM) is lower in Asia than in western countries, (Wasser 2005). Clinically, monoclonal protein can be found in 3-4% of the total population of the elderly people who are above the age of 50 years, (Blade 1992).

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Multiple myeloma enhances accumulation of cancer cells in the bone marrow which eventually overtake healthy blood cells. These harmful proteins released can damage kidney resulting in some signs and symptoms such as bone problems, frequent infections, low blood counts, fatigue and kidney problems which can be used to detect multiple myeloma before it gets to advance stage, (Drayson 2006). Some of the main risk factors of multiple myeloma include age, gender, exposure to radiation, lowered immunity, monoclonal Gammopathy of Undetermined Significance (MGUS), body weight, family history and lowered immunity. Patients are only assured of health improvement but they cannot be completely cured. Treatment only brings it to remission. Blood tests, urine tests, bone marrow tests, x-rays among others help in staging MM. There are three stages of MM in which at the last stage, level of B2M and LDH are normally high and people diagnosed at this stage have at least 3years life expectancy, (Lonial 2011). Beginning at the point of first treatment, the median survival rate of patients is usually 62 months for stage 1, 44 months for stage 2 and 29 months for stage 3, (Blade 1992). Various types of myeloma include Smoldering Multiple Myeloma, Active multiple myeloma, Extramedullary plasmacytoma, and Solitary plasmacytoma of the bone.

Presence of monoclonal protein in the urine or serum remains a feature and precise results can be obtained if serum free light chain (FLC) is used or 24-hour urine study is adopted. Therefore, if a patient is suspected to be having multiple myeloma, it is recommended to carry out various screening strategies such as serum, immunofixation, serum protein electrophoresis screening, and serum FLC essay. The main areas targeted during diagnosis are calcium of the serum, blood count, urine protein electrophoresis and serum creatinine, (Tibshiran 2002). Actually, albumin is a healthy protein in the body but when the level of Beta-2 microglobulin (B2M) and lactate dehydrogenase (LDH) is high then the disease is more advanced. Also, any changes in the genetic makeup of cancer cells reflect an aggressive stage of multiple myeloma, (Rajkumar 2012).

Treatment

Oncologists have to carry out the detailed diagnosis in order to come up with a precise stage of myeloma and the type. Their main aim is to reduce the chances of recurrence as well as prolong the life of the patient. There are various therapies that are carried out on patients suffering from multiple myeloma and some treatment entails a combination of drugs and intravenous injection, (Herrinton 1996). These drugs are to modulate the steroids, immune system together with chemotherapy drugs.

Treatment Options for Multiple Myeloma

Targeted Therapy

Targeted therapy treatment entails administration of a drug that target a specific abnormality within the cells of cancer which makes them survive. The use of ixazomib, Bortezomib, and carfilzomib as some of the target drugs helps in blocking the action of any substances in the cells of myeloma which breaks down proteins. Actually, it makes the cells of myeloma to die. It is mainly administered through the vain of an arm or in pill form. Besides, monoclonal antibody drugs can also be used which bind to the particular protein that is present in myeloma cells,(Rajkumar 2012).

Biological Therapy

Drugs of biological therapy use the immune system of the body to fight myeloma cells. Drugs such as pomalidomide, thalidomide, and lenalidomide enhance the cells of the immune system which identify and attack the myeloma cancer cells. They are normally administered as pills.

Chemotherapy

Through chemotherapy, fast-growing cancer cells can get killed faster. It is administered through a vein or as a pill. However, the high dose of chemotherapy pills can only be used before the transplant of the bone marrow.

Corticosteroids

Dexamethasone and prednisone are the corticosteroids that are used to regulate the immune system of the body and prevent inflammation in the body. A patient can take them as a pill or administer through injection in the arm, (Huang 2007).

Bone Marrow Transplant

A bone marrow transplant is used to replace the diseased bone marrow with the healthy bone marrow it is also known as stem cell transplant. Before the procedure I carried out, the doctor has to collect blood-forming stem cells from the blood then administer high doses of chemotherapy to destroy the affected bone marrow. After that, the stem cell is again installed into the body where they move to the bones and start rebuilding the bone marrow, (Rosen 2001).

Radiation Therapy

Beams of energy like x-rays and protons are used to damage myeloma cells and end their growth. Radiation therapy is actually used to shrink any form of myeloma cells in a particular area for example where there is a collection of abnormal plasma cells which forms a tumor and cause pain or destroys a bone.

Treating Complications of Multiple Myeloma

Multiple myeloma presents so many complications and therefore it is also important to treat those specific conditions.

• Bone pain: Taking pain medications, surgery and radiation therapy can act as a remedy to severe bone pain
• Kidney complications: dialysis can be used with people that have severe kidney damage.
• Infections: when the plasma cells have become so weak, antibodies used to fight infections can be overwhelmed. Hence diseases such as pneumonia and flu can be prevented by using certain vaccines to prevent further infections, (Huang 2007).
• Bone loss: bone loss can be curbed if the doctor prescribes bisphosphonates medications such as zoledronic or pamidronate to prevent bone loss.
• Anemia: Oncologists can recommend the use of certain medications to increase red blood cell count if the anemia is so persistent.

Treatment Procedures

Normally, doctors when treating multiple myeloma majorly focus on therapies that can decrease symptoms and signs of the disease. Consequently, if there is just a paraprotein and some abnormalities in the bone marrow without organ damage such as smoldering myeloma, doctors might consider deferring treatment or even restricting it to clinical trials. When handling the proliferation of plasma cell, bisphosphonates are administered to prevent further fractures and also have a direct effect on anti-tumor even in patients who don't have known skeletal disease. Erythropoietin or transfusion of red blood cell can be used to manage anemia

Initial Therapy

Initiation of any therapy depends on the presence or otherwise of other illness and the age of the patient. People that fall under the age of 65 are given high dose chemotherapy that contains lenalidomide-dexamethasone and bortezomib, (Munshi 2013). Chemotherapy is followed by autologous hematopoietic stem-cell transplantation (ASCT) whereby the stem cell of the patient is transplanted. The procedure is carried out to prolong the rate of survival. However, if healthy stem cells of a patient are transplanted a procedure referred to as allogeneic stem cell transplantation then there is a probability of cure though preferred in relapsed setting and not during initial treatment.

Patients above the age of 65 cannot withstand stem cell transplantation and therefore the preferred treatment for this group of people is chemotherapy with prednisone and melphalan. There have been improvements when treating these people with the use of new chemotherapy regime. Actually, if bortezomib, prednisone, and melphalan are used together the survival rate is at 83% which is 30 months, (Munshi 2013).

Maintenance Therapy

It is possible for relapse to occur after the initial therapy and therefore maintenance therapy is normally advised to prevent relapse. Medications of low toxicity are used during maintenance therapy. Using ASCT therapy as post maintenance therapy can improve the survival in people and those that have high-risk myeloma can benefit from lenalidomide and bortezomib-based maintenance strategy, (Tibshiran 2002).

Relapsed Multiple Therapy

Relapsed multiple myeloma is very complicated and therefore so many factors are considered before treatment is initiated, (Lonial 2011). First, it is important to consider how the patient responded to the previous therapy, availability of the drug, eligibility for ASCT, the aggressiveness of the relapse and whether the relapse occurred off or on therapy, (Kumar 2004).

Treatment of Various Types of Myeloma

Smouldering Multiple Myeloma

Smouldering myeloma is a condition that lays between monoclonal gammopathy of undetermined significance and active multiple myeloma. People with this condition have 30g/l and more of monoclonal protein level in the blood. Once diagnosed they have to go for regular check up at least after every 3-6 months to monitor if it's progressing to active myeloma, (Drayson 2006). Basically, it is predicted that people with low risk smouldering MM can progress to active MM after 19 years.

Active Multiple Myeloma

Some of the features diagnosed in people with active MM include presence of monoclonal protein in the urine or blood, plasma cells occupying 10 % or more of the blood cells, kidney failure, osteolytic lesion and high blood calcium, (Knapp 1987).

Solitary Plasmacytoma of the Bone

When abnormal cells accumulate in one place and form a single tumour it results to plasmacytoma. This type of MM is where a single tumor composed of myeloma cells is found in one bone, (Drayson 2006). It has no feature of MM but the x-ray shows osteolytic lesions and less than 10% of plasma cells are identified in the bone marrow. Eventually people with Solitary plasmacytoma will develop multiple myeloma though it requires radiation therapy form of treatment, (Herrinton 1996).

Extramedullary plasmacytomaIt originates outside the bone marrow actually in the soft tissue of the body. Extramedullary plasmacytoma is mostly common in the upper part of respiratory tract such larynx, nasal cavity, breast and brain. Its diagnosis is possible after the biopsy of the tumor. Main treatments carried out on people with extramedullary plasmacytoma include surgery and radiation therapy, (Drayson 2006).

Conclusion

Major advances have been made in the last decade in the diagnosis and treatment of multiple myeloma. Actually, besides the current clinical procedures for MM, future investigations and trials should address early interventions towards the cure of myeloma, optimal treatment of advanced MM, the objective of MRD as an aim of therapy, optimal sequencing of various treatments and induction of monoclonal antibodies to the existing in a cost-effective manner. However, it should be noted that MM is an incurable disease and in case someone suspects any of the above-stated symptoms then he/she should seek medical attention. Cancer is rapidly becoming a fatal disease and its treatment whic...