MYELOMA
What is Myeloma?
Myeloma is a cancer of plasma cells, a type of white blood cell. Healthy plasma cells are part of the immune system. Plasma cells develop from B cells, a type of white blood cell. Normally when bacteria or viruses enter the body, some B cells mature and change into plasma cells. Plasma cells then make antibodies (also called immunoglobulins) that help the body fight infection. Myeloma happens when there is a mutation to a single plasma cell, causing it to become a myeloma cell instead of a normal plasma cell. This mutated myeloma cell multiplies into many myeloma cells. As the myeloma cells build up in the bone marrow, they crowd out other types of healthy blood cells. As a result, the body may not have enough healthy red blood cells, white blood cells and platelets.
Statistics and Extent
In India, myeloma accounts for about 1.5–2% of all cancers. Multiple myeloma (MM) accounts for approximately 10–15% of hematological malignancies and 1% of all cancers. The age-adjusted incidence is approximately 1.0–1.3 cases per 100,000 people per year, which is slightly lower than in Western countries but increasing steadily.
It is most commonly seen in older adults (above 50 years), with a male predominance. Studies from AIIMS Delhi, and regional cancer centers show that most Indian patients are diagnosed in advanced stages (Stage II or III) due to delayed detection.
Common Sites
Bone marrow ,especially in spine, ribs, pelvis, and skull
Long bones (femur, humerus)
Stages
- Based on Beta2-microglobulin, albumin levels, lactate dehydrogenase in blood
- Bone marrow plasma cell percentage
- Presence of organ damage (CRAB criteria: Calcium elevation, Renal failure, Anemia, Bone lesions)
- Stages range from Stage I (early) to Stage III (advanced).
It is classified as-
- Smouldering- asymptomatic
- Symptomatic- possesses symptoms
Symptoms
- Persistent bone pain
- Fatigue, weakness, or breathlessness
- Frequent infections
- Unexplained weight loss
- Fractures with minimal trauma
- Kidney problems
- Numbness or weakness in legs (spinal cord compression)
Risk Factors and Causes
- Increasing age
- Family history of plasma cell disorders
- Chronic exposure to pesticides, radiation, or petroleum products
- Obesity and poor nutrition
- MGUS (Monoclonal Gammopathy of Undetermined Significance) or solitary plasmacytoma
- Immune system suppression (e.g., HIV or post-transplant patients)
Prevention
- Routine blood tests for unexplained anemia or high calcium levels
- Maintaining a healthy lifestyle with balanced diet and exercise
- Avoiding prolonged exposure to harmful chemicals
- Awareness programs for early detection among the elderly
Diagnosis
- Serum Protein Electrophoresis (SPEP) and Immunofixation: Detect abnormal monoclonal (M) proteins
- Bone marrow biopsy: Confirms presence of myeloma cells
- Free Light Chain Assay: Measures abnormal antibodies
- X-ray, MRI, or PET-CT: Detect bone lesions or organ involvement
- Kidney function tests: Assess myeloma-related damage
Treatment
- Chemotherapy and Immunomodulatory drugs: e.g., lenalidomide, thalidomide, bortezomib
- Corticosteroids: To reduce inflammation and control plasma cell growth
- Stem cell/Bone marrow transplantation: In eligible younger patients for long-term remission
- Bisphosphonates: Strengthen bones and prevent fractures
- Radiotherapy: For painful bone lesions or spinal compression
- Supportive care: Includes pain management, blood transfusions, and infection control
Side Effects and Maintenance
Short-term effects: Fatigue, nausea, low blood counts, infection risk, neuropathy (nerve pain), high calcium levels and constipation
Long-term effects: Bone weakness, kidney damage, relapse, and immune suppression
Maintenance therapy: Low-dose lenalidomide or bortezomib may be used after main treatment to delay relapse.
FAQs
Q: Is myeloma common in India? A: It’s less common than leukemia or lymphoma but rising steadily, especially in older adults.
Q: Is it curable? A: Myeloma is treatable but not usually curable. However, long-term remission and good quality of life are possible with modern therapies.
Q: Who is at risk? A: Older males, people with family history of myeloma, and those with chronic chemical exposure are at higher risk.
Q: Can it affect young people? A: Rarely. It’s mostly seen after age 50.
Q: What is the survival rate? A: With current treatments, 5-year survival in India ranges between 50–60%, depending on stage and response to therapy