Multiple myeloma treatment is a highly complicated issue. Not only is the procedure cumbersome, but with each option there are a significant number of pro’s and con’s attached. Understanding the significance is perhaps the last thing on the mind of the affected person due to the life-threatening nature of the disease itself. However, it is this process that decides the ultimate fate of an individual. Surprisingly, it is quite true that treatment options like stem cell transplant, which seem to offer a complete cure, are strongly associated with mortality themselves. Hence, treatment options must be wisely chosen !
Multiple Myeloma Investigations
The diagnosis of multiple myeloma is done with microscopic examination of a smear of blood to show abnormal plasma cells. But several confirmatory tests are essentially done for confirmation of the diagnosis and staging of the disease.
- Bone marrow biopsy or aspiration – to demonstrate tumor cells in bone marrow.
- Serum calcium – to demonstrate high calcium levels and for staging.
- Hemoglobin – to look for anemia and for staging.
- Serum creatinine – for evaluation of kidney function.
- Urine tests – for Bence Jones proteins (excess antibodies excreted in urine) and staging.
- Serum electrophoresis – demonstration of presence of high antibodies in blood and staging.
Multiple Myeloma Treatment
Treatment of multiple myeloma consists of tumor therapy and supportive therapy for treatment of complications.
Tumor therapy for multiple myeloma relies heavily on chemotherapeutic drugs and stem cell transplant. Chemotherapy aims to reduce the abnormal plasma cells by selectively attacking the rapidly multiplying cells of the body. This causes a nearly complete depletion of the normal bone marrow cells as well, and requires supportive therapy until the recovery of bone marrow. This may well take 3-4 weeks of time, during which a person is highly susceptible to infections and feels tired because of the decreased number of cells in blood.
Once the large burden of abnormal plasma cells is cleared, a person becomes suitable for stem cell transplant. Stem cells are bone marrow cells taken from another person (allograft) or the same person (autograft). These cells are transplanted in the bone marrow of a person with multiple myeloma. They have an action against tumor cells as well as promotion of blood cell production. However, due to the foreign nature of the cells, they frequently cause destruction of normal cells of the recipient by immune reactions(since they have been trained to recognize only the cells of the original donor and not the recipient). It is these reactions that lead to life threatening complications. Hence, one has to be very careful while choosing this option and be fully aware of the consequences. A blood relative, especially a twin, is an ideal donor of stem cells for this purpose. Young patients are ideal candidates for stem cell transplant along with high dose chemotherapy, which results in higher chances of cure. Elderly patients on the other hand are unable to bear this treatment and frequently succumb to one or more complications.
Supportive therapy of multiple myeloma aims at preventing the complications from occurring and providing symptomatic relief. The agents commonly used in supportive therapy are
- Erythropoietin – for prevention of anemia and increasing the hemoglobin levels.
- Bisphosphonates – for inhibition of osteoclasts to prevent bony erosions.
- Dialysis – to prevent renal failure and related complications.
The complications related to bone pains and fractures have to be managed separately with relevant immobilization of the concerned parts. Renal failure and brain functions return to normal as soon as the incriminating plasma cells are destroyed. However, if damage caused to the kidney and brain is severe, it may result in permanent impairment. With the advent of technology, the life span of an individual may have improved, but not all people live life to that extent. Multiple myeloma, is just one of the several hundred reasons for early death. Hence, a positive outlook and determination can surely keep depression and worthlessness from ruining the remaining days !