Myeloma: causes, symptoms and treatment of this bone marrow cancer


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Myeloma: causes, symptoms and treatment of this bone marrow cancer


What is myeloma?

Myeloma - also known as "multiple myeloma" or "Kahler's disease" in medical language - is a hematological malignancy, that is to say a cancer of the bone marrow. It is a rare cancer since in 2012, about 5000 new cases of myeloma were detected in France, less than 2% of all cancers detected.

What is it about ? Everything begins in the bone marrow: this spongy tissue (found inside the bones, especially those of the pelvis and thorax, but also in the ribs and dorsal vertebrae) plays a role in the formation of bone and in the production of blood cells - white blood cells, red blood cells and platelets.

In the bone marrow are plasma cells: the role of these "improved B lymphocytes" is to manufacture antibodies to neutralize the undesirable substances that enter the body (viruses, bacteria ...): this is part of the immune response.

But in case of myeloma, a plasmocyte divides and proliferates uncontrollably. These abnormal plasma cells start producing an excess antibody: it is the "monoclonal protein" or "paraprotein" that will serve as a biological marker for the disease.

The results ?

  • The immune system is weakened. Indeed, the antibody produced by diseased plasma cells is not functional, and "normal" antibodies can no longer grow due to the decrease in the number of "healthy" plasma cells that usually produce them. Result: the body is less able to fight against infections.
  • The production of blood cells within the bone marrow decreases, as diseased plasma cells grow to the detriment of other cells.
  • Diseased plasma cells activate cells that destroy bone and disrupt bone building mechanisms.
  • The monoclonal protein produced by the sick plasma cells circulates in the blood and, when it passes through the kidneys, it can form deposits that impair their proper functioning.

What are the risk factors for myeloma?

The reasons which lead a healthy plasmocyte to dysfunction are not yet fully known. However, some risk factors have been identified by medical research:

  • Myeloma affects men a little more than women because they represent 54% of patients,
  • The median age at diagnosis is 70 years in men and 74 years in women. However, about 40% of patients are under 65 when the disease is discovered, and 3% of cases are diagnosed before the age of 40,
  • In very rare cases, one can observe a familial form of myeloma,
  • Ionizing radiation related to accidental exposures and occupational exposures to pesticides are known risk factors.

It should also be noted that there are several forms of myeloma: in case of myeloma with light chainsthe antibody produced by the diseased plasma cells is incomplete; in case of plasma cell leukemia (1% to 2% of the myelomas only), there is a blood invasion by the abnormal plasma cells; in case of myeloma without immunoglobulin or circulating light chainsabnormal plasma cells do not produce antibodies.

What are the symptoms of myeloma?

In about 20% of cases, myeloma is asymptomatic and is only discovered when a blood test reveals the presence of an excess of antibodies - this is called "asymptomatic multiple myeloma". Some symptoms, however, are characteristic of an advanced stage of the disease:

  • Bone pain, especially in the vertebrae,
  • Frequent (micro) fractures, especially at the level of long bones (femurs, humerus), ribs or vertebrae (vertebral compression). These bone lesions affecting 80% of patients are also called "lytic lesions" or "osteolytic lesions",
  • Hypercalcemia, that is to say, an abnormally high amount of calcium circulating in the blood,
  • Kidney failure,
  • Anemia (which corresponds to a decrease in the level of red blood cells in the blood),
  • Repeated infections (pulmonary, ENT ...).

What treatments for myeloma?

The diagnosis is based on both clinical signs (the doctor questions the patient about his symptoms), on biological examinations (blood tests and urine to look for the famous monoclonal protein, a control of the disease) and on a myelogram (a bone marrow sample under local anesthesia to count and study plasma cells).

MRI, CT scan, radiographic skeletal assessment for bone lesions and / or positron emission tomography (PET) can also be performed.

Good to know : treatment is not systematically started as soon as a myeloma is diagnosed. Indeed, when the disease is not accompanied by any symptoms, simple monitoring is sufficient - with regular blood, urine and radiological examinations.

If there are symptoms, however, treatment is put in place. This is mainly based on chemotherapy: you can add a drug treatment to protect the bones, prevent or treat anemia, prevent or treat infections, and / or fight against pain.

  • If the patient is under 65 years old: the treatment begins with a chemotherapy of about 4 months, which aims to quickly regress the signs of the disease and allow the collection of stem cells in the blood. Then comes intensive chemotherapy (to destroy as many cancer cells as possible), which ends with a self-transplant of stem cells to renew the blood cell population. In total, the treatment lasts between 6 and 8 months, with several weeks of hospitalization.
  • If the patient is over 65: intensive chemotherapy with auto-transplant is rarely recommended because it is too risky. The treatment therefore consists in administering conventional chemotherapy over a longer period (between 12 and 18 months).

To know : current treatments do not provide a clear cure for myeloma - we will speak rather of remission. After a variable time depending on the person, the disease tends to reappear.

sources:

National Cancer Institute

French Association of Multiple Myeloma Patients (AF3M)

Institut Curie

Foundation against Cancer

French Society of Hematology

Read also :

⋙ Soon to need chemotherapy for bone marrow transplantation?

⋙ Agnès, bone marrow transplant: "Knowing what I was going through helped me"

⋙ Bone marrow donation, easier than you think


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