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Plasma cells produce antibodies, the proteins that are used by the body's immune system to fight off bacteria and viruses. In people with myeloma, plasma cells grow in an uncontrolled way and produce an abnormal form of protein called a paraprotein. In some myeloma patients, paraproteins are present in the blood or urine.
The over-production of myeloma cells in the bone marrow affects the production of the different types of cells that make up blood: white cells, red cells and platelets. Myeloma cells may also cause damage to bones, which can leave them prone to breaking.
Myeloma generally develops in older patients, although sometimes it is found in patients under the age of 40.
The signs and symptoms of myeloma vary from patient to patient. They may include the following:
- a feeling of exhaustion
- loss of appetite
- increased bruising of the skin
- fever and recurrent infection
- pain in lower back or ribs and bone fractures.
Some of these symptoms are caused by the increased numbers of myeloma cells and a decrease in the amount of normal blood cells in the blood stream and the bone marrow. Feeling tired and looking pale can be a sign of a lack of red blood cells (anaemia). Bruising of the skin may be caused by a lack of platelets and recurrent infections can result from a lack of white blood cells.
Many of these symptoms occur in other conditions and most patients with these symptoms will not have myeloma.
Damage to the bones caused by myeloma cells can lead to increased amounts of calcium (the main ingredient of bone) in the blood. This is called hypercalcaemia. High calcium can cause dehydration and damage to your kidneys. The levels of calcium in your blood will be monitored to make sure it is not raised. Patients with raised levels will be encouraged to drink as much fluid as they can.
A series of tests or investigations will be done to confirm or rule out a diagnosis of myeloma and to check on your general health. These tests may include:
Bone marrow sample
In order to confirm your diagnosis and to plan your treatment, it is necessary to examine a small sample of bone marrow. This is normally taken from the hip bone and is examined to determine whether any myeloma cells are present.
The process is conducted under local anaesthetic and takes five to ten minutes. The procedure will be explained to you before it is carried out and you will be able to ask any questions or raise any concerns you might have.
Blood and urine tests
Tests on your blood and urine will look for paraproteins, the abnormal protein that is produced by myeloma cells. Blood and urine tests will be taken throughout your time as a patient to assess the progress of your treatment.
Myeloma can cause the weakening of bones, so a series of X-rays of the major bones will be taken to see if they are damaged.
Myeloma is treatable, but at present there is no cure. The aim of treatment in myeloma is to slow down the development of the disease, keep any symptoms under control and keep the myeloma cells at a low level. Treatments include chemotherapy, stem cell transplants and radiotherapy.
The main treatment for myeloma is with chemotherapy (anti-cancer) drugs, often in combination with steroids.
Chemotherapy drugs may be given by mouth or intravenously into your arm. The effects and side effects of the regime chosen for you will be explained by your doctor or nurse. Please ask any questions you have about the drugs and why they have been chosen.
You may be given thalidomide as part of your chemotherapy. If this drug will form part of your treatment plan, your doctors or clinical nurse specialist will explain the guidelines you must follow during treatment.
Stem cell transplant
Your treatment may include a peripheral stem cell transplant, which will allow you to be treated with high-dose chemotherapy. High-dose chemotherapy allows a better response to treatment and may produce a greater reduction in the amount of myeloma cells.
If a transplant will form part of your treatment, your consultant and clinical nurse specialist will explain the procedure and what the benefits and side effects might be.
Radiotherapy is effective in treating local bone pain because it can be targeted to where the pain is felt. Occasionally, surgery may be necessary to prevent and repair damage to the bones in the limbs and back.
Drugs known as bisphosphonates can help reduce bone damage caused by the myeloma and help bones to heal. They can also help reduce raised calcium levels in the blood if they are too high. They can be given orally (as tablets) or by intravenous injection, usually as a long-term treatment.
Having myeloma and being treated for the disease will have an effect on your life.
After your treatment is finished you will continue to be monitored with regular checkups and blood tests. If you notice new symptoms or have any concerns about your health between appointments, contact your doctor.
Some chemotherapy drugs can damage the ovary or testes, leading to an increased risk of infertility and, in women, early menopause.
Chemotherapy may affect sexual organs or functions in various ways. You may experience changes in your desires or desired level of sexual activity or you may notice no difference. Loss of libido (sex drive) is not uncommon in both women and men. However, chemotherapy in itself doesn’t usually affect sexual performance or cause impotence.
During your treatment you may start to feel tired and listless. This may be general fatigue or it may be that you become tired more easily after normal activities. This is quite normal and usually occurs with leukaemia and its treatments.
Do talk about how you are feeling with your consultant or clinical nurse specialist. They will be able to suggest ways of conserving your energy or may be able to treat the causes of your tiredness, such as not being able to sleep or anaemia.
If you are at home, try to plan your day so that light activities are spaced between more energetic activities. Do get enough rest and only do what you feel you can cope with.
People will often be willing to lend their support. If you get tired easily, limit your activities and conserve your energy for the things that mean the most to you. Ask your family and friends to help with household chores.