Multiple myeloma is a common, but also a devastating type of cancer. More often found in men over the age of 65 – there are still no risk factors one can avoid in getting MM. So far, the only findings are that it seems to be more common in native americans and people suffering from MGUS or other plasma cell diseases. Other smaller risk factors are: obesity, radioactivity, family history and working in petroleum related industries. Another interesting finding is that parts of the MM patients’ number 13 chromosome is missing, thus making the myeloma more aggressive and resistant to treatment. This all concludes that myeloma is unfortunately just something that ‘happens’.

To explain this type of cancer better, one would call it ‘cancer of the plasma cell’ (plasma cells being a type of white blood cells). A disorder occurs in the neoplasm of the plasma cells. Healthy plasma cells develop from white blood cells, reside in the bone marrow and produces antibody proteins in the blood. When in disorder, tumors may form in the bone marrow, causing abnormal antibodies to form in the blood and urine. This also makes the body much more prone to infections.

Symptoms of MM would normally entail: bone pain – especially in the long bones, pelvic bone, skull and lower back, anaemia, frequent infections, muscle weakness (with tingling in hands and/or feet), bruising, nose bleeds, headaches, drowsiness, nausea, weakness, anorexia, renal (kidney) failure and carpal tunnel syndrome.

To diagnose MM there are various tests to undergo. Some of the tests will most probably be: a bone marrow aspiration from the hip-or chest bone, testing the M-proteins in the urine, a blood profile of the red blood cells, white blood cells and platelets, x-rays to see the condition of the bones, and also a MRI scan. Tests will be done to see if the patient is suffering from hypercalcaemia (high levels of calcium in the blood due to calcium leaching out of bones into the bloodstream), and to see how high his/her M-protein levels are. Malignant plasma can cause high M-protein levels, which overloads the kidneys – a high risk for renal failure. MM also causes osteolytic lesions (holes in bones), putting the patient at risk to sustain spontaneous fractures. Doing only a bone marrow aspiration cannot always be conclusive, as some ‘pockets’ in the bone marrow may be more infected that others – which makes staging difficult.

Staging (advancement) of MM relies on the levels of beta-2-microglobulin and albumin in the blood. The kidney function, platelet count and patient’s age will also be taken into consideration. In stage I a small number of myeloma cells are found – and prognosis are 62months, in stage II a moderate number of myeloma cells are found – prognosis 44 months, and in stage III a large number of myeloma cells are found, with a prognosis of 29months. Like with any cancer, the sooner diagnosis takes place, the higher the chances of successful treatment, leaving the patient in (permanent) remission.

Treatment of MM has become very advanced due to the constant research in this field. Chemotherapy and tandem stem cell transplants will most probably be done. The tandem stem cell transplantations are ideally done two-to three months apart (preferably two autologous transplants) – followed by chemotherapy. The use of thalidomide, bortezomib or lenalidomide will be done separately, or in conjunction with chemotherapy. The 5year survival rate of MM has risen in the last decade to about 34.7% - the younger the patient, the better the prognosis. To achieve remission will be the oncologists’ goal with his/her patient. When in remission, it is of utmost importance to undergo MAINTENANCE THERAPY – thus halting a recurrence.

Pain control management is also at an advanced stage. When in pain – speak up!! Physicians have learned that pain control is priority in the treatment of any cancer. Pain during the course of myeloma is mainly due to bone lesion growth, and neuropathic pain that may occur whilst receiving therapy. To halt lesion growths, high dosages of zoledronic and pamidronate can be administered. Halting of lesion growths will definitely aid in pain. Opioids and narcotics (morphine and codeine) are two of the analgesics used for pain. A fentanyl (opioid) patch, fentanyl dissolvable tablets, or fentanyl lozenges are also used in pain control. In some cases (when pain is caused by nerve damage), anti seizure drugs and antidepressants will be prescribed. During the advanced stages of MM, methadone is usually used.

Whilst in therapy for multiple myeloma, it is important to focus on good nutrition. CUT DOWN on salt, coffee, alcohol and fat. INCREASE water intake, high fibre foods, fruit (especially citrus) and vegetables (dark leafy and yellow). Keep a check on protein intake, and try high calorie-and-protein shakes. For alternative wellness, try visualisation, meditation, massaging and rest.