Multiple myeloma

The term myeloma refers to a disease of cells located in the bone marrow, the plasma cellsPlasma cell : A cell that produces and excretes antibodies into the blood.. It is called “multiple” because many bones are affected by the disease.

Multiple myeloma was also called Kahler’s disease.

What is it?

Multiple myeloma is a lymphoid lymphoid: Refers to the organs where lymph cells are found (partly responsible for immune defence) malignantMalignant: Cancer cell  blood disease. It is characterized by the multiplication of abnormal plasma cellsPlasma cell: A cell that produces and excretes antibodies into the blood. in the bone marrow.

 

In most cases, multiple myeloma tends to become chronic: patients go through a succession of remissions and relapses. The durations of these phases are variable. Suitable treatment needs to be instituted by medical teams.

What are the figures?

Myeloma is a relatively rare cancer:

  • 2nd most common malignant blood disease representing 1% of cancers [1],
  • 6 to 8 people out of 100 000 affected in Europe [1] but this figure is increasing partly due to the ageing of the population,
  • The 5-year survival rate with treatment is close to 50% [2].

 

The median age at diagnosis is 70 years for men and 74 years for women [3]. Younger people are occasionally also affected:

  • 3% of cases are diagnosed before age of 40 [4].

What is the mechanism of the disease?

Plasma cells Plasma cells: A cell that produces and excretes antibodies into the blood. are the most mature cells of the B cells. Their role is the production and excretion of antibodies, or immunoglobulins, into the blood plasma.

 

Plasma cells normally produce and secrete different types of antibodies to meet the needs of the immune system. In the context of multiple myeloma, an abnormal plasma cell multiplies identically and uncontrollably in the bone marrow causing its invasion, it is a clone.

What are the symptoms?

The four most common clinical and laboratory signs of multiple myeloma can be recalled using the mnemonic C.R.A.B.:

  • Calcium (abnormal increase in calcium blood levels),
  • Renal failure (deterioration of kidney function),
  • Anaemia (decrease in the red blood cell levels in the blood),
  • Bone damage, lesions in the tissue constituting the bones (often bone pain and/or spontaneous fractures).

Symptoms at diagnosis [5]

Bone pain
Fatigue
Weight loss
ParesthesiaParesthesia : Sensory disorder: Tingling, prickling sensation, numbness.…
Asymptomatic

The onset of symptoms is usually related to disease progression. Multiple myeloma can however also be discovered in asymptomatic patients, particularly during a health check.

 

It is important to note that these clinical and laboratory signs are not specific to multiple myeloma and are not sufficient for a diagnosis to be made.

How is the disease diagnosed?

Various in-depth examinations are required to confirm the disease, its nature and its extent in order to best adapt the choice of treatments to each patient’s needs:

  • A clinical examination, to assess the general state of health of the person and the presence of possible symptoms,
  • Blood and urine tests, to check for abnormal results and assess kidney function,
  • A myelogramMyelogram: Medical examination used to analyse the morphological characteristics and balance of the various cells present in the bone marrow after a sample has been taken. , to confirm diagnosis,
  • An imaging assessment, to locate any bone lesions.

References:

[1] Dimopoulos MA, Terpos E. Multiple myeloma. Annals of Oncoloy 2010 ;21 (Suppl 7) : 143-150.

[2] David Robinson, Satyin Kaura, Daniel Kiely, Mohamad A. Hussein, Knar Nersesyan et Brian G. M. Durie. Impact of Novel Treatments on Multiple Myeloma Survival. Blood 2014 Volume 124 (Issue 21) : 5676.

[3] Haute Autorité de Santé. Guide – Affection de longue de durée : Tumeur maligne, affection maligne du tissu lymphatique ou hématopoïétique Myélome Multiple.
www.has-sante.fr/portail/upload/docs/application/pdf/2011-02/ald_30_gm_myelome_vf.pdf, consulté le 27 mars 2018.

[4] INCa, AF3M. Comprendre le myélome multiple. www.e-cancer.fr/Expertises-et-publications/Catalogue-des-publications/Comprendre-le-myelome-multiple, consulté le 16 mars 2018.

[5] Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Procceedings 2003 Volume 78 (Issue 1): 21-33

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