Bay Biosciences provides high quality, clinical grade, biopsy tissue samples, FFPE tissue blocks with matched cryogenically preserved K2EDTA plasma, sera (serum) and peripheral blood mononuclear cells (PBMC) biofluid samples from multiple myeloma patients.
The K2EDTA plasma, sera (serum) and PBMC biofluid specimens are processed from multiple myeloma patient’s peripheral whole-blood using customized collection and processing protocols.
Multiple myeloma tissue and matched biofluid samples are collected from unique patients diagnosed with multiple myeloma and are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Multiple Myeloma (MM) Overview
Multiple myeloma (MM) is a cancer of the plasma cells. Plasma is a type of white blood cell that helps fight infections. Bone marrow produces plasma cells, and multiple myeloma affects the bones.
This condition is a type of plasma cell neoplasm, and it also affects the immune system, kidneys, and red blood cell count.
The American Cancer Society (ACS) estimate that around 1 in 132 individuals will develop multiple myeloma at some time in their life.
Multiple myeloma tends to affect older people. Doctors diagnose fewer than 1% of cases in people below 35 years of age. It is most common in people aged 65 years and over and slightly more common in males than females.
Definition of Multiple Myeloma (MM)
Multiple myeloma is a type of cancer. Cancer starts when the structure of the DNA in a cell change. This is called a genetic mutation.
A mutation can lead, to rapid cell growth and can also stop unwanted cells from dying. As the mutated cells do not die off, they build up and form tumors.
Plasma cells are a type of white blood cell. They produce antibodies that help defend the body from infections.
Bone marrow produces white blood cells and is the soft, spongy tissue in the middle of most bones.
When multiple myeloma develops, the body produces too many plasma cells inside the bone marrow. As these cells multiply, tumors can develop. The cells also produce a protein known as monoclonal protein, or M protein.
A doctor will diagnose multiple myeloma when plasma cells make up 10% or more of the bone marrow or when a person has multiple tumors.
At first, the cells reproduce in the bone marrow of the spine. From there, they enter the bloodstream and travel to bone marrow in other parts of the body. They collect in the bone marrow and the hard, outer part of the bones.
As this progression happens, the plasma cells can cause multiple tumors. This development is then known as multiple myeloma.
Unlike many cancers, multiple myeloma appears to spread via the bloodstream. It can reach different parts of the body quickly, making it hard to treat.
Multiple myeloma is a type of plasma cell neoplasm. Other examples include monoclonal gammopathy of undetermined significance (MGUS) and plasmacytoma.
Plasma cell neoplasms can be benign or malignant. Benign forms are noncancerous, although some types can become cancerous later in life. Around 1% of patients per year with MGUS have a risk of developing multiple myeloma.
Stages of Multiple Myeloma
There are four stages of multiple myeloma. While many health care professionals use different staging, these are various stages cited by many clinicians:
- Smoldering: multiple myeloma with no symptoms
- Stage-I: early disease with little anemia, relatively small amount of M protein and no bone damage
- Stage-II: more anemia and M protein as well as bone damage
- Stage-III: still more M protein, anemia, as well as signs of kidney damage
Because staging criteria differ according to different medical groups, some clinicians simply define the individual’s multiple myeloma without assigning a stage and simply estimate a prognosis for their patient.
In 2013, an international group divided stages into three stages based on two criteria, the concentration of beta-2-microglobulin and serum albumin levels; over time, these defined criteria may become widely accepted.
However, each individual is unique and may do better or worse than the prediction based on the various stages.
Signs and Symptoms of Multiple Myeloma (MM)
The symptoms of multiple myeloma depend on the stage of cancer and the general health of the patient. There may be no symptoms in the early stages.
If symptoms do occur, they can include the following:
- Anemia
- Bone tenderness and pain, especially in your spine or chest
- Constipation
- Bones that fracture easily
- Excessive thirst
- Enlarged tongue
- Frequent urination
- Fatigue
- Fever
- Frequent infections
- Hypercalcemia
- Kidney damage
- Loss of appetite
- Mental fogginess or confusion
- Nerve damage (compression of the spinal cord)
- Nausea
- Shortness of breath
- Skin lesions (rash)
- Swelling of legs
- Weight Loss
- Weakness or numbness in the legs
Related Conditions to Multiple Myeloma
As symptoms of multiple myeloma increase and worsen, patients may develop one or more related conditions.
These conditions are a consequence of the early symptoms of multiple myeloma and include:
Hypercalcemia
Hypercalcemia is when a person has high levels of calcium in their blood.
Patients may experience extreme thirst, confusion, loss of appetite, and gastrointestinal symptoms, including constipation and nausea as a result of hypercalcemia.
Anemia
Anemia is when a person’s red blood cell count is low.
Myeloma cells push out red blood cells from the blood, causing anemia.
Reduced Kidney Function
Multiple myeloma may affect kidney function and cause kidney damage.
Bone Problems
Advanced multiple myeloma may eventually cause fractures, pain, and bone thinning.
Infections
Myeloma cells weaken the immune system and inhibit the body’s ability to fight infections.
Causes and Risk Factors of Multiple Myeloma (MM)
Doctors do not know exactly what causes multiple myeloma, but the following factors may increase the risk:
Age: Most diagnoses occur in people aged 65 years or over.
Race or ethnicity: It is more likely to affect African Americans
Sex: It is slightly more common in males.
Genetic factors: Some people with multiple myeloma have a relative with the condition.
Obesity: This appears to increase the risk.
Other plasma cell conditions: Having MGUS can increase the risk.
A study published in 2012 concluded that exposure to chemicals that people use in farming, printing, and cleaning may increase the risk.
Doctors do know that multiple myeloma begins with one abnormal plasma cell in your bone marrow, the soft, blood-producing tissue that fills in the center of most of your bones. The abnormal cell multiplies rapidly.
Because cancer cells don’t mature and then die as normal cells do, they accumulate, eventually overwhelming the production of healthy cells. In the bone marrow, myeloma cells crowd out healthy blood cells, leading to fatigue and an inability to fight infections.
The myeloma cells continue trying to produce antibodies, as healthy plasma cells do, but the myeloma cells produce abnormal antibodies that the body can’t use. Instead, the abnormal antibodies (monoclonal proteins, or M proteins) build up in the body and cause problems such as damage to the kidneys. Cancer cells can also cause damage to the bones that increases the risk of broken bones.
Is Multiple Myeloma a Hereditary Disease?
Scientists have not established the definitive cause of multiple myeloma, but research has suggested several factors may be risk factors or contribute to multiple myeloma development in an individual.
A genetic abnormality such as c-Myc oncogenes and others have been associated with multiple myeloma development. Currently, there is no evidence that heredity plays a role in the development of multiple myeloma, therefore it is not considered a hereditary disease.
Researchers have suggested environmental exposures to herbicides, insecticides, benzene, hair dyes, and radiation as causes, but definitive data is lacking.
Some scientists have suggested inflammation and infection as causes, but again not proven to cause multiple myeloma. However, a benign proliferation of a plasma cell can result in a situation where a monoclonal antibody is produced in high amounts (but not as high as seen with multiple myeloma).
This result is termed monoclonal gammopathy of unknown or undetermined significance (abbreviated as MGUS). Around 20% of MGUS patients develop multiple myeloma in about two to 19 years after MGUS diagnosis.
In addition, smoldering multiple myeloma (also termed inactive) is an early precursor to multiple myeloma. Abnormal proteins in blood or urine are detectable with special testing before multiple myeloma symptoms occur.
Multiple Myeloma Connection with MGUS
Multiple myeloma almost always starts out as a relatively benign condition called monoclonal gammopathy of undetermined significance (MGUS).
MUGS like multiple myeloma, is marked by the presence of M proteins, produced by abnormal plasma cells, in your blood. However, in MGUS, the levels of M proteins are lower and no damage to the body occurs.
Complications of Multiple Myeloma (MM)
Complications of multiple myeloma include the following:
- Frequent infections. Myeloma cells inhibit your body’s ability to fight infections.
- Bone problems. Multiple myeloma can also affect your bones, leading to bone pain, thinning bones and broken bones.
- Reduced kidney function. Multiple myeloma may cause problems with kidney function, including kidney failure.
- Low red blood cell count (anemia). As myeloma cells crowd out normal blood cells, multiple myeloma can also cause anemia and other blood problems.
Diagnosis of Multiple Myeloma (MM)
Lab work, imaging, and bone marrow testing are used to reach a diagnosis of multiple myeloma.
Sometimes multiple myeloma is diagnosed when your doctor detects it accidentally during a blood test for some other condition. It can also be diagnosed if your doctor suspects you could have multiple myeloma based on the signs and symptoms.
Diagnostics Tests and procedures used to diagnose multiple myeloma include the following:
- Blood Tests: Laboratory analysis of your blood may reveal the M proteins produced by myeloma cells.Another abnormal protein produced by myeloma cells, called beta-2-microglobulin, may be detected in the blood and give your doctor clues about the aggressiveness of the myeloma.Additionally, blood tests to examine your kidney function, blood cell counts, calcium levels and uric acid levels can give the doctor clues about your diagnosis.
- Urine Tests: Analysis of your urine may show M proteins, which are referred to as Bence Jones proteins when they’re detected in urine.
- Examination of the Bone Marrow: Your doctor may remove a sample of bone marrow for laboratory testing. The sample is collected with a long needle inserted into a bone (bone marrow aspiration and biopsy).In the lab, the sample is examined for myeloma cells. Specialized tests, such as fluorescence in situ hybridization (FISH) can analyze myeloma cells to identify gene mutations.
- Imaging Tests: Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include an X-ray, MRI, CT or positron emission tomography (PET).
Assigning a Stage and a Risk Category
If tests indicate you have multiple myeloma, your doctor will use the information gathered from the diagnostic tests to classify your disease as stage I, stage II or stage III. Stage I indicates a less aggressive disease, and stage III indicates the most aggressive disease.
The multiple myeloma may also be assigned a risk category, which indicates the aggressiveness of the disease.
Stage multiple of multiple myeloma and risk category help the doctors understand your prognosis and your treatment options.
Treatment of Multiple Myeloma
There is no cure for myeloma, but treatment can help manage the progression of the disease, decrease the occurrence and severity of symptoms and prolong life.
Various treatments are explained below. These interventions aim to:
- Manage cancer by removing malignant cells from the bone marrow
- Prevent the cells from returning for as long as possible
- Relieve symptoms, such as pain, anemia, and kidney damage
Chemotherapy
Chemotherapy can destroy myeloma cells. In chemotherapy, a doctor prescribes powerful drugs that can help kill cancer cells or stop them from dividing.
Chemotherapy can be either:
- Systemic, which means it works throughout the body, or
- Regional, targeting a specific area
A person can take these either by mouth or intravenously (IV) over several months.
Chemotherapy can kill cancer cells, but it can also kill healthy cells. This means it can have severe adverse effects. However, these side effects typically resolve after treatment finishes.
How long does Chemotherapy Last?
The doctor will make a plan with an individual that specifies when treatment sessions will occur and how many sessions the individual will need.
A person may receive chemotherapy for a specific amount of time or for as long as it works.
A course of chemotherapy treatment usually lasts 3–6 months, depending on the type of drug and stage of cancer. Doctors typically administer chemotherapy in cycles, with rest periods between 1–4 weeks. Cycles have rest periods in between to allow a person’s body to recover.
An individual might have treatment on one day, followed by 1 week’s rest, then another 1-day treatment followed by a 3-week rest period, and so on. A person may repeat this schedule several times.
Stem Cell Transplantation
Stem Cells are immature blood cells. Following high dose chemotherapy, the individual may receive a transfusion of stem cells that originate either from their own cells or those of a donor.
A patient who has stem cell treatment may be able to tolerate a higher dose of chemotherapy, as the new stem cells help the body recover more effectively.
The use of this option depends on the disease progression, age, and the general state of health of the patient with myeloma.
Other Drugs
Corticosteroids: A doctor may prescribe drugs known as corticosteroids. These may encourage the immune system to stop the growth of new cancerous cells, but how they work is unclear.
Biologic Therapy: These can delay or prevent tumor growth by affecting the way the immune system works. They include Thalidomide and interferon.
Targeted Therapy: Some medications can identify and attack cells or functions that promote cancer growth. Unlike chemotherapy, they only affect certain cells, which means they should have fewer adverse effects. Monoclonal antibody therapy is one example.
There are currently two immunotherapy options for multiple myeloma that the Food and Drug Administration has approved:
- Daratumumab (Darzalex)
- Elotuzumab (Empliciti)
These are known as monoclonal antibodies. They target specific pathways and may help some patients with advanced multiple myeloma.
Surgery and Radiation Therapy
Sometimes a doctor will recommend a combination of surgery and radiation therapy to remove a tumor.
There are also clinical trials for multiple myeloma. Anyone who may be interested should speak to their doctor about joining one of these. Participating in trials can give a person access to new treatment options that are not yet available to everyone.
Managing Symptoms
A doctor may prescribe different treatments for other symptoms and complications, such as:
- Pain relief medication for back or bone pain
- Dialysis for kidney problems
- An annual influenza (Flu) jab to prevent infections
- Therapy and possible transfusion for anemia
The doctor may also recommend staying hydrated and avoiding certain medications that can worsen kidney symptoms.
Sometimes, a patient will not receive any treatment, but they will instead attend routine visits to allow the doctor to monitor for changes. This approach is called watchful waiting.
Dietary Tips
Dietary tips that may help strengthen the body during treatment include:
- Avoiding crash diets
- Consuming bland foods, such as crackers, yogurt, and potatoes, so reducing the risk of nausea
- Eating 5–6 small meals a day or a small meal every 3 hours
- Following food hygiene rules, as the patient may have a higher risk of infection
- Consuming plenty of fresh fruits and vegetables
- Maintaining a healthy weight
- Including protein-rich foods, such as eggs, fish, or nuts, which play a role in cell repair
- Eating whole-grain foods, such as whole wheat bread and rice
- Staying hydrated, especially by drinking water
- Limiting or avoiding sweets, sugars, and alcohol
- Monitor bowel habits for changes
The above choices can help reduce the impact of myeloma on everyday life.
Outlook
Multiple myeloma is not curable, but it is treatable. A patient who receives a diagnosis has the following chance, on average, of living at least another 5 years:
- Early stage: 73.9%
- Later stage: 51.1%
Around 4.8% of people receive a diagnosis in the early stages.
Health authorities calculate these percentages by using past statistics. However, individual factors will affect how long a person lives with any type of cancer.
These factors include:
- Type of cancer
- Patients age
- Overall health, especially their kidney function
In addition, thanks to scientific and medical progress, the chances of surviving most types of cancer have increased over the last few years and continue to do so.
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