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FAQ for Myeloma

Introduction

Plasma cells a type of white blood cell live within bone marrow (the soft, spongy tissue in the centre of the bones). The role of plasma cells is to produce and release special proteins called antibodies, which help destroy disease-causing germs, such as bacteria and viruses.

Multiple myeloma occurs when a plasma cell becomes abnormal and cancerous. The cancerous plasma cell then divides and multiplies out of control, creating an excessive amount of abnormal antibodies (which cannot perform their normal function and protect the body from antigens).

It is most common in people aged 65 and over, rarely occurs in younger people and does not occur in children. Men are more affected than women.The cause of multiple myeloma is not known, but there are treatments to stop the progress of the condition and help relieve symptoms.

What are the symptoms ?

There may be no symptoms early on in myeloma, and some people don't even realise they have it until they get the results of a routine blood test.Bone related problems:

It will be suspected on a simple blood test. I will have a look at your blood film and then you will have a bone marrow test, which is essential to diagnose MDS. We will also do some special test on the marrow to detect the severity of the disease. Some tests will take upto 1-2 weeks to come back.

• Bone pain : Often the first of the symptoms are continual aches and pains, usually in the lower back, pelvis and ribs (although any bone can be affected).

• Bone erosion : The excessive amount of plasma cells and antibodies in the bone marrow can cause the bones to weaken and wear away.

• Fractures : Because the bones are so weak they may fracture or break very easily, often for no apparent reason.

• Hypercalcaemia :  Once the bones begin to break down, they release a high level of calcium into the blood. This can cause dehydration, constipation, nausea and vomiting, kidney damage, tiredness, and also the need to pass urine a lot more than usual.

As well as bone problems, other possible symptoms of multiple myeloma include:

• Anaemia : This is when you have fewer red blood cells in your blood than expected - symptoms may include tiredness, breathlessness and headaches.

Loss of appetite and weight loss.

Excessive bleeding after cuts or scrapes, due to the lack of platelets being produced (the cells which cause blood to clot and stop bleeding).

• Repeated infection :  such as flu, sinusitis, bladder or kidney infections, shingles and pneumonia. This is due to a weakened immune system caused by reduced white blood cells and abnormal antibodies.

How is it diagnosed ?

There are a number of tests doctors commonly use to diagnose myeloma and find out how far the disease has progressed. These tests may be repeated from time to time to monitor the progress of the disease, and response to treatment.

Blood and urine tests

Samples will be tested to check for abnormal amounts of antibodies, protein and calcium, as well as any signs of anaemia.

X-rays and other scans

An X-ray of your bones will show any weakened, thinned or eroded areas.

Bone marrow test

Local anaesthetic is used to numb the area, and a small sample (a biopsy) of bone marrow is removed from the pelvic bone or chest bone using a needle and syringe.

How is it treated ?

Myeloma is treated aggressively and is used to control the progress of the condition, ease the symptoms and significantly improve quality of life. Standards treatments include chemotherapy and radiotherapy. After treatment, depending on the patients age a stem cell (bone marrow) transplant may be necessary.

Chemotherapy

Chemotherapy is the most common treatment for myeloma. The drugs are given either by mouth, or by injection into a vein, to try and kill the abnormal cells and stop them spreading. In most cases, each cycle of chemotherapy is followed by a rest period of one to four weeks.Depending on the type of chemotherapy you have, you may be able to go home on the same day as you are given chemotherapy, or you may need to stay hospital for a few days. Again, depending on which drug combination you are given, there may be some side affects, such as sickness, diarrhoea, and hair loss.

Radiotherapy

Radiotherapy aims to damage the abnormal cells and stop their growth with radiation from X-rays. This treatment is very important as it can target specific areas in the body so, for example, if a tumour (a clump of abnormal cells) in the bone marrow is causing bone pain or eroding the bone, then radiation can target the tumour, and shrink and destroy it. Radiotherapy affects people in different ways some people have side effects such as tiredness, lack of appetite, and depression, whilst some people have none.

Bone marrow transplant

Stem cells are the immature cells in the bone marrow that go on to become mature, fully functional blood cells (including plasma cells). Healthy stem cells will be injected into your blood stream, usually through a vein in the neck or groin. You will either be given stem cells from a donor, or some of your healthy stem cells will be taken from your body before you have chemotherapy or radiotherapy and put back into your body when your treatment is complete.For some time after the transplant you may need to have regular blood transfusions (when donor blood is given through a vein) to maintain the right level of blood cells in your body and prevent anaemia.

Other treatment

Because myeloma can cause a number of symptoms and problems, you may also need specific treatment to help relieve those. You will be told about these treatment if required.

There are also some self-care techniques you can use to keep the condition under control.

• Drink plenty of fluids

• Exercise helps to keep the bones strong so keep as active as you can. If pain is stopping you from exercising, ask your doctor to help you come up with a fitness plan to suit you.

Complications

Multiple myeloma can cause a number of complications.

A weakened immune system can result in repeated infection from viruses, even serious illnesses like pneumonia.

Kidney damage or kidney failure symptoms include tiredness, water retention (when the body stores water), nausea, increased need to pass urine, and shortness of breath. Kidney dialysis can be given to treat this.

Other complications are also seen and will be explained to you if we think you are at increased risk.

Please do not hesitate to contact me for more information. Keep faith in God and we will do our best to achieve our target!

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