Multiple Myeloma

Multiple myeloma is a cancer of plasma cells, the white blood cells in the bone marrow that make antibodies. The abnormal cells crowd the marrow, release a useless antibody called a paraprotein and damage bone and kidneys.

It mostly affects people over 60. Myeloma is treatable and many people have long periods of remission, but it usually returns and is managed as a long-term illness with successive lines of therapy. An early stage called smouldering myeloma, and the precursor MGUS, are often only monitored.

Symptome

• Persistent bone pain, especially in the back, ribs or hips
• Fractures after minor injury
• Tiredness and breathlessness from anaemia
• Repeated infections
• Thirst, constipation and confusion from high calcium
• Foamy urine or reduced kidney function
• Unexplained weight loss
• Numbness or weakness in the legs if the spine is affected

Ursachen und Risikofaktoren

The cause is unknown. Myeloma develops from MGUS, a common and usually harmless finding in older adults, in about 1 in 100 people with MGUS each year. Risk rises with age and is higher in men, in people of African descent and in those with a close relative affected. Genetic changes acquired inside the plasma cells, such as deletion 17p or translocation t(4;14), influence how the disease behaves and are tested at diagnosis.

Wie es diagnostiziert wird

• Blood and urine protein tests: Serum electrophoresis, immunofixation and free light chains detect and measure the paraprotein.
• Blood count, calcium and kidney tests: Look for the organ damage that defines active myeloma.
• Bone marrow biopsy: Counts plasma cells and provides material for cytogenetic (FISH) testing.
• Whole-body low-dose CT, MRI or PET-CT: Find bone lesions. Plain X-rays miss too many.
• Staging: The revised international staging system combines albumin, beta-2 microglobulin, LDH and genetics.

Behandlungsmöglichkeiten

• Combination drug therapy: Three or four drugs together, typically a proteasome inhibitor such as bortezomib, an immunomodulator such as lenalidomide, dexamethasone and an anti-CD38 antibody such as daratumumab.
• Autologous stem cell transplant: High-dose melphalan with return of your own stored stem cells, offered to fit patients to deepen and prolong remission.
• Maintenance: Usually lenalidomide, continued for years.
• Bone protection: Zoledronic acid or denosumab, with a dental check beforehand. Radiotherapy or cement injection for painful spinal lesions.
• Treatment at relapse: Different drug combinations, bispecific antibodies and CAR-T cell therapy where available.
• Supportive care: Vaccinations, infection prevention, kidney protection and pain control.

Wenn es dringend ist

Sudden back pain with leg weakness, numbness or loss of bladder or bowel control may mean spinal cord compression and needs an emergency department within hours. Fever during treatment, confusion with extreme thirst, or a sharp fall in urine output are also emergencies to be handled locally.

Reisen nach Türkiye zur Behandlung

Myeloma therapy runs continuously for years, so your main haematologist should be near home. Reasons that can justify travel are a second opinion on the diagnosis and risk group, a planned autologous transplant, which needs about 4 to 6 weeks in the city, or access to a drug not available to you. Check in advance that any medicine started abroad can be continued at home. Bring marrow reports with FISH results, protein measurements over time and imaging.

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