Multiple myeloma: what it is, causes, symptoms and treatment

“The battle that brought me to the deepest core of human frailty has begun. With you I will win it.” Thus the pianist and composer Giovanni Allevi (53) thanked on Instagram those who gave him thoughts of encouragement and closeness after the announcement of his disease, a multiple myeloma, a sweet but insidious name. “The one diagnosed in Allevi is a blood cancer, which develops from some cells present in the bone marrow, the spongy tissue contained mainly in flat bones, such as those of the pelvis and ribs, and in the ends of long bones”, explains Professor Francesco Angelinidirector of the Oncology Unit of the Regina Apostolorum Hospital in Albano Laziale.

What is Multiple Myeloma

«This haematological tumor is characterized by the abnormal proliferation of a particular family of white blood cells, the plasma cells, which begin to multiply in a clonal way, that is, they are all the same, ”explains Professor Angelini. Plasma cells are normally found in the bone marrow and are part of the immune system, because under normal conditions they have the task of producing antibodies (immunoglobulins or gammaglobulins) to defend us from infections.

“In the case of multiple myeloma, however, they begin to grow in a disordered wayto the point of creating clusters, visible in the radiographs, which “erode” the bones and create cavities inside them, making them more fragile and subject to spontaneous fractures, with no apparent cause ».

What are the causes of multiple myeloma

Though the causes are not yet knownmultiple myeloma comes considered a disease of the elderly, because its incidence increases with age and mainly affects people over 70 years of age. A probable risk factor is represented bylifetime exposure to certain chemicals (such as benzene and pesticides), ionizing radiation (in fact it is frequent in atomic bomb survivors) and some viruses (in particular that of Human Herpes 8, HHV-8, although there are no conclusive data in this regard).

“Multiple myeloma is often preceded by a condition called monoclonal gammopathy of uncertain significance, that is, an excessive production of immunoglobulins all the same, which normally does not give symptoms and it is discovered randomly during routine exams or prescribed for other reasons. But be careful: not everybody patients with this condition develop multiple myeloma, but almost all patients diagnosed with myeloma are affected ”, the expert points out. Elderly people, males and patients with previous cases in the family are more prone to monoclonal gammopathy.

How do you know you have multiple myeloma

Multiple myeloma it develops silently, so in the early stages it can be completely asymptomatic. “With the passage of time, however, they appear bone painsmostly located at the level of the skull, back and pelvis, which is associated with a higher frequency of fractures », explains Professor Angelini.

“They can also manifest themselves asthenia and weakness, hypercalcemia, renal insufficiency and anemia not linked to other causes ». The diagnostic suspicion arises mainly when elevated levels of immunoglobulin are detected in the blood through a laboratory test called serum protein electrophoresis. “At that point other blood, urine and radiological tests are prescribed, to then arrive at the bone marrow biopsy, a fundamental investigation to diagnose myeloma with certainty, which consists in the sampling and subsequent analysis of a fragment of bone and of the marrow contained in it “.

Which organs does it affect

Exist different types of myeloma: the multiple one affects different skeletal districts, so it can affect all bones; the solitary one, on the other hand, has a single localization (for example, the femur); extra-bony can also affect soft tissues (such as the stomach, for example). “Multiple myeloma is the most common, albeit however rare: in Italy 5,500-6,000 cases are diagnosed every year, so it does not have the same frequency as breast, colon, lung or prostate cancer “.

How many stages does the disease have

From the various tests it is possible to establish a staging of the disease, which can be asymptomatic (stage 1), in the intermediate stage of development (stage 2) or symptomatic (stage 3). “Establishing it serves to assess the spread of the disease in the body, understand its severity, predict its evolution and decide the best type of therapy in the individual case”, Professor Angelini describes.

In the first stage, multiple myeloma has not yet induced serious complications: there is no anemia or hypercalcemia, there are no bone lesions visible on the X-ray of the skeleton and the amount of immunoglobulins in serum and urine is not very high. On the contrary, in the third stage, severe anemia and hypercalcemia are present, there are at least three bone lesions, and immunoglobulins are significantly increased. In the middle, that is, in the second stageall patients who do not meet the criteria for stage 1 or 3 are found.

How many years can you live with multiple myeloma

Until 1950multiple myeloma could not count on any therapy, so it inevitably resulted lethal within a few months. “Todayinstead, the average survival exceeds seven yearsbut 10-12 percent of patients heals completely”.

The success is due to the paraphernalia available to doctors, which is very broad: ai chemotherapy classic (such as prednisone, cyclophosphamide or doxorubicin), in more recent years proteasome inhibitors (bortezomib and carfilzomib), thalidomide and its derivatives (lenalidomide, pomalidomide) have been added.

In addition, for patients who do not respond to standard treatments, more innovative therapies, such as monoclonal antibodies which stimulate the elimination of cancer cells by the immune system. “In patients under the age of 65 who do not have heart, lung, liver or other contraindications, it may be possible to hematopoietic stem cell transplantation, which are taken from the patient’s own blood or marrow or from a compatible donor and then infused after drug treatment. From 65 to 75 years, the indication for transplantation is assessed on a case-by-case basis, after excluding concomitant pathologies, while those over 75 are generally not candidates for treatment “.

What is the difference between lymphoma and myeloma

Despite the assonance, myeloma it is not to be confused with lymphoma, which affects another family of blood cells, namely lymphocytes. “Myeloma, on the other hand, has the characteristic of originating from plasma cells, highly specialized lymphocytes in the production of immunoglobulins”, concludes the expert. “Research on this pathology continues: not all clinical trials always translate into better treatment, but certainly there is great excitement among researchers and, therefore, hope”.