Myeloma: What it is, Causes, Treatment & More

What is Myeloma?

Plasma cells are a type of white blood cell produced in the bone marrow, important for producing antibodies to fight infections. Myeloma begins when the DNA of a single plasma cell becomes damaged during its development, causing it to mutate into a cancerous cell. This abnormal cell then begins to multiply uncontrollably within the bone marrow, eventually crowding out the healthy red blood cells, white blood cells, and platelets that the body depends on. 

When abnormal plasma cells get accumulated in the bone marrow, they disrupt the production of healthy blood cells, compromise bone integrity, and place considerable strain on the kidneys and the immune system.

Unlike many other cancers, myeloma does not form a single lump or tumour. Instead, it spreads to multiple sites in the body where bone marrow is usually active, including the bones of the pelvis, skull, rib cage, arms, and legs. This is why the condition is most often referred to as 'multiple myeloma'.

What are the Types of Myeloma?

Multiple myeloma is classified in several ways, such as by immunoglobulin type, gene mutation, and disease stage. Here is an overview of the main types of cancer:

How Common is Myeloma in India?

According to the Global Cancer Observatory (GLOBOCAN) 2020, the five-year prevalence of multiple myeloma in India is approximately 2.2 cases per 1,00,000 people, compared with 5.78 per 1,00,000 globally. The disease accounts for around 1.23% of all cancers in the country and is responsible for nearly 5,900 deaths every year.

Globally, the median age of diagnosis is about 70 years, but in India, patients are diagnosed around a decade earlier. The country’s younger population structure is partly to blame, researchers say. The incidence of myeloma in young adults in India was 8.5%, which was higher than what has been reported in Western studies. The most common symptoms at presentation are bone pain and bony lesions, occurring in the vast majority of patients at diagnosis. Renal failure is another big issue, especially in older patients.

Symptoms of Myeloma

Myeloma is a cancer of plasma cells, a kind of white blood cell mostly found in the bone marrow. It may not cause symptoms at first, but when they do, they can affect the bones, blood levels, kidneys, calcium levels, and the body's ability to fight infections.

Stages of Myeloma

The Revised International Staging System (R-ISS) is the accepted method used to predict outcomes in multiple myeloma at diagnosis. Created by the International Myeloma Working Group, it looks at blood protein levels, kidney health, enzyme levels, and chromosome results to sort patients into one of three risk groups.

Related Diseases Comparison

Myeloma has similarities with other blood and plasma cell diseases, which can make your diagnosis difficult. Knowing how it is different from related conditions helps explain why special tests and expert evaluation are needed.

Myeloma vs AL Amyloidosis vs Non-Hodgkin Lymphoma

Medicines Used to Treat Myeloma

Myeloma cannot be cured for most patients right now, but it is treated with combinations of medicines that aim to put the disease in remission, control relapses, and provide supportive care.

• Proteasome inhibitors, such as bortezomib

• Immunomodulatory drugs, including lenalidomide and thalidomide

• Corticosteroids, like dexamethasone

• Alkylating chemotherapy, including cyclophosphamide and melphalan

• CD38-directed monoclonal antibodies, such as daratumumab

• Bone-modifying agents, including zoledronic acid

Living with Myeloma in India: Daily Challenges, Financial Burden, and Caregiver Support

Living with myeloma is hard physically, emotionally, and financially. But with the right treatment and support, many people can manage their myeloma symptoms and keep a good quality of life.

Myeloma Treatment Cost in India

Myeloma treatment often goes on for a long time. Costs can rise if the disease gets worse, comes back, needs bone support, or if a stem cell transplant is needed.

Disclaimer: The numbers are example costs and can change depending on city, provider, and treatment plan.

What Causes Myeloma?

Myeloma begins when a plasma cell in the bone marrow undergoes a genetic mutation, causing it to behave abnormally. Instead of following the normal cycle of growth and death, the mutated cell begins dividing uncontrollably, producing large numbers of cancerous myeloma cells. 

As myeloma cells get collected in the bone marrow, the production of healthy red blood cells, white blood cells, and platelets gets disrupted and the body cannot function normally. Myeloma cells continue to produce antibodies, as normal plasma cells do, but the antibodies they make, known as M proteins, are abnormal and serve no useful purpose. Instead, they accumulate in the body and can damage the kidneys and other organs.

The cause of this sudden mutation is unknown. These mutations are acquired rather than inherited and develop after birth. They appear to develop spontaneously over a person's lifetime, which may explain why the disease is more commonly diagnosed in older adults.

Risk Factors of Myeloma

While the exact cause of myeloma is not fully understood, certain factors are known to increase the likelihood of developing the disease.

• Older Age: Myeloma is primarily seen in those who have crossed the age of 50, with the majority of cases occurring in the late 60s.

• Gender: Men are more likely to be diagnosed with multiple myeloma than women as per research.

• Family History: Having a parent or sibling with myeloma may increase the risk, although the disease is not usually inherited.

• Developing MGUS: MGUS is a condition where the plasma cells start producing M proteins. Those with MGUS have a greater chance of developing multiple myeloma over time.

• Obesity: Research has linked being overweight to an increased risk of developing myeloma.

• Exposure to Harmful Chemicals or Radiation: Long-term exposure to pesticides, fertilisers, radiation, or certain industrial chemicals and metals may increase the risk of developing myeloma.

• High-Risk Occupations: Some studies suggest that people working in occupations with frequent exposure to chemicals or smoke, such as firefighting, may have a higher risk of developing myeloma.

What are the Complications of Myeloma?

If myeloma is not treated or progresses over time, it can affect several organs and body systems, leading to serious health complications.

• Frequent Infections: Myeloma weakens the immune system, making the body more vulnerable to repeated infections, especially bacterial infections such as pneumonia.

• Bone Damage: The disease can weaken bones, causing persistent bone pain, thinning of the bones, and increasing the risk of fractures.

• Kidney Damage: Abnormal proteins produced by myeloma cells can harm the kidneys and, in severe cases, lead to kidney failure.

• Anaemia: Myeloma can reduce the production of healthy red blood cells. This can cause anaemia, leading to tiredness, weakness, and other blood-related problems.

• High Calcium Levels (Hypercalcaemia): Bone breakdown can release excess calcium into the bloodstream, resulting in hypercalcaemia, which may require urgent medical treatment.

• Peripheral Neuropathy: Peripheral nerve damage can cause numbness, tingling, pain, or increased sensitivity in the hands and feet. This may result from the disease itself or its treatment.

• Amyloidosis: Abnormal proteins produced by myeloma can accumulate in organs, interfering with their normal function.

• Cryoglobulinaemia: Certain abnormal proteins may damage blood vessels and interfere with normal blood circulation.

• Hyperviscosity Syndrome: Excess proteins in the blood can make it unusually thick, reducing blood flow and requiring emergency medical care.

• Spinal Cord Compression: Weakened bones in the spine can press the spinal cord, leading to pain, weakness, or nerve-related problems that require immediate treatment.

When Should I See My Healthcare Provider?

If you have symptoms that may be a sign of myeloma, see your healthcare provider as soon as you can. Early diagnosis increases the chances of better treatment outcomes. If you have already been diagnosed, stay in regular touch with your doctor and tell them immediately if you develop any new or worsening symptoms or side effects of treatment. The doctor can also explain what symptoms to expect during treatment, which symptoms will need a routine appointment and which symptoms may need immediate emergency medical attention.

How is Myeloma Diagnosed?

Doctors diagnose myeloma by combining your medical history, physical examination, laboratory investigations, imaging studies, and bone marrow testing, as no single test can confirm the disease.

How is Myeloma Treated?

Treatment for myeloma depends on the stage of the cancer, the severity of symptoms, and the patient's overall health. Common treatment options include:

• Monitoring: If myeloma is at an early stage and not causing symptoms, doctors may recommend regular blood and urine tests along with periodic check-ups to monitor the disease before starting treatment.

• Targeted Therapy: These medicines target specific proteins or pathways in myeloma cells, helping destroy cancer cells while limiting damage to healthy tissues.

• Immunotherapy: This treatment strengthens the body's immune system so it can better recognise and attack myeloma cells.

• CAR T-Cell Therapy: In this advanced form of immunotherapy, a patient's own T cells are modified in a laboratory and returned to the body to identify and kill myeloma cells.

• Chemotherapy: Powerful anti-cancer medicines are used to destroy rapidly growing myeloma cells and are often given before a stem cell transplant.

• Corticosteroids: Steroid medicines help reduce inflammation and also work directly against myeloma cells. They are commonly used along with other treatments.

• Stem Cell Transplant: This procedure replaces damaged bone marrow with healthy blood-forming stem cells, usually collected from the patient's own body. It is also called a ‘bone marrow transplant’.

• Radiation Therapy: This therapy uses radiation to shrink tumours, relieve bone pain, and treat areas where the cancer has damaged the bones.

Can Myeloma be Prevented?

There is no guaranteed way to prevent myeloma because the exact reason why healthy plasma cells become cancerous is still not fully understood. However, here are a few things you can do:

• Maintain a Healthy Weight: Being overweight is associated with an increased risk of myeloma, so maintaining a healthy body weight may be beneficial.

• Follow a Healthy Lifestyle: Eat a balanced and nutritious diet, exercise regularly, avoid smoking, and limit alcohol consumption to support your overall health.

• Minimise Exposure to Harmful Chemicals and Radiation: If possible, avoid unnecessary exposure to radiation and to chemicals such as certain pesticides, fertilisers, and other hazardous substances linked to a higher risk of myeloma.

• Focus on Early Detection: Since most risk factors, such as age and family history, cannot be changed, paying attention to persistent symptoms and seeking timely medical evaluation can help with earlier diagnosis and treatment.

What is the Prognosis of Myeloma?

Although there is currently no permanent cure for myeloma, advances in treatment have significantly improved survival and quality of life for many patients. The prognosis looks different in every case, depending on the cancer stage, the person's overall health, and how well the cancer responds to treatment. 

In general, people diagnosed at an early stage tend to have a much better prognosis than those diagnosed after the disease has become more advanced. The overall five-year survival rate for myeloma is about 62%. However, when the condition is detected early, the five-year survival rate increases to around 80%. Many people are also able to live for 10 years or longer with appropriate treatment and regular follow-up care.

Does Health Insurance Cover Myeloma?

Yes, health insurance covers the treatment of blood cancers like myeloma. Most policies cover hospital room rent, surgeon's fees, medicines, diagnostic tests, ambulance expenses, and specified pre- and post-hospitalisation expenses.

Critical illness plans also cover blood cancers, offering a lump-sum payment that you can use for treatment costs. You become eligible for a payout after diagnosis, subject to a waiting period of 90 to 180 days and a survival period of 7 to 30 days. In fact, some insurers also offer dedicated cancer insurance plans that provide coverage for pre-existing cancer after the predetermined waiting period is over.

To understand the exact inclusions, exclusions, and other conditions of your policy, you must read all policy documents carefully.

How Much Health Insurance is Required for Myeloma?

Cancer treatment involves surgical procedures, long-term radiation therapy, chemotherapy, etc. A health insurance coverage of at least ₹10 lakh to ₹20 lakh is ideal, considering the high cost of many of these treatments.

However, if you are at higher risk for myeloma because of family history, age or other factors, you should consider opting for a higher sum insured.