Signs of end-stage multiple myeloma, complementary care to manage it

Health experts reveal what are the signs of end-stage multiple myeloma and what is the complementary care that the doctors suggest for managing the condition

Multiple myeloma is a cancer of plasma cells in the bone marrow where these cancerous plasma cells multiply in the bone marrow and can affect the body in multiple ways. If not diagnosed and managed early, can lead to end-stage myeloma which can present with organ damage.

Signs of end-stage multiple myeloma, complementary care to manage it (Photo by Sander Sammy on Unsplash)

In an interview with HT Lifestyle, Dr S Jayanthi, Senior Pediatric Oncologist at Kamineni Hospitals in Hyderabad, shared, “Myeloma is a type of cancer arising from plasma cells if bone marrow. Early diagnosis and risk stratification is key for better outcome. A complete workup that includes BMA, cytogenetics by FISH, urine test for monoclonal protein, FLC , imaging for skeleton lesion ( PET or whole body MRI) are the basic tools for appropriate diagnosis.”

She advised, “Multidisciplinary approach is key for better outcome. All patients are not treated alike. Personalized treatment tailored to the biology of the disease and symptoms of the patient play a great role in planning the treatment. Patients' age, comorbidities and wishes also play a great role in treatment decisions. Treatment includes Induction therapy with 2-3 drugs followed by maintenance therapy interspersed with BMT for patients.”

The health expert added, “Recent advances include CART cell therapies and Teclistamab targeting the B cell maturation antigen ( BCMA ) present on myeloma cells and CD 3 protein present on T cells. In today's world, multiple myeloma is a chronic disease rather than a killer. We have come a long way and can conquer it if diagnosed and treated appropriately early before irreversible damage occurs to patients. Together, we CAN.”

Bringing his expertise to the same, Dr Satish Kumar A, Consultant - Hematologist and Hemato-Oncologist at Manipal Hospital Yeshwanthpur and Hebbal, highlighted the signs of end-stage myeloma as:

• Extreme fatigue – The cancerous myeloma cells multiply in bone marrow decreasing the production of normal Red blood cells, causing anaemia which can be severe if not diagnosed early leading to severe fatigue
• Bony pains – These abnormal plasma cells cause damage to the bones. These cells cause an imbalance between bone resorption and new bone formation, leading to the weakening of bones, and bone pains. These bones are prone to fractures, which increases pain further. Bone pain can occur in any part of the body, but is most commonly felt in the back (spine), ribs and hips. Pain is more often induced by movement and can be severe.
• Renal failure – The plasma cells secrete abnormal proteins, which can deposit in kidneys or damage kidneys in various ways leading to kidney failure. They may become dialysis dependant if not diagnosed early, and kidney damage may be irreversible
• Paralysis of legs – If the myeloma tumours compress the spinal cord or fractured vertebral bone impinges on the spinal cord, it can lead to paralysis
• Infections – Since the normal immune cells are decreased, the patients are prone to serious infections like severe pneumonia or urinary tract infection.

According to Dr Satish Kumar A, the comprehensive therapy for end-stage myeloma involves:

• Primary treatment of multiple myeloma with 3 or 4 drugs simultaneously, at the earliest, to destroy the cancerous plasma cells; this can reverse renal failure in 40% of cases
• Drugs to strengthen the bones – Monthly Bisphosphonates or denosumab
• Adequate pain management
• Haemodialysis for end-stage renal failure
• Surgery in cases of vertebral fracture and collapse causing spinal cord compression
• Radiotherapy to shrink myeloma tumours, if they impinge on the spinal cord causing weakness in the legs
• Immunization – Pneumococcal and Flu vaccine to everyone; Antibiotics for the proper duration if they have infections.

He suggested, “If the patient is <65 years of age and reasonably fit, s/he should be planned for autologous stem cell transplant after 4 months of primary treatment, once a satisfactory response is achieved. If >65 years, the treatment should be continued for 9 to 12 months. Maintenance with low-dose drugs should be given after completion of treatment to all patients for at least 2 years to prolong the disease-free duration.”