Monday, March 22, 2010

So What Is Multiple Myeloma?

I had never heard of Multiple Myeloma until I was diagnosed with it in November of 2008. I immediately consulted the decade-old medical encyclopedia that was gathering dust on my home office bookshelf and one glaring fact captured my attention: I was going to die. Or so I thought!

Since then, I have survived over a year of aggressive treatment, achieved complete remission and resolutely immersed myself in a world I never could never have previously imagined.

For those of you keeping score, following are are some simple facts about the disease:

What is MM?

Multiple Myeloma is a cancer of a particular type of white blood cell (WBC) called a 'plasma B cell.' Plasma cells, like all WBCs, are the major components, the soldiers, if you will, of a person's immune system. Our immune system, as you know,  protects us from infections and diseases.

Plasma cells (and all other blood cells) are manufactured in the Bone Marrow (BM), the spongy tissue found in the center of most of our bones. Some of these plasma cells stay close to home in the bone marrow, and some travel to other parts of the body and go to work.

Our bodies have many different types of plasma cells. Each plasma cell produces one specific kind of  'immunoglobulin' or 'antibody' which fights a specific substance invading the body. Antibodies are made up of proteins. 

When plasma cells become cancerous they reproduce uncontrollably. You've heard of one bad apple spoiling the whole bunch?  Well get a load of this:

In MM, one stinking little plasma cell creates a cancerous copy of itself and that dastardly clone makes a copy of itself, those cells make clones, over and over again. These don't have the normal genetic cell directive to die- you have to kill them. These abnormal plasma cells, all exactly alike, are called  "monoclonal," cells, meaning that they all originated from one common cell. I can identify the type of Myeloma I have from the existence of great numbers of specific kinds of plasma cells in my bone marrow. My Myeloma came from one traitorous original plasma cell that went haywire. BTW, doctors still don't know why this happens- but they will figure it out!

As these malignant Myeloma cells increase in number in the bone marrow, they begin to crowd out and displace healthy WBCs, healthy red blood cells (RBCs)`and healthy platelets, preventing them from doing the jobs our bodies need them to do. If you don't have enough WBCs working for you, your body is susceptible to infections and disease. Not enough RBCs? You can't transport enough nutrition/oxygen (via hemoglobin) to your body's cells and you become grossly fatigued and anemic. When you don't have enough
platelets, which help blood to clot when arteries, veins and capillaries are damaged, you are in danger of uncontrolled bleeding. 

Here's the scary scenario that I faced. Healthy bone marrow contains roughly 3-5% plasma cells. When I was diagnosed, tests revealed that my marrow was comprised of 77.5% plasma cells. Yikes! Sean had too many  cancerous Myeloma cells and not enough RBCs, WBCs and platelets. I have friends with Myeloma (some affectionately call us Myelomiacs) with 90% plasma cells at diagnosis. I have a sneaking suspicion that we weren't headed for anything pleasant had we not been diagnosed and thrust into treatment. 

Sounds like a Myeloma infomercial. These malignant plasma cells produce 'osteoclast activating factors' (OCFs) which cause calcium to be leached out of the bones and into the bloodstream. This results in (1) 'hypercalcemia' or dangerously high levels of calcium in the bloodstream and (2) 'osteolytic lesions' or holes literally being punched out in the bones. These holes weaken the affected bones, making them prone to fractures. Lift up a paint can- break your arm! you might have Myeloma. Kick a soccer ball and break your femur. Hey, you might have Myeloma! Not kidding here. I was sitting up after a PET Scan and my sternum broke.

Sometimes the Myeloma cells join together to form tumors, or plasmacytomas, which may subsequently break through the weakened bone structures. In addition to my sternum, I've had fractures in my shoulder blades, arms, ribs, and several collapsed and/or compressed vertebrae. OUCH is right! 

If that's not enough, these malignant plasma cells also produce excessive monoclonal immunoglobulins, or antibodies, called M-proteins which can overload the kidneys, leading to abnormal kidney function and possible renal failure. My Myeloma cells over-produce Immunoglobulin G (IgG) proteins. 

In brief (too late!), MM can cause bone pain, anemia, and renal failure. Frequent infections are common because of compromised immune systems. And here is a biggie: 

There is no known cure for Multiple Myeloma.

Major strides have been made in fighting this disease in the last few years. Brilliant research scientists and doctors continue to try to unlock the mysteries of this horrible cancer. Remissions are possible with new treatments, but Myeloma cells are infamous for becoming resistant to common chemotherapy. The immediate goal is to get the disease growth under control and to keep patients in remission, with a good quality of life, for as long as possible. 

The Numbers

Patients are usually diagnosed in their mid to late 60s or older. I was 49. MM accounts for between 10% - 15% of all hematological (blood) malignancies, with roughly 15,000 new cases diagnosed in the U.S. each year.  MM makes up roughly 1% of all diagnosed cancers and 2% of annual cancer deaths. Over 50,000 Americans are currently living with Multiple Myeloma. Median survival rate for patients in the United States is roughly 2.5 to 3 years from diagnosis, but it varies from the severity of the disease at diagnosis, treatment and support quality, and the patient's response to drugs, stem cell transplants, etc. MM is more common in men than women, and in African Americans than Caucasians.    

There you have it! Not very pretty, but I am convinced that major developments will happen over the next 5 -10 years. My doctors at UAMS believe that a cure will be found. That is what I pray for. In any event, I will not give up!

How did I get into remission? That'll be for a future post. For a deeper understanding of MM, check out the links to the right.

In the meantime, I'll keep fighting the good fight here in Myelomaville!

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