March is Multiple Myeloma Awareness Month, and we'd like to put some focus on this cancer that remains unknown to many people. Multiple myeloma is the second-most common blood cancer. It's a cancer of the plasma cells, which are found mainly in the bone marrow and create antibodies that allow the immune system to fight pathogens. When these cells become cancerous, they start producing irregular proteins that can have a host of side effects.

Causes and Risk Factors

A relatively uncommon cancer, multiple myeloma has a lifetime risk of .76%, or 1 in 132. That doesn't mean it's easy to dismiss, however: it's estimated that there will be over 32,000 newly identified cases of it this year, and over 12,000 deaths.

Factors which may increase the chances of developing multiple myeloma:

• Genetic predisposition: likelihood of developing myeloma increases if a first-degree relative has had it.
• Racial predisposition: people of African descent are twice as likely to get it.
• Gender: men are 1.5 times more likely to get it.
• Age: it is most frequently diagnosed in 65 to 74 year olds.
• Virus triggers: HIV, AIDS, hepatitis, certain forms of herpes, and Simian virus 40 (a contaminant in certain polio vaccines during the 1950s and 60s) may trigger it.
• Exposure to atomic radiation.
• Exposure to toxic chemicals: engine exhausts, fuels, cleansing materials, solvents, benzene, agricultural chemicals, and dioxins.

Symptoms

Some people with multiple myeloma don't have obvious symptoms, but in at least 70% of patients common symptoms will appear, and these include back or bone pain, fatigue, and recurrent or persistent infections. Consult your doctor if you're experiencing symptoms such as:

• Persistent or worsening tiredness or fatigue.
• Recurrent unexplained infections: common ones include sinus infections, pneumonia, and urinary tract infections.
• Persistent or recurrent back or bone pain.
• Swelling of the extremities.
• Shortness of breath.

Associated Conditions

There are a number of associated conditions resulting from the overgrowth of plasma cells.

Low Blood Counts: overgrowth of plasma cells in bone marrow can crowd out other blood cells, causing conditions like

• Anemia: a shortage of red blood cells, which can cause fatigue and weakness.
• Leukopenia: a shortage of white blood cells, which can lead to a weakened immune system.
• Thrombocytopenia: a shortage of platelets, which can lead to bruising and bleeding.

Bone Weakness and Excessive Calcium: myeloma cells speed up the action of osteoclasts, cells that break down old bone to be replaced with new. New bone cell doesn't get replaced quickly enough, leading to weakness and fractures.

It can also cause hypercalcemia, high levels of calcium in the blood, which is marked by:

• Extreme thirst and excessive drinking to combat it.
• Frequent urination.
• Dehydration.
• Kidney problems or failure.
• Abdominal pain.
• Severe constipation.
• Loss of appetite.
• Weakness.
• Drowsiness.
• Confusion.

Infections: Multiple myeloma causes abnormal plasma cells to crowd out healthy ones, and the abnormal cells produce antibodies that don't aid the immune system. This makes the patient susceptible to infections. Pneumonia is particularly common.

Treatments for Multiple Myeloma

The advancement of multiple myeloma often determines much of the treatment course. Many myelomas are smoldering, or possessing the abnormal proteins produced by a myeloma without the disease advancing. Although the disease may become active, it can remain smoldering for years even without treatment. Studies continue regarding the potential of treatments during this stage to delay activation and improve life expectancy.

Active myeloma has many potential treatments. Among them:

• Chemotherapy.
• Stem cell transplants: creates a new source of healthy blood cells in the bone marrow to replace those killed in chemotherapy.
• Proteasome inhibitors: drugs that prevent cancer cells from replacing old proteins with new ones, causing them to die.
• Immunomodulatory drugs (IMiDs): drugs that activate certain immune cells, block some cancer growth signals, and kill myeloma cells.
• Steroids: in high volumes can kill myeloma cells.
• HDAC inhibitors: blocks production of a protein that allows myeloma cells to grow and divide.
• Antibodies: train the immune system to target specific proteins in myeloma cells.

Supportive care is a major component of managing myeloma. As with all cancers, there is a focus on pain management, patient comfort, and maintaining good morale. With myeloma, supportive care also includes a focus on countering the disease's associated conditions, especially the bone weakness that often results. This care may include:

• Fall-risk assessment: prevention of falls to avoid bone fractures.
• Fitness and activity.
• Physical therapy.
• Adjunctive treatments for bone damage, kidney damage, anemia, and infections.