What is it about ?
Multiple myeloma (MM), better known as Kahler’s disease, is a malignant proliferation (cancer) of cells in the bone marrow, more specifically B cells. It is a group of descendants of a certain type of white blood cells, which produce antibodies against intruders such as viruses.
What is its frequency?
There are about 4 to 5 new cases per 100,000 people per year. The diagnosis is usually made between the ages of 50 and 70, rarely before 40. Overall, the disease affects men as often as women. The average survival prognosis varies from 2 years to more than 10 years, depending on the risk assessment. The average life expectancy has almost doubled over the past 20 years and now stands at around 7 to 8 years. The chances of survival vary from person to person.
How to recognize it?
Symptoms in MM are all related to involvement of the blood, bone marrow or kidneys. Thus, a person with MM can:
- have more infections because of the drop in the number of white blood cells;
- possibly suffer from bone pain and unexplained fractures due to bone damage;
- feeling tired, short of breath and looking pale from a lack of red blood cells (anemia);
- show signs of sudden confusion (delirium);
- have a persistent fever, often with bone pain;
- suffer from fluid build-up (edema) in the legs, swollen eyelids, etc. All these symptoms are due to too low protein content in the blood, due to the loss of protein via the kidneys (nephrotic syndrome);
- sometimes cause blood clots (thrombosis).
How is the diagnosis made?
Depending on your medical history, symptoms, physical examination, and urine and blood tests, your doctor may make a probable first diagnosis of multiple myeloma. Urinalysis should determine the loss of protein and check what kinds of protein are present in the urine.
If the results are in the direction of multiple myeloma, the doctor will refer you to a specialist in blood diseases (hematologist). Your doctor may suggest a bone marrow puncture as well as an x-ray or magnetic resonance imaging (MRI).
Sometimes the disease presents with a serious complication:
- severe generalized infection (sepsis), pneumonia, for which hospitalization in intensive care is required;
- renal failure for which dialysis may be necessary;
- “Blood too thick” (hyperviscosity of the blood);
- excess calcium in the blood;
- compression of the spinal cord;
- abnormal bone fractures.
In these cases, the hematologist calls on other specialists to establish a diagnosis and a treatment plan with them. The diagnosis of MM is not always easy to make.
What can you do ?
If you are sick and have persistent symptoms as mentioned above, go to your GP. If you are thought to have multiple myeloma, talk to your doctors and get proper advice. It is important to take the necessary exams.
MM treatments are often heavy and come with many side effects. Good communication with doctors and nurses as well as the support of those around you are therefore essential. You can also use self-help initiatives for people with cancer. Thus, the cancerinfo line of the Foundation against cancer can, for example, be a listening ear and inform you of the administrative aspects related to living with cancer. If you are feeling overwhelmed, you can also activate psychological support.
What can your doctor do?
If the GP suspects MM, they will refer you to the hematologist to confirm the diagnosis and initiate treatment. If the diagnosis of MM is confirmed, treatment will be offered if symptoms are present. Often, a first therapeutic phase is initiated with cortisone and chemotherapy for a stem cell transplant. A stem cell transplant is done before the age of 70, preferably with your own cells. You will only be able to receive stem cells from another person in exceptional cases.
In addition to the basic treatment, you also benefit from a complementary treatment (adjuvant): fluid therapy, control of the balance of salts, control of infections (antibiotics), treatment of excess calcium in the blood, administration of blood cells red blood cells and platelets by transfusions, possibly administration of EPO in case of anemia, painkillers, radiotherapy in case of skeletal damage or bisphosphonates to slow down bone damage and treat excess calcium in the blood. Vaccination against pneumococci and influenza is also necessary.
The doctor is your contact person and your trusted person. You should therefore not hesitate to discuss it with him, especially if you find your treatment particularly heavy. It is important to discuss side effects and raise concerns. If necessary, the doctor can discuss with other doctor colleagues and ask for help.
Want to know more?
- The radiography, here, Where to find on this page of Cliniques St Luc UCL
- MRI, here, Where to find on this page of Cliniques St Luc UCL
- The spinal and lumbar punctures, here, Where to find on this page of Cliniques St Luc UCL
- Chemotherapy – Foundation against cancer
- Receiving a stem cell transplant – canadian cancer society
- Radiotherapy – Foundation against cancer
- EPO – CBIP – Belgian Center for Pharmacotherapeutic Information
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