Myeloma: Signs, Diagnosis & Treatments in Singapore

Myeloma affects multiple places in the body, which is why it is sometimes referred to as ‘multiple’ Myeloma. Myeloma affects where bone marrow is normally active in an adult, such as in the bones of the spine, skull, pelvis, the rib cage, long bones of the arms and legs and the areas around the shoulders and hips.

Multiple Myeloma Symptoms

The common signs and symptoms of Myeloma include:

Pain in the bones, particularly the spine and ribs
Unusual tiredness
Recurring infections
Mental disorientation, fogginess, and confusion
Kidney damage
Unexplained weight loss
Numbness or weakness in the legs
Increased thirst.

Myeloma Diagnosis

Tests and procedures that can help in the diagnosis of multiple Myeloma include:

Blood tests

Myeloma causes high levels of some proteins in the blood. Blood tests to examine the levels of different proteins such as M protein, serum-free light chains, beta-2-microglobulin (β2M), albumin, and immunoglobulins can help in the diagnosis of Myeloma.
β2M is one of the important indicators of the activity and extent of Myeloma in the blood. Blood tests to assess your kidney functions, blood cell counts, uric acid and calcium levels can also help with the diagnosis.

Urine tests

A urine sample can be taken to check for Myeloma proteins, which are referred to as Bence Jones proteins when they are passed in the urine.

Imaging Tests

A skeletal survey that includes a series of X-rays of the long bones, skull, and spine can help to detect Myeloma. X-rays can also help to identify the specific areas of bone damage that have caused the collapse or fracture, which require immediate attention. Other imaging tests such as PET-computerized tomography (PET-CT) scans and magnetic resonance imaging (MRI) can be performed to identify areas of bone damage that are not easily detected by X-rays.

Bone marrow tests

Bone marrow tests are essential for determining the amount and presence of Myeloma cells in your bone marrow in proportion to other blood cells.

Multiple Myeloma Treatments

There are two goals of the treatment for Myeloma:

To bring the Myeloma into remission
To improve the patient’s quality of life by relieving the symptoms and preventing complications associated with Myeloma such as bone pain and anaemia.

If you are not experiencing any symptoms, you may not require treatment. However, the doctor will monitor your condition regularly for signs of disease progression. This may involve regular blood and urine tests.

Most patients with Myeloma are given a combination of drugs and treatment. The choice of drugs depends on the patient’s physical status, including age and overall health, the extent of renal impairment or organ damage, and the specific sub-type of Myeloma.

Treatment options include:

Chemotherapy

Chemotherapeutic drugs can destroy fast-growing cancer cells in patients with Myeloma. Chemotherapy drugs can be taken orally as pills or administered as an injection into a vein in your arm. Higher doses of chemotherapy drugs can be used prior to a bone marrow transplant.

Corticosteroids

Prednisone and dexamethasone are commonly used corticosteroids for regulating the immune system functions and controlling inflammation in the body. Steroids have anti-myeloma effects, as they can trigger the death of Myeloma cells. Corticosteroids can be taken orally in pill form or administered intravenously in your arm.

Immunotherapy

Immunotherapy works by stimulating your immune system to fight against Myeloma cells. Immunomodulating drugs commonly used for Myeloma include Thalidomide, Lenalidomide, and Pomalidomide.

Targeted Therapy

This treatment targets specific abnormalities in cancer cells which enable them to survive. It involves the use of Proteasome Inhibitors such as Bortezomib that can inhibit the action of substances in Myeloma cells which break down proteins. This causes Myeloma cells to die.

The use of monoclonal antibodies, such as Elotuzumab and Daratumumab allow immune cells to identify and attack Myeloma cells more efficiently.

Stem Cell Transplant

A stem cell transplant involves the replacement of diseased bone marrow with healthy bone marrow. In most cases, the patient’s stem cells are transplanted. Healthy blood-forming stem cells are collected from the blood and stored in advance of the transplantation. For the actual transplantation, high doses of chemotherapy drugs are then given to destroy the diseased bone marrow. The collected stem cells are then infused back into the blood and travel to the bones to rebuild healthy bone marrow.

Radiation Therapy

This treatment involves the use of beams of energy, such as protons and X-rays, to destroy Myeloma cells and prevent their growth. Radiation therapy would shrink Myeloma cells quickly in a specific area. Radiation therapy is effective at alleviating bone pain and disease due to Myeloma. It is also effective for treating a tumour called plasmacytoma caused by the collection of abnormal plasma cells.

FAQs on Myeloma

What are the risk factors for Myeloma?

Several factors can increase your risk of Myeloma, including:

Age, Race, and Gender
The risk of Myeloma increases with age. It is twice as common in individuals of African origin than of Asian and Caucasian origins. The incidence of this disease is 1.5 times higher in men than in women.

Family History
People having a parent, sibling, or child with Myeloma are nearly two times more likely to develop it compared to the general population.

Personal History
A history of MGUS (monoclonal gammopathy of undetermined significance) can increase the risk of Myeloma.

Exposure to toxic elements
Repeated exposure to toxic elements such as radiation, agricultural chemicals, and petrochemicals increases the risk of Myeloma.

Obesity
Obesity is a common risk factor for several forms of cancers, including Myeloma.

What are the complications of Myeloma?

Frequent infections. Myeloma cells stop your body from fighting infections effectively.
Bone Damage. Myeloma cells can interfere with the normal process of bone maintenance and cause bone problems such as bone pain, thin and broken bones.
Higher calcium levels in the blood related to eroding bones. The symptoms of high calcium are thirst, nausea, vomiting, confusion and constipation.
Kidney damage. The abnormal protein produced by myeloma cells can damage the kidneys, as can high calcium levels.
Low red blood cell count (anaemia). As myeloma cells result in the crowding of healthy blood cells, it can also cause anaemia and other blood problems.

How are Myeloma complications treated?

In addition to treating Myeloma, the doctor may also need to treat the complications of Myeloma.

Bone pain. Pain relief medication, radiation therapy and surgery may alleviate bone pain.
Bone loss. The doctor may recommend medications called bisphosphonates, such as pamidronate or zoledronic acid. These help to prevent bone loss.
Kidney complications. Dialysis may be required for people with severe kidney failure.
Infections. Certain vaccines may be recommended to prevent infections such as the flu and pneumonia vaccinations.
Anaemia. If the anaemia is persistent and severe, medication such as erythropoietin, or blood transfusions may be given to increase the red blood cell count.

Does Multiple Myeloma show up on X-Ray / MRI?

Both an x-ray and an MRI scan are often used to diagnose bone involvement by multiple Myeloma. They may show features that are suggestive of Myeloma involvement, however we cannot fully diagnose Myeloma based on radiological changes alone.

Is Myeloma genetic?

While Myeloma is not inherited in the same manner diseases such as breast cancer are, which is often from a single gene. There is a slightly higher occurrence of Myeloma within family members when compared to the entire population, but presently, the inheritance pattern of Myeloma is unknown.

Does Multiple Myeloma affect walking?

Since Myeloma affects the bones, many patients experience weakness and pain. However, weight-bearing exercises, such as walking, can aid in strengthening the bones. Patients should always consult with our doctors before attempting a new workout routine and if they experience pain or notice a change in their symptoms.

How fast does Myeloma progress?

Myeloma is often a slowly progressing disorder initially and in the initial phases patients may not notice any symptoms.

However, some forms of more aggressive Myeloma can be rapidly progressive, in particular in patients with heavily pretreated Myeloma, or refractory forms of Myeloma.

What happens if multiple Myeloma is left untreated?

If multiple Myeloma is left untreated, it can lead to excess amounts of protein. This can eventually lead to kidney damage or failure, or other complications such bone involvement and fractures. If you are suffering from symptoms of Myeloma, speak to our doctors and seek treatment early.

Can you live a normal life with Myeloma?

Myeloma is a serious medical condition and the diagnosis and its associated symptoms often have an impact on the quality of life of patients.

That being said, there have been significant improvements in the treatment of Myeloma. Most initial treatments are outpatient based, with manageable side-effects, and many patients are able to continue with their daily activities.

What is the life expectancy for someone with Myeloma?

The life expectancy of someone diagnosed with Myeloma depends on the stage of their Myeloma, and in addition prognostic markers such as the presence of poor risk or good risk genetic abnormalities will influence the outcomes.

The diagnosis and monitoring of Myeloma during treatment has become increasingly sophisticated, and we are now able to detect presence of Myeloma at very low levels in the bone marrow (known as detecting minimal residual disease – MRD). Patients who are able to attain MRD negativity with Myeloma treatment have a significantly improved overall survival.

In general, for Myeloma patients at diagnosis, around 50% of patients will be alive and well at 5 years. However, these numbers do not factor in all variables, such as age and overall health. Additionally, treatment options for Myeloma are continuously improving. Speak to our doctor for a better understanding of the success rates of your treatment plan.

FAQs on Myeloma Treatments

These are possible treatments that are administered to Myeloma patients:

Chemotherapy
Corticosteroids
Immunotherapy
Targeted therapy
Radiation therapy
Stem cell transplant
CAR T-cell therapy

How is chemotherapy administered for Myeloma treatment?

Chemotherapy drugs can be taken orally as pills or administered as an injection into a vein in your arm.

How do corticosteroids work as a treatment for Myeloma?

Corticosteroids regulate the immune system functions and control inflammation in the body. Steroids have anti-myeloma effects and can trigger the death of Myeloma cells.

How does immunotherapy work as a treatment for Myeloma?

Immunotherapy works by stimulating your immune system to fight against Myeloma cells.

How does targeted therapy work as a treatment for Myeloma?

Targeted therapy targets specific abnormalities in cancer cells which enable them to survive. It inhibits the action of substances in Myeloma cells which break down proteins. This causes Myeloma cells to die.

How does radiation therapy work as a treatment for Myeloma?

Radiation therapy uses beams of energy to destroy Myeloma cells and prevent further growth. It is able to shrink Myeloma cells quickly in a specific area to alleviate bone pain in Myeloma patients.

How long can you live with multiple Myeloma after a stem cell transplant?

Patients with multiple Myeloma typically receive an autologous stem cell transplantation as consolidation after they have completed their initial induction phase of chemotherapy.

The response to an autologous stem cell transplantation depends on the disease risk stage of the underlying Myeloma, as well as whether a complete remission is attained before transplantation.

Outcomes are improving significantly for patients with Myeloma. However, the autologous stem cell transplantation is not curative in most cases and rather serves to extend the duration of remission for treated patients.

How does CAR T-cell therapy work as a treatment for Myeloma?

CAR T-cell therapy is a form of immunotherapy that involves collecting a patient’s immune cells and modifying them in a laboratory to target against Myeloma cancer cells. These modified cells are then returned into the patient to strengthen their immune system against the Myeloma cancer cells.

How successful is treatment for Multiple Myeloma?

While there is, unfortunately, no cure for multiple Myeloma currently, treatment such as chemotherapy and immunotherapy, amongst others, can be used to successfully manage the condition for years.

With the introduction of novel drug therapies, as well as the use of 3-4 drug combinations for upfront treatment of Myeloma, the majority of newly diagnosed Myeloma patients are able to achieve a partial or complete response to initial therapy.

Many of these patients will eventually relapse over time. Treatment strategies such as the use of autologous stem cell transplantation, as well as the use of longer term maintenance therapy have been adopted successfully to delay the time to relapse (ie. prolong the disease free interval)

These approaches do not factor in variables such as age and overall health. Speak to our doctor for a better understanding of the success rates of your treatment plan.

How much does Myeloma treatment cost in Singapore?

The cost of Myeloma therapy varies significantly depending on the drugs used for treatment, as well as whether additional therapies such as a bone marrow transplantation are needed.

Factors such as disease stage, age of the patient and additional medical conditions (such as diabetes, or heart disease or kidney failure) all need to be considered in determining the most appropriate treatment for patients.

Do speak to our doctors about your Myeloma treatment plan and our team will help to advise on the treatment options as well as the costs of the treatment.