In order to better follow Crash's treatment for multiple myeloma cancer, it is helpful to understand some of the intrusive symptoms that he may be experiencing, as well as some fundamental explanations about the different treatment aspects themselves. All information has been taken directly from literature published and distributed by the International Myeloma Foundation.
What is Multiple Myeloma?
Multiple myeloma (also known as myeloma and plasma cell myeloma) is a cancer of the immunoglobulin-producing plasma cells found in the bone marrow. It is a cancer that involves the immune system. The cancerous plasma cells, or myeloma cells, rarely enter the blood stream. The myeloma cells accumulate in the bone marrow, causing the following:
• Disruption of normal bone marrow function most commonly causing anemia (a low level of red blood cells in the bloodstream), although reduction in white blood cells and platelet counts can also occur.
• Damage to bone surrounding accumulated myeloma cells.
• Release of an abnormal protein, monoclonal protein (M protein), into the blood stream and/or urine.
• Suppression of normal immune function, observed as reduced levels of normal immunoglobulins and increased susceptibility to infection.
Myeloma cells can also grow in the form of localized tumors or plasmacytomas. Plasmacytomas may be single or multiple and either medullary (confined within bone marrow), or extramedullary (outside of the bone). When there are multiple plasmacytomas inside or outside the bone, this condition is also called multiple myeloma.
What Causes Fatigue and Anemia in Patients with Multiple Myeloma?
Fatigue: You're Not Alone
Fatigue associated with multiple myeloma usually is caused by underlying
anemia. This type of fatigue severely affects patients' quality of life and
everyday functioning. The continued interference with normal functioning is
what sets cancer-related fatigue apart from normal fatigue. Fatigue is very
common in patients with multiple myeloma and is estimated to affect 90% -
100% of patients with the disease. Patients need to understand that fatigue
is a symptom of their disease and is not necessarily a sign that their
condition is getting worse. Even though cancer-related fatigue is very
common in patients with multiple myeloma, the exact physiologic mechanisms
that cause the fatigue are not known. It is known, however, that is related
to the patient's anemia, and there are ways to manage it and help you cope.
Anemia: The Case of Missing
RBC's
Anemia occurs in patients with multiple myeloma because
plasma cells in bone marrow grow faster than normal, increase in number, and
produce tumors in the marrow. These tumors interfere with the
blood-producing activities of bone marrow, leading to a shortage of red
blood cells (RBC's). This shortage is known as anemia.
There are a number of causes of anemia in patients with multiple myeloma. The disease itself suppresses the body's ability to make enough RBC's, resulting in low RBC counts. Unfortunately, the chemotherapy that kills the cancer cells in patients with multiple myeloma also destroys RBC's, thus also increasing the chances of developing anemia. Anemia is very common in patients with multiple myeloma. In fact, at least 60% - 70% of patients with multiple myeloma have anemia at the time they are diagnosed with the disease,
What Are Vertebral
Compression Fractures?
Vertebral compression fractures are fractures of the bones of the
spinal column. A VCF occurs when the vertebra fractures or collapses because
the bone is too weak to withstand the pressure or stress placed upon it.
With multiple fractures, the spine shortens and becomes misaligned, causing
a "hunchbacked" condition known as kyphosis.
Vertebral compression fractures are usually caused by osteoporosis, but they can also be caused by diseases that affect the bone such as myeloma. In myeloma patients, moderate to severe back pain is usually caused by VCFs. Approximately 70% of patients with myeloma and back pain already have one or more VCFs at the time of diagnosis. There are several known facts about how myeloma affects bone and contributes to VCFs.
Bone is living tissue that is maintained by a delicate interplay between cells that form new bone (osteoblasts) and the cells that remove old bone (osteoclasts). Myeloma cells do not directly affect bone; however, they indirectly destroy bone by signaling the osteoclasts to resorb (break down) bone uncontrollably. The malignant cells spread throughout the skeletal system, causing bone loss that mimics osteoporosis.
Because so much bone is lost, high levels of calcium are released into the bloodstream. This condition is called hypercalcemia, and is common in patients with myeloma. Hypercalcemia increases bone destruction and frequently impairs kidney functioning.
In patients with myeloma, excessive osteoclast activity suppresses the formation of osteoblasts, the cells that create bone. This imbalance between bone-destroying and bone-creating cells further weakens the skeleton.
BALLOON KYPHOPLASTY
Balloon kyphoplasty is a medical procedure that is similar to
vertebroplasty in several ways. Like vertebroplasty, balloon kyphoplasty is
a minimally invasive procedure that uses bone cement to stabilize the
fracture, which in turn, reduces bone pain and helps increase the patient's
overall quality of life. Unlike vertebroplasty, balloon kyphoplasty uses
orthopedic balloons in an attempt to correct the vertebral deformity,
restore the height of the collapsed vertebra, and create a void before bone
cement is deposited. After the void has been created, the balloon is
deflated and removed, and then the bone cement is used to fill the void.
Though some cement leakage has been reported, this controlled filling
reduces the risk of cement leakage. It has been reported that in both cancer
and osteoporosis patients treated with balloon kyphoplasty, cement leakage
is lower than in patients with vertebroplasty.
In a prospective evaluation (Khanna et al; Osteoporosis International, 2006 17:817-826), 56 patients with myeloma induced VCFs that were treated with balloon kyphoplasty at Cleveland Clinic were evaluated at a medium time of 12.8 months after the procedure. Improvements in 7 of 8 equality of life categories were not only noted, but were found to be significant. The 7 categories that demonstrated marked improvement were: social functioning, mental component, physical component, physical function, physical role, vitality and bodily pain. Other studies also cite significant improvement in equality of life and mobility.
Introduction
Many patients with myeloma develop bone disease can cause the bones to become thinner and weaker (osteoporosis), and it can make holes appear in the bone (lytic lesions). The weakened bone that results is more likely to break under minor pressure or injury (pathologic fracture). The bones most commonly affected are the axial skeleton (spine, pelvis, ribs, and skull) and the upper ends of the long bones of the arms and legs. Myeloma cells cause bone cells called osteoclasts, causing them to break down bone. In addition to giving rise to bone disease, this process also releases calcium; if this release happens too quickly, a condition called hypercalcemia can occur. Both myeloma bone disease and hypercalcemia can be treated with a group of drugs called bisphosphonates.
What Are Bisphosphonates?
Bisphosphonates are small inorganic molecules that bind to a substance called hydroxyapatite on the surface of damaged bones. At the sites of bone damage, osteoclasts are inhibited and destroyed. Since bone damage is caused by increased numbers and activity of these osteoclast bone cells, bisphosphonates reduce new bone damage and allow an opportunity for bone healing to occur.
Bisphosphonates therefore have several beneficial effects, including:
• Preventing further bone damage
• Reducing bone pain and the need for painkillers
• Correcting and preventing hypercalcemia (higher than normal levels of calcium in the blood)
• Reducing the need for radiotherapy
• Reducing pathologic feature due to myeloma (i.e., fracture at a site where myeloma has weakened the bone)
• Improving quality of life
• Improving the chances of healing and recovery of strength of the bone
Are Bisphosphonates A Type of Chemotherapy?
Bisphosphonates are not a type of chemotherapy. They were first introduced over 20 years ago as an additive for toothpaste to reduce dental decay.
Bisphosphonates are generally very safe and do not have the types of risks or side effects associated with chemotherapy, which is used to directly attack the myeloma. Bisphosphonates are used to treat several types of bone disease, including osteoporosis in women, as well as the bone-thinning effects of steroid treatment.
