Ep. 51 – Hematological Cancers Part 1: Multiple Myeloma (plus a case study!)

Today kicks off my 3-part series on hematological cancers – there’s so much to know about these types of cancers, & I’m excited to share an overview each episode about one of these specific cancers. We start today discussing multiple myeloma, which is a patient population I’ve developed a passion for over the past year, largely because of the patient case I will cover in my mini-case study at the end of today’s episode – enjoy!

Multiple myeloma is a plasma cell neoplasm.

  • Plasma cells are made by B-cells to make & release antibodies in order to fight infection.
  • When plasma cells replicate out of control, creating tumors in several sites, they are called plasma cell neoplasms.
  • There are several other types of plasma cell neoplasms.
    • I won’t cover all types here, but…
    • There is a condition called monoclonal gammopathy of undetermined significance (MGUS) that may predispose individuals to developing further plasma cell neoplasms or lymphomas later in life.

Physiological effects of multiple myeloma

  • Plasma cells release chemicals that stimulate osteoclast growth & activity, which leads to bone resorption.
    • Eventually, these areas of bone breakdown will appear as lesions on imaging. These lesions cause the bone to weaken & can lead to fractures.
    • Because of this, pain & fractures can be the first symptoms of multiple myeloma.
    • Fractures in the lumbar spine are the most common.
  • Due to the increased bone resorption & subsequent increased levels of calcium in the blood, a person may develop kidney issues related to hypercalcemia.
  • Malignant plasma cells release M-proteins, which increase viscosity of blood, potentially causing strokes.
  • Plasma cells, calcium, & proteins in the blood at excessive levels can lead to anemia, fatigue, & thrombocytopenia through their deleterious effect on red blood cells & platelets. These blood level abnormalities can also weaken a patient’s immune system.
    • Multiple myeloma can cause death if a person’s immune system is weakened & develops an opportunistic infection.

Because of these physiological effects, common signs & symptoms of MM include: bone pain &/or fractures, abnormal blood level symptoms (anemia, infections, etc.), nervous system issues (pain, paresthesias, weakness related to nerve damage or compression; confusion & dizziness related to blood level abnormalities), & kidney issues.

Treatment of Multiple Myeloma

Treatment of MM can include a multitude of options, often depending on a patient’s staging & prognosis:

  • Chemotherapy
  • Radiation
  • Surgery
  • Hematopoietic stem cell transplant
  • Immunotherapy
  • Watchful waiting – observation

Check out some great resources for more on hematological cancer treatments:

I also took over the Academy of Oncology Physical Therapy’s Twitter feed this week, talking all about multiple myeloma – check it out!

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