Multiple myeloma is a cancer of plasma cells. Plasma cells are important to the body’s immune system. Indeed, PCs are committed to the production of immunoglobulins, i.e. our antibodies. In MM, there is the massive expansion of a clonal population of PCs that usually produces a single specific type of immunoglobulin or part (light chains) of a given immunoglobulin.

The bone marrow is markedly affected by the expansion of abnormal PCs, with several consequences, including an inefficient immune activity.

STAFF

At the IEO multiple myeloma is treated by a multidisciplinary team consisting of specialists in:

• Clinical Haemato-Oncology
• Haematopathology
• New Drugs and Early Drug Development for Innovative Therapies
• Department of Pathology and Laboratory Medicine
• Department of Medical Imaging and Radiation Sciences

Multiple myeloma risk factors are:

• Age: the risk of developing multiple myeloma is higher when people get older
• Gender: multiple myeloma is more frequent for men than women
• Family history
• Obesity
• Having other plasma cell disorders

Symptoms and diagnosis

Main symptoms of this blood cancer are:

• Bone pain
• Weakness, easily fatigued
• Nausea, vomiting, confusion, or feeling a greater thirst
• Numbness, tingling, or weakness
• Losing weight without changing eating habits

Main tests for diagnosis of this blood cancer:

• Blood and urine tests
• Bone marrow biopsy
• Imaging: X-ray or MRI and others, with particular attention to the study of bones

Multiple myeloma can follow a very slow course and causes no manifestations (smoldering myeloma) or present with more rapidly growing diseases and distressing symptoms. The treatment decision therefore varies according to many factors including the blood cancer nature and the patient general condition and comorbidities.

In general, treatment options can be:

Observation and follow up without any specific therapy, for patients with smoldering form of MM.
Active treatment for all patients presenting with more active disease, includes: 

• Chemotherapy: a number of protocols of chemotherapy drugs are available in the treatment of multiple myeloma. The selection is based on the patient and disease related feature and the specificity and toxicity profile of each drug.

• Steroid medicines: are important part in the treatment that potentiate the killing of blood cancer cells

• A class of drugs known as immune-modulating drugs, have been introduced in the treatment of MM, over the last 15 years. These drugs can arrest the growth of blood cancer cells and are usually employed either alone or most often in combination treatments

• BM transplant: this type of transplant is done using the same person bone marrow cells and the procedure is known as auto-transplantation. The bone marrow cells that generate the blood elements are collected. The patient then receives a more intensive chemotherapy regimen that aims to kill all blood cancer cells but it also kill normal BM cells. So, after the intensive chemotherapy, the collected BM cells are put back in the patient body to support him during the period needed for recovery from the chemotherapy effect. At present, auto-transplant is a major treatment option in MM, at least for patients aged <65 yrs.

Several treatment options are now available in MM; at present, the common approach includes the alternation of different treatment schedules, with the alternating delivery of steroids, immune-modulating drugs and conventional chemotherapy, either alone or in combination, and intensified chemotherapy with auto-transplant, as well, if feasible. Indeed, intensified chemotherapy with autotransplant is a key treatment option in MM, particularly in adult patients aged < 65 years. Programs extending the use of autotransplant-based therapy to elderly subjects are under evaluation.

The transplant procedure with hematopoietic stem cells from a compatible donor, i.e. the allogeneic transplantation (alloSCT), has a minor role in the management of MM. However, in younger patients, with reduced response to standard treatment for blood cancers, including the new immune-modulating drugs, the allogeneic transplantation may be an alternative and potentially effective treatment option.