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Types of multiple myeloma

Types of multiple myeloma

"When I learned that I was diagnosed with ‘smoldering (asymptomatic, indolent) myeloma’ my immediate response was when and where are we going to start the treatment. The doctor’s response was, that for the time being, they were just going to observe me! And regardless of my diagnosis, life still goes on."
Results of the blood, bone marrow and urine test in combination to other diagnostics procedures (X-rays and other imaging diagnostics, etc.) reveal the type of multiple myeloma. The majority of patients of multiple myeloma cases, approximately 65 %, belong to the subclass IgG. Patients are characterized by clonal and non-functional antibodies (protein) excreted by plasma cells. The second most common subclass in patients is subclass IgA. Subclasses IgM, IgD and IgE are rare. But multiple myeloma is not the only plasma cell disorder. There are other similar diseases as well. The clinical picture of a multiple myeloma can vary tremendously. Some patients suffer from symptoms of a ‘smoldering, indolent’ disease which does not require immediate treatment. But with others, a sudden onset of multiple myeloma can take an aggressive turn targeting bones, kidneys and cause organ failure.
Typically the multiple myeloma develops from a previous ‘irregularity/disease’ called MGUS or ‘monoclonal gammopathy of undetermined significance’. The onset of this disease is more common in older persons (3 % of people older than 70 years, with age the percentage increases). It is a benign and constrained overgrowth of plasma cells which produce a relatively low amount of M-protein (monoclonal protein). Such a condition doesn't require treatment, but patients do need to be regularly monitored and observed. Probability that MGUS will develop into multiple myeloma increases by 1 % for every additional year (e.g. a 60-year-old patient with MGUS will have a 20 % chance of developing multiple myeloma when he turns 80).
Physicians distinguish between various types of multiple myeloma.

    The course of multiple myeloma

    Despite the fact that the treatment is successful for the majority of patients, this disease has a high relapse rate. The goal of the treatment is therefore to prevent relapse, reduce complications and extend lifespan. If the disease relapses, the treatment should be repeated. Now our aim is to reach a complete response rate when treating multiple myeloma with the new drugs. This will significantly impact any possible complications arising from the disease and extend the survival rate of patients treated.

    AL amyloidosis – light-chain amyloidosis

    15 to 20% of patients who suffer from multiple myeloma can have a subdued AL amyloidosis. This means that clonal plasma cells produce excess free light-chains which in turn form a special amorphous protein called amyloid. This protein accumulates in all organs of the body except for the central nervous system. It accumulates in the heart, respiratory system, kidneys, peripheral nervous system, gastro-intestinal tract, etc.
    Patient’s clinical signs include signs of heart failure and kidney failure (they in turn secrete large amounts of protein), shortness of breath, diarrhea, weight loss, tingling sensations and numbness of hands and feet, light-headedness, it can result in loss of consciousness and carpal tunnel syndrome. Diagnosis is determined histologically. This means that a part of affected tissue has to be microscopically examined. Fat is usually affected; thus a biopsy of fat can be carried out. Associated AL amyloidosis is treated by treating multiple myeloma. By effectively treating multiple myeloma, clinical issues arising from amyloidosis subside as well.
    Even if the patient isn't suffering from multiple myeloma, plasma cells can still produce amyloid and after a clonal sample too. This is also known as AL amyloidosis. Organ impairment, clinical picture and diagnostic procedures are the same with patients suffering from multiple myeloma with accompanying AL amyloidosis. Concentration of M protein is elevated slightly with patients suffering from amyloidosis the same way it is with patients suffering from MGUS (monoclonal gammopathy of undetermined significance), a predecessor to multiple myeloma. An elevated level of protein in urine and elevated hormone levels in the blood which point to heart failure (BNP) are characteristic of the disease.
    AL amyloidosis is treated with the same methods as multiple myeloma, even with autologous HSCT if the patient’s condition allows it. The aim of the treatment is to suppress plasma cell clones which excrete amyloid and therefore prevent its deposition in the tissues.