Multiple Myeloma

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Multiple Myeloma
Multiple Myeloma is a form of cancer which affects the plasma cells of the body, which are white blood cells. Multiple Myeloma, first described in 1848, is a disease “characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein.” To understand how Multiple Myeloma affects an infected person’s plasma cells, it helps to have a general understanding of how normal blood cells are formed and how they act. Most blood cells develop from stem cells, which can be found in bone marrow (soft material inside our bones – the “filling”). Stem cells mature into white blood cells, red blood cells, or platelets.2 The purpose of white blood cells is to fight off infection, while red blood cells carry oxygen and platelets aid in blood clotting, which controls bleeding. Plasma cells make antibodies, which are parts of the immune system and help the body protect itself from germs and other harmful substances (Exhibit 1).2

Myeloma begins when a plasma cell begins dividing uncontrollably, which sets off a chain reaction of abnormal cell divisions. These abnormal plasma cells are called myeloma cells. Eventually, there is a large buildup of myeloma cells in the bone marrow, potentially damaging the outer, solid part of the bone. The reason the disease is called multiple myeloma because it usually affects several bones in any given infected person. The myeloma cells, instead of creating the normal antibodies, create M proteins, which can collect in the urine, blood, or even in organs as blood spreads it throughout the body (Exhibit 2).2

Whether or not Multiple Myeloma has genetics roots which are traceable is still up for debate, but there isn’t much evidence to suggest that there is a genetic component in multiple myeloma diagnoses. A research study done by the Centre for Haematological Oncology at The General Infirmary at Leeds in England looked at 23 patients diagnosed with multiple myeloma. The test showed that of those, only 1 patient (3.2%) had a detected p53 mutation. P53 is a tumor suppressor gene, meaning its purpose is to stop the formation of tumors by regulating the cell cycle (Exhibit 3). While there are instances where a child inherits only one functional p53 gene from their parents (known as Li-Fraumeni syndrome), this is a very rare instance and the more common form of p53 deficiencies is the mutation of the p53 gene. More than 50% of all adult cancers involve a mutated p53 gene; however, as shown above, multiple myeloma normally does not involve a mutated p53 gene. There some risk factors involved with multiple myeloma that increase one’s chances of being diagnosed, which are discussed in the subsequent section, along with multiple myeloma case data.

While there are several risk factors for multiple myeloma, it is generally unknown as to why a particular person develops multiple myeloma.3 The first risk factor for multiple myeloma is age – most people diagnosed with multiple myeloma are over 65, and the disease is very rare amongst people younger than 40. 3 Another risk factor is race – the risk of multiple myeloma is highest for those of African descent, and lowest amongst those of Asian descent. The disease is significantly more common in men than in women – each year, approximately 11,200 men are diagnosed with multiple myeloma, as opposed to 8,700 women. The reason for the race and gender risk factors of multiple myeloma, however, is unknown.3 While there is no consistent statistical data, it is widely accepted amongst doctors that family history, especially of a 1st level relative (parents, siblings), is a risk factor for multiple myeloma. Monoclonal gammopathy of undetermined significance (MGUS) is “a benign condition in which abnormal plasma cells make M proteins.”3 There are usually no symptoms, but it has been found that there is an increase in probability of someone being diagnosed with multiple myeloma if there have...
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