Multiple Myeloma is a type of cancer that is in a type of white blood cell referred to as the plasma cell. The responsibility of Plasma cells is to fight infections in the body by making antibodies that can identify and attack any germs. Cancerous plasma cells form and group themselves in the bone marrow, therefore, leading to the release of healthy blood cells from the bone marrow when one suffers from Multiple Myeloma. Due to it being an uncommon type of cancer of the blood, patients can still survive depending on their stage of diagnosis. A stage I patient with multiple myeloma can survive up to 62 months. A stage II patient can then survive upto44 months and 29 months for a stage III. However, the life expectancy of the patients might differ due to several factors such as heath, kidney functioning, and age. Furthermore, myeloma cannot be cured and treatment options can be administered to control symptoms to ensure improvement of quality of life.
The common symptoms for Multiple Myeloma comprise Bone pain on the spine and chest area, nausea, constipation, weight loss, infections, mental confusion, and loss of appetite. Bone pain is common due to the numerous growths of blood cells and the replacement of them in the bone marrow releasing the healthy cells. Other symptoms that have been reported include tiredness, fever, numbness, weak bones that break easily, frequent nose bleeding, and bleeding gums. However, multiple myeloma symptoms occur most at advanced stages and can cause other vague symptoms at the beginning similar to other diseases making it hard to identify at the beginning unless tests are conducted (Mikhael et al,2019). Constipation, high levels of calcium in the blood, extreme thirst, and urination are also associated with multiple myeloma. When tested, multiple myeloma can be found early enough if blood tests show an abnormal high protein count present in the blood.
The pathogenesis for multiple myeloma is the uncoupling of the bone-related remodeling processes. Therefore, the interaction between myeloma cells and the bone results in the activation of osteoclasts as it suppresses osteoblasts and results in bone loss and pain. The exact of multiple myeloma remains unknown although science explains that it begins with one plasma cell multiplication in the bone marrow, the cells divide indefinitely rather than dying. However, age, race, personal history, gender, and exposure to radiation and chemicals can increase the chances of a person developing multiple myeloma. Cancer research has also established that people with a mutation of the lysine (K)-specific demethylase 1A are at greater risks of developing multiple myeloma with up to six to nine times more than one without the gene mutation. In terms of age, 65 years and above especially in males with past family histories of cancer have greater chances of developing multiple myeloma. The risk of development increases with age and the average age of most of the people diagnosed with multiple myeloma ranges between 66 and 70 years of age. Research has also concluded that about 37% of the people diagnosed with the same are younger than 65 when they got diagnosed. Although the mutations responsible for multiple myeloma are acquired and that are not inherited, another risk factor remains to be a family history.
The treatment options that are available for multiple myeloma include drug therapies such as proteasome inhibitors, steroids, immunomodulatory drugs as well as HDAC inhibitors, antibodies, and chemotherapies. All the treatment options work differently however its common goal is to control and destroy any multiple myeloma cells. Patients get administered with their drug combinations depending on their health such as kidney functionalities which only works for patients with active multiple myeloma. Often, the combination of the drugs administered
contains bortezomib, dexamethasone, and lenalidomide. The latest treatment option is called Selinexor which is a new type of drug under selective inhibitors of nuclear export. The drug has been approved by FDA as of July 2019, however, it is combined with dexamethasone to treat patients with multiple myeloma who have tried at least four of the previous treatment options without success (Rajkumar &Kumar,2020).
Other standard treatment options for multiple myeloma are therapies ranging from targeted therapies, immunotherapies, corticosteroids, bone marrow transplants, and chemotherapy. These forms of therapies are all present in most first-world nations. According to the American Cancer Society, local and systemic treatment options are available, however, stem cell transplant and other CAR-T-cell therapies are common for multiple myeloma patients. In third world countries, especially in the Sub-Saharan, the last step for the management of multiple myeloma treatment is therapeutic interventions. The current standard treatment is palliative care to offer supportive and psychological care for the patients. There is a notable gross inadequacy in the offering of palliative care for patients in developing countries due to its nature of being life-threatening and suffering associated with the disease.
According to recent studies, the overall survival rate for multiple myeloma patients is low in third-world countries. In these countries, according to research, only 7.6% of the patients survive up to only 5 years after post-diagnosis. However, targeted therapies with the help of drug combinations are used to suppress the conditions of multiple myeloma to keep patients surviving. Treating complications still exist in both cases of developing countries and first-world nations where bone pain medications and kidney dialysis must be considered for patients with severe
kidney damages. Doctors must also ensure to treat infections and recommend other vaccines that would help in the prevention of infections. To increase blood cell count that had been reduced in patients with anemia, doctors are forced to recommend medications.
Third world regions that have the highest ASIR of multiple myeloma as of 2016 were North America, Western Europe, and Australasia and it caused 2.1 million infections globally in 2016. The disease is common among African Americans which is common due to high-risk association with lower hemoglobin levels and an increase in the levels of lactate dehydrogenase which is responsible for an increased rate of disease infections. In first-world countries such as the United States, the multiple myeloma prevalence rate is very low where the lifetime risk of developing the disease is 0.76% which is 1 in every 132 persons (Bassali et al,2020). About 34,920 new cases have been estimated by the American Cancer society in 2021 where more men were diagnosed than females. The number of diagnosed males was estimated at 19,320 while that of females was estimated at 15,600.
Power differentials in the control and issuing of treatment options for multiple myeloma exist as well as giving preventive measures between governmental and private institutions. However, the government through its controlling units such as the American Cancer Society and the National cancer institute are responsible for conducting extensive research about multiple myeloma. This research surrounds the treatment options, prevention, and control of several types of cancer including multiple myeloma. This way hematologists and medical oncologists chip in the research to provide results for the public and the rest of the private institutions to help in the management of the disease and the provision of standard care.