The simplest definition of multiple myelomas is that they are a form of a cancer, which arises from a single blood cell in the bone marrow, called the plasma cells. The plasma cells that become cancerous are termed myeloma cells. Myelomas do not represent a single disease entity, but rather encompass a large number of subtypes with diverse natural histories, from those that remain indolent for long periods to those that grow rapidly, and can prove fatal very quickly if untreated.
There are four subtypes of multiple myeloma (typically referred to as simply myeloma or plasma cell myeloma; also known as myelomatosis), dependent on the type of monoclonal protein produced. Each type appears to be associated with a different disease pattern; for example, IgA myeloma is associated with more organ damage, such as in the kidneys, than bone disease. About 50 per cent of patients with myeloma have cytogenetic abnormalities. The bone marrow often contains in excess of 30 per cent plasma cells. Rarely a variant of myeloma, called smoldering myeloma is diagnosed when the plasma cells in the bone marrow are between 10 and 30 per cent and no other findings of myeloma are present.
Treatment of Multiple Myelomas Cancer at World Class Cancer Hospital in India
Stem Cell Transplant for Multiple Myeloma
A stem cell transplant, also called a bone marrow transplant, can be an effective part of treatment for multiple myeloma. Hematopoietic stem cells reside in the bone marrow. They can produce all types of blood cells, including white blood cells, red blood cells, and platelets. In this procedure, hematopoietic stem cells are collected from the patient or another person.
A patient’s own stem cells are collected before chemotherapy, then returned when chemotherapy is complete.
Stem cells are given by a donor, most commonly a brother or sister. Autologous stem cell transplantation is more common for multiple myeloma, but either type of transplant can be used.
CAR T-cell Therapy for Multiple Myeloma
Chimeric antigen receptor (CAR) T-cell therapy is a type of cancer immunotherapy. It helps the body’s own immune system find and attack cancer cells. CAR T-cell therapy is also sometimes talked about as a type of cell-based gene therapy, because it involves altering the genes inside certain immune cells to help them attack the cancer.
To make this treatment, immune cells called T cells are taken from the person’s blood during a process called leukapheresis. Blood is removed through an IV line and goes into a machine that takes out the T cells. The remaining blood then goes back into the body. This process typically takes a few hours, and it might need to be repeated.
The T cells are then frozen and sent to a lab, where they are genetically altered so they have specific receptors (called chimeric antigen receptors, or CARs) on their surface. These receptors help the T cells attach to proteins on cancer cells. The T cells are then multiplied in the lab, which typically takes several weeks.
Once the CAR T cells are ready, the patient gets chemotherapy for a few days to help prepare the body. Then the CAR T cells are infused back into the patient’s blood, where they can seek out the cancer cells and help the immune system attack them.
Specialists will have a structured management plan for patients with symptomatic myeloma comprising specific supportive care to control symptoms, and also to minimise the risks of myelomarelated complications, such as bone disease and kidney failure, in addition to specific anti-myeloma therapy. Since the disease remains incurable at present, most specialists tend to offer treatment only to patients who become symptomatic.
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