Myeloma is a malignancy of plasma cells. These are the cells of the immune system that normally produce antibodies to protect us against infection. Patients with myeloma commonly present to their general practitioners with bone pain and fatigue. Laboratory tests to investigate these symptoms may reveal anaemia and damage to the kidneys. X-rays often show fractures.
Myeloma is commonly diagnosed in older people. The average age at diagnosis is about 70 years. The incidence of myeloma in Ireland is approximately 5 per 100,000 per year. There are, therefore, about 240 patients diagnosed with myeloma annually in Ireland.
The treatment of myeloma has greatly improved over the last 15 years, and it is considered one of the success stories of modern cancer treatment. New types of drugs have been developed, including proteasome inhibitors such as bortezomib (Velcade) and immune-modulatory drugs such as lenalidomide (Revlimid). These are now in widespread use in Ireland, allowing patients to live much longer with the disease. Many patients diagnosed this year can expect to live for a decade, if not longer.
The Haematology Service at St. James’s Hospital is the largest in Ireland and includes the National Adult Stem Cell Transplant Centre. There is a dedicated Myeloma Service, which looks after patients with a range of plasma cell disorders, including symptomatic myeloma, solitary plasmacytomas, light chain amyloidosis and monoclonal gammopathy of uncertain significance. There are currently over 70 patients with myeloma and amyloidosis attending our clinic.
The specialist myeloma clinical team consists of two consultants, Dr. Patrick Hayden and Professor Paul Browne, a clinical lecturer and a clinical nurse specialist, Ms Emma Hayes. There is a dedicated Myeloma Multi-Disciplinary Team (MDT) Meeting at which newly diagnosed patients are discussed and treatment options are reviewed.
There is one Myeloma Clinic each week and another for Myeloma Transplantation Counselling.
What is Myeloma?
Myeloma is a malignancy of mature B-lymphocytes, or plasma cells. These are the cells of the immune system that normally produce antibodies to protect us against infection. When a plasma cell becomes malignant, it often continues to produce an antibody in excessive amounts. This antibody can be measured as a ‘paraprotein’ in the blood and is a useful indicator of the amount of disease within the body.
The diagnosis of myeloma is made when an antibody-type protein is found in the blood or urine and a bone marrow biopsy reveals a large number of plasma cells. The term symptomatic myeloma is used when blood tests or X-rays reveal that the protein and cells are starting to damage the body. Sometimes, a patient may be anaemic, a sign that the normal cells in the bone marrow are not functioning properly. Occasionally, the kidneys are affected. Often, X-rays or special scans will show damage to the bones. Any of these changes indicate the need to start treatment.