Multiple myeloma is a type of blood cancer that affects the blood system, mainly resulting in complications in the kidneys and bones — with symptoms that are difficult to differentiate from other various diseases.
The disease attacks plasma cells, a type of white blood cell, which has the function of producing antibodies to fight infections. Instead of healthy cells, malignant versions appear that multiply and start producing abnormal antibodies, known as M protein or monoclonal protein, which harm different parts of the body – and that is why the disease bears the word “multiple” in its name.
Patients usually feel, before any other sign, low back pain, a very generic symptom, which can be the result of a night’s sleep in a not so comfortable position, too heavy a workout at the gym or many other day-to-day factors. But that is also considered the main symptom of this rare cancer.
It was precisely this discomfort that led tradesman Luiz Fernando Fontenele, 37, to begin a long journey of examinations and medical consultations until he discovered the disease. “I was in a lot of pain and only seven months after suffering the first fracture did I receive the diagnosis. I myself raised the suspicion because I had read about the symptoms on the internet”, he recalls.
As with Luiz Fernando, the disease can lead to fractures, as it makes bones weaker, anemia, due to the excess of plasma cells in the bone marrow, which causes a reduction in the number of blood-forming cells, and in more severe cases, the renal failure, due to the damage that the condition causes to the renal tubules.
Although rare, it is the second most common blood cancer in the world. In Brazil, it is estimated that four out of every hundred thousand people suffer from the disease, an average of 7,600 new cases each year.
The disease is more common in people over 60, but it is diagnosed in younger people. The most emblematic case in world literature happened here in Brazil. An 8-year-old boy, resident of Salvador, Bahia, was diagnosed with the condition. According to the IMF (International Myeloma Foundation Latin America) organization, he was the first child in history to receive the diagnosis.
Multiple myeloma can be detected by urinalysis or a blood test called a serum protein electrophoresis, ordered when symptoms indicate inflammatory disease, autoimmune disease, acute or chronic infection, liver or kidney disease.
“Although I believe that the exam does not need to be routinely ordered for all people – even because this could mean public spending that would take resources from other diseases – I consider it unacceptable that a patient can stay so long with symptoms, and due to the lack of knowledge of professionals who are not specialists, do not have an exam request that leads to the diagnosis”, says Angelo Maiolino, professor of hematology at UFRJ (Federal University of Rio de Janeiro).
After the first symptoms, 29% of patients with multiple myeloma take a year to receive the diagnosis, and 28% wait for an even longer time, according to a survey by Abrale (Brazilian Association of Lymphoma and Leukemia).
“I’ve seen cases of people who were undergoing dialysis, with very compromised kidneys, who only discovered the disease three years later”, says Maiolino.
Treatment
Since the first diagnosis of multiple myeloma, in the 18th century, medicine has made advances in the evolution of both the biological knowledge of the disease and the treatments, which today allow patients with this type of cancer to live longer and with more well-being.
The disease has no cure, but in many cases, treatments allow patients to live well, with good control of symptoms. “It’s as if they had a chronic disease such as diabetes, hypertension…”, says Maiolino.
Early intervention, according to the doctor, is the way to prevent the advancement of the disease from irreversibly compromising the health of patients. “We use one type of treatment for each stage of the disease, but if the condition is discovered late, the patient will not be able to reap the benefits of the early stages of care,” he explains.
Another very common option is the indication of stem cell transplantation. Before the transplant is performed, treatment with chemotherapy or radiotherapy is done so that the existing bone marrow (place where the body makes blood, white and red blood cells and platelets) makes room for a new marrow to be created.
The new bone marrow is a gelatinous fluid that can come from a donor or be autologous (from the patient himself).
Luiz Fernando was transplanted, but suffered a recurrence, that is, the disease returned. “It was more difficult than receiving the diagnosis. I have a specific treatment, with a combination of drugs every 28 days in a hospital environment and every 21 days at home. I discovered multiple myeloma at the age of 28 and I don’t remember a day that I passed without pain. It is difficult, but we learn to live with it. The combination of medicines allows me to have a normal life.”
* This text has been originally published on BBC News Brazil.
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