multiple myeloma | Multiple myeloma (Kahler's disease)

Multiple myeloma (Kahler's disease)

Multiple myeloma is the uncontrolled division of malignant plasma cells into the bone marrow. Bone marrow is the spongy, red tissue in the inner of our bones. Here are also our normal plasma cells.

Plasma cells are white blood cells that make antibodies. Another word for malignant plasma cells is myeloma cells. Multiple means several. The myeloma cells can be in several places in the bone marrow. Hence the name multiple myeloma.

Multiple myeloma was formerly known as Kahler's disease. Otto Kahler (1849-1893) was the Austrian internist who first described the disease. In the Netherlands the term Kahler is still used, but not abroad.

How often does multiple myeloma occur?
Every year about 1100 people get multiple myeloma. In men, the disease is slightly more common than in women. The average age is 70 years. One third of patients are over 75 years of age. A very small proportion of patients are under 45 years of age.

Bone marrow and blood cells
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There are different types of white blood cells. These all play a role in the weather. One kind of white blood cell is called lymphocyte. Certain lymphocytes can mature into plasma cells in the lymph nodes. A plasma cell nests after exit ping in the bone marrow. But plasma cells can also occur outside the bone marrow: for example in the intestines, the respiratory tract and the lymph nodes.

Plasma cells make our antibodies. Antibodies protect the body against infections with viruses and bacteria. Each plasma cell can only make one type of antibody.
Antibodies are proteins. Another word for protein is protein.
Uncontrolled growth
In the DNA of the plasma cells errors can occur during cell division. These changes in the genetic material are usually repaired. Sometimes there is no recovery. Then the cells can become malignant and start to share uncontrollably.

Normally, the number of plasma cells is less than 5% of the total number of cells in the bone marrow. In multiple myeloma, the number of plasma cells is often more than 5%. Sometimes it can be 90%.
Fireplaces
Malignant plasma cells can spread through the blood. Multiple myelomas are usually quickly placed in several places in the bone marrow. These places are called fireplaces.

Sometimes the malignant plasma cells grow from the bone marrow into the tissues, or they grow outside the bone marrow. Then the fireplaces are called plasmacytomen.
Plasma cell leukemia
Very often there are also a lot of plasma cells in the blood. That's called plasma cell leukemia.

Plasma cell leukemia is an aggressive disease. A stem cell transplant is often needed to achieve healing. This is then the only treatment with which someone can possibly cure. 

Plasma cell leukemia can also occur in a later phase of multiple myeloma.

M-protein

In multiple myeloma, a different plasma cell grows into a clone. A clone consists of cells that are all the same. In this case, all plasma cells with the same abnormality. 

The plasma cell makes an anti-dust. Because a clone consists of many of the same plasma cells, you get a large amount of 1 type of antibody at multiple myeloma. This is called a monoclonal antibody or M-protein. The M-protein is in the blood and sometimes in the urine to measure.

Light Chains

Antibodies are made up of 2 heavy chains and 2 light chains. Also the M-protein consists usually of heavy and light chains. Sometimes the M-protein is not completely created, but only a small part of it. The anti-dust consists of only light chains. Also sometimes a part of the M-protein is not completely created and a part does. Then someone has light chains and complete M-protein in the blood. 

With a special test, the light chains can be measured in the blood. 

The light chains are quite small. The kidney filters them out of the blood, but also takes them up again. If a lot of light chains are made, then the kidney cannot absorb them all again and a part in the urine is ended. The light chains can therefore be measured in the urine. They are called Bence-Jones proteins. 

The light chains can also accumulate in the kidneys. Then arise kidney problems.

Very sometimes the malignant plasma cells do not produce M-protein or light chains at all. This is called a non-secreting multiple myeloma.

Shortage of healthy plasma cells and other blood cells

In multiple myeloma, 1 type of plasma cell is shared uncontrollably. Because of this proliferation, normal plasma cells do not have enough space to develop well. As a result, there are fewer normal plasma cells in the bone marrow. Also, the associated normal antibodies in the blood are often reduced. This can lead to reduced resistance. 

Also, not enough other types of blood cells can be created. This may cause the following problems:

A shortage of red blood cells causes anemia

White blood cells are an important part of the resistance system. Decrease in healthy white blood cells increases the risk of infection.

Because of a shortage of platelets the blood solidifies less well. As a result, you can get more bruises or spontaneous nose or gum bleeding.