Myeloma bone marrow cancer
Several types of cancer can develop in the bone marrow, but the main ones are leukemia, acute or chronic, and myeloma. What are the symptoms? What development to expect? How is it treated?
Do not confuse bone marrow with spinal cord. Unlike the bone marrow, the spinal cord belongs to the nervous system and has the function of transmitting the commands that allow movement and feeling, from the brain to the nerves. It is located in the canal formed by the stacking of the vertebrae of the column. Myeloma, also called multiple myeloma.
What is bone marrow?
Bone marrow is a substance inside the bone; in adults, it is mainly found in the flat bones, namely the sternum, ribs, vertebrae and pelvic bones. Every day it makes billions of cells called hematopoietic stem cells which give rise to different blood cells. This continuous production, through a process called hematopoiesis, allows the destroyed blood cells in our body to be permanently replaced with new cells.
There are three families of blood cells:
- red blood cells (or red blood cells or erythrocytes) which carry oxygen;
- white blood cells (or leukocytes) that protect our body from attacks;
- platelets that allow blood to clot.
Bone marrow plays a vital role in the body. In the event of dysfunction, i.e. in the case of serious blood diseases (leukemia for example), only a bone marrow transplant can restore the function of the marrow.
Types of bone marrow cancer
The bone marrow can be affected by different types of cancer. The most common are myeloma and leukemia, acute or chronic.
Most myeloma affects people aged 45 to 70 (3% of patients are under 40), and more frequently men. It is characterized by the uncontrolled production of immune cells called plasma cells. These diseased cells invade the bone marrow. In France, approximately 5,000 new cases of myeloma are detected each year.
• Acute leukemia
Leukemia is said to be acute when it progresses rapidly. It is characterized by an abnormally high production of abnormal white blood cells, that is to say whose development is not complete. They then invade the bone marrow and then the blood. Once in the circulation, they can reach other organs. Acute leukemia causes approximately 4,000 deaths per year in France, especially among children and the elderly.
• Chronic leukemia
It is characterized by invasion by mature white blood cells into the bone marrow. The disease is generally of slow evolution. Each year, nearly 4,500 new cases are diagnosed in France in 2012. This leukemia represents just over 1% of all cancers and 30% of all leukaemias. Men are more affected than women and the average age at diagnosis is 70 years. The 5-year survival rate is over 80%.
They are still little known. “Several avenues are being studied: genetics, environmental, in particular exposure to chemical industrial radiation. They can also be consecutive to a treatment of chemotherapy or of radiotherapy.”
The bone marrow is where blood cells, i.e. white blood cells, red blood cells and platelets, are produced. When cancer reaches this part of the body, it becomes less functional. This results in a decrease in the number of red blood cells (resulting in anemia responsible for fatigue and pallor), a decrease in the number of platelets (with a risk of bleeding) and the number of white blood cells (resulting in a fragility of the immune system, and therefore an increased risk of infections). Very significant bone pain, with spontaneous fractures, can also occur, as well as kidney failure.
To establish the diagnosis, your doctor first performs a clinical examination, then blood tests. If necessary, he will complete these examinations with a myelogram, that is to say a bone marrow sample and an analysis of its content.
Apart from acute leukemia, which constitutes a real threat in the short term (a few weeks or even a few days), the other diseases can present themselves in different forms, from very inactive diseases sometimes requiring only simple monitoring, to a disease declared requiring specific treatment initiation. The care will then be personalized according to the evolution of the cancer.
Read also: Why Do Many People Get Cancer?
Treatment for bone marrow cancer usually requires chemotherapy or immunotherapy. Targeted therapy can also be proposed as well as a bone marrow transplant. “A brand new treatment is being developed: it is an immunotherapy based on CAR-T cells. The patient’s own immune cells are modified to induce them to kill the bad cells. A multidisciplinary medical team meets to discuss treatment options appropriate to each patient’s situation.
- Chemotherapies such as melphalan (Alkeran®), cyclophosphamide (Cytoxan®), doxorubicin (Adriamycin®), liposomal doxorubicin (Doxil®) and vincristine (Oncovin®)
- High-dose chemotherapy and stem cell transplantation
- Corticosteroids like dexamethazone or prednisone, often in combination with chemotherapy
Immunomodulating agents (IMiDs) such as thalidomide (Thalomid®), lenalidomide (Revlimid®) and pomalidomide (Pomalyst®)
- Proteasome inhibitors (PIs), such as bortezomib (Velcade®), carfilzomib (Kyprolis®), and ixazomib (Ninlaro®)
- Monoclonal antibodies (MoAbs) such as daratumumab (Darzalex®)
Chronic leukemia has a good prognosis: 5-year survival is 80%. For myeloma, it is 40% at 5 years.