KATHMANDU: Multiple myeloma also known as plasma cell myeloma is a kind of cancer that begins in the plasma cells. Plasma cells are types of white blood cells and are responsible for producing antibodies, which help in protecting the body from germs and harmful substances. These cells are produced in the bone marrow. “In the case of multiple myeloma, these plasma cells are produced in a large number in the bone marrow. They are then circulated through peripheral circulation. This is how it comes into the general blood circulation,” explains Dr Ajay Kumar Jha, MD, DM Consultant Haematologist, Bhaktapur Cancer Hospital, Bhaktapur.

No early symptoms

Multiple myeloma is a disorder of plasma cells in the bone marrow. Smouldering myeloma, which is the first stage of multiple myeloma, is usually asymptomatic. There are usually no signs and symptoms during this stage. People diagnosed with smouldering myeloma aren’t given any treatment. It is usually a wait-and-watch situation, as per the doctor.

Multiple myeloma is usually seen in elderly people, usually around the ages of 70/80 years. It can also occur in younger age groups such as 30-40 years. “There is no specific reason for the occurrence in young ages as such but the cases of multiple myeloma are also reported in young people,” adds Dr Jha.

In addition, the exact cause of multiple myeloma is not yet known.

Bleeding, low count of platelets, anaemia and infection such as pneumonia can be seen in the patients during the later stages. Many people have complaints of bone and back pain. “This is why many patients usually visit orthopaedics in the beginning,” reveals the doctor.

The pain in bones, back pain, fracture of spine and long bones are some of the other symptoms visible in patients. There could be a radiating pain in the patients. “The pain in the back usually spreads to the thigh and legs,” informs Dr Jha.

Along with the problems in bones, some of the patients also show symptoms such as tingling sensation and numbness. This is why before visiting a haematologist many patients go to neurologists in the beginning, as per the doctor.

Multiple myeloma can occur in patients with renal failure. Some other signs of the disease include bone tenderness, weakness, hypercalcemia — increased calcium level in blood. Some of the people even can have an obstruction in excretion and urination.

Little awareness

People are less aware about the disorder of the cells. “As there is a very little awareness about this type of cancer, the patients usually come to us quite late having visited several other doctors,” informs Dr Jha.

There is a dilemma in the patients about where to go for treatments during such symptoms as they do not have a clear idea of the disease s/he is suffering from. They also do not have an idea about which doctor to visit. “This is why doctors treating patients with such symptoms must be very conscious. They must advise patients for tests to find out platelets and white blood cells count. And if there is no normal report in them, then they must be immediately referred to a haematologist,” advises Dr Jha.

If the investigation is done on time, then it will be beneficial for the patients as the treatment for the disease can be immediately started. The ways to treat the disease are chemotherapy and bone marrow transplant. “The same treatment is given to everyone. Depending upon the cases, different cycles of chemotherapy are given to patients. A patient can become symptom-free after the treatment and can live for decades too,” adds the doctor.

Condition in Nepal

There is no exact data of the people suffering from multiple myeloma in the country. But as the treatment of the disease is a bit expensive, the government has given an assistance of Rs 1,00,000 for needy patients. This assistance is only available in comprehensive cancer centres such as in Bhaktapur Cancer Hospital, as per Dr Jha. “Bone marrow transplant services in the country aren’t available in government hospitals. The transplant in private institutions isn’t regular either,” adds Dr Jha.

“It isn’t established on an institutional level. This is why the patients are forced to visit Indian hospitals. Had we been able to provide the services for patients here in the country, a lot of time and money of the patients would have been saved,” opines the doctor.