Multiple Myeloma

WRITTEN BY:

KHUSNUL LATIFAH
PO.71.34.1.19.016

DIPLOMA III MEDICAL LABORATORY TECHNOLOGY

POLTEKNIK KESEHATAN KEMENTERIAN KESEHATAN PALEMBANG
2019/2020
 PREFACE

First of all, thanks to Allah SWT because of the help of Allah, writer finished
writing the paper entitled “Multiple Myeloma” right in the calculated time.

The purpose in writing this paper is to fulfill the assignment that given by Ms. Siti
Nuraziza Tuzzuhro, M.Pd as lecturer in English major. 

In arranging this paper, the writer trully get lots challenges and obstructions but
with help of many indiviuals, those obstructions could passed. Writer also realized
there are still many mistakes in process of writing this paper.

Because of that, the writer says thank you to all individuals who helps in the
process of writing this paper. Hopefully Allah replies all helps and bless you all.
The writer realized tha this paper still imperfect in arrangment and the content.
Then the writer hope the criticism from the readers can help the writer in
perfecting the next paper. Hopefully, this paper can helps the readers to get more
knowledge about Multiple Myeloma.

Palembang, November 9th, 2019

Author
 CHAPTER I
INTRODUCTION

A. Background
A disease is an abnormal condition affecting a living organism. Diseases
are generally understood to be medical conditions that involve a
pathological process associated with a specific set of symptoms. Localized
diseases affect specific parts of the body; disseminated diseases spread to
other parts of the body; and systemic diseases affect the entire body.

Each disease process has an origin, or etiology, but some diseases may
present with different or confusing symptoms, making them difficult to
diagnose or determine. The physical symptoms of disease may be
accompanied by emotional symptoms, and some diseases that affect the
chemical balances of the nervous system may manifest in physical
symptoms.

Categories of diseases include autoimmune, bacterial, blood, cancer,

digestive, heart, nerve (or neurodegenerative), sexually transmitted or
thyroid. Diseases may be communicable or noncommunicable. External
sources that can cause disease include acquired viruses or bacteria, and
internal causes of disease include autoimmune or genetic dysfunction.
Some diseases are chronic, meaning that they are continually present and
may present symptomatically during a long duration.

Multiple myeloma disease is a cancer of a plasma cells. Cancer is a disease

where the cells grow abnormally, out of control, in a wrong place. Our
bodies are made from billions of cells, like bricks make a house. The cells
in our bodies thaat meke up the heart, lungs, kidneys, muscles and skin are
all quite different. When the cells are damaged, they can start growing in a
way that is not normal. The uncontrolled cells will form a lump called a
tumour, or they travel inside the bloods vessels (leukemia) or in the lymph
nodes (lymphoma).
B. Problem Identification

a. What is Multiple Myeloma?

b. What are the causes of Multiple Myeloma?

c. What are the symptoms of Multiple Myeloma?

d. What are the risk factors for Multiple Myeloma?

e. What are the treatments for Multiple Myeloma?

f. How to diagnosis of Multiple Myeloma?

g. What are the complication of Multiple Myeloma?

C. Purpose

The purpose of writing this paper is to:

a. Know the definition of multiple myeloma

b. Knowing the causes of multiple myeloma

c. Knowing the symptoms of multiple myeloma

d. Knowing the risk factors of multiple myeloma

e. Knowing how to diagnose multiple myeloma

f. Knowing the complication of multiple myelomahs.

g. Knowing the treatments for multiple myeloma

.
 CHAPTER II
THEORY AND DISCUSSION

1. Multiple Myeloma

Blood is made of many types of cells, called blood cells. The three main
types of blood cells are platelets, red blood cells, and white blood cells.
Each type of blood cell has a certain job in the body. Platelets help
control bleeding. Red blood cells carry oxygen throughout the body.
White blood cells help fight germs and infections in the body. They are
part of your body’s disease fighting system called the immune system.

Most blood cells are made in bone marrow. Bone marrow is the soft,
sponge-like tissue found in the center of most bones. Blood cells are
made from special, immature cells called blood stem cells. Blood stem
cells can develop into all types of mature blood cells.

Many types of white blood cells are made from a blood stem cell. Types
of white blood cells include granulocytes, B cells, and T cells. The
different types of white blood cells fight germs in different ways. When
germs invade the body, B cells change into plasma cells. In a healthy
person, less than 5 out of 100 cells in the bone marrow are plasma cells.

Plasma cells make antibodies (also called immunoglobulins).

Antibodies are proteins that help your body find and kill germs. Each
type of plasma cell makes only one type of antibody. The type of
antibody made is meant to attack the specific germ that is causing the
infection or illness. There are five types of antibodies or
immunoglobulins (IgG, IgA, IgM, IgE, and IgD). Each type has a
different role.

Multiple myeloma (also simply called myeloma) is a cancer that starts

in plasma cells. Plasma cells grow and then divide to make new cells.
New cells are made as the body needs them. When plasma cells grow
old or get damaged, they die.

Genes are the instructions in cells for making new cells and controlling
how cells behave. Changes in genes turn plasma cells into myeloma
cancer cells. An abnormal change in a gene is called a gene mutation or
defect.

In contrast to healthy plasma cells, myeloma cancer cells make more

and more new cells that aren’t needed and don’t die quickly when old or
damaged. The myeloma cells continue to make millions of copies of
themselves. As a result, a group of myeloma cells with the same gene
mutation forms, often referred to as a clone of cells. Myeloma cells may
be spread throughout the bone marrow or form masses growing in one
or more spots outside of the bone marrow. These masses can destroy
the bone around them as they grow.

A mass of myeloma cells is called a plasmacytoma. When there is only

one mass of myeloma cells, it is called a solitary plasmacytoma. When
myeloma cells grow and spread throughout the bone marrow, it is called
multiple myeloma.

The myeloma cells can crowd out normal blood cells in the bone
marrow, destroy bone tissue, and spread all over the body. It is not fully
known why a normal plasma cell changes into a myeloma cancer cell.

Like plasma cells, myeloma cells also make antibodies. But, the
antibodies made by myeloma cells are all copies of one specific type of
antibody. Since they are made by a clone of myeloma cells, they are
called monoclonal proteins or M-proteins. Myeloma cells make M-
proteins without control and not in response to a specific germ in the
body. M-proteins don’t help to fight infections.

In most patients, myeloma cells make very large amounts of M-

 proteins. Rarely, the myeloma cells make very little or no M-protein.
This is called oligosecretory or nonsecretory myeloma.

Normal antibodies are made of two heavy protein chains and two light
protein chains. Heavy chains are one of five types—A, D, G, E, or M.
Light chains are one of two types—kappa or lambda. The form of
heavy chain defines the type of antibody.

Like normal antibodies, M-proteins are also made of two heavy chains
and two light chains. However, myeloma cells tend to make more light
chains than needed to form a complete M-protein. This leads to excess
light chains that aren’t attached to a heavy chain. These are called free
light chains. High levels of free light chains are found in the urine of
some people with myeloma.

The light chains from M-proteins found in the urine are also called
Bence Jones proteins. In about 15 out of 100 people with myeloma, the
myeloma cells only make light chains and no complete M-proteins.
Doctors call this light chain myeloma or Bence Jones myeloma.

2. Symptoms of Multiple Myeloma

In a healthy person, there are plenty of normal blood cells and normal
amounts of all five types of antibodies. In a person with myeloma, fewer
normal blood cells are made when the bone marrow is full of myeloma
cells. Likewise, normal antibodies are outnumbered by the one type of
abnormal antibody—M-protein—made by the myeloma cells. As a result,
symptoms of the myeloma will appear. Symptoms of multiple myeloma
felt by each patient are generally different. In the initial course of the
disease, sufferers often do not feel any symptoms.

When myeloma is causing symptoms or affecting organs, it is called active

(symptomatic) myeloma. Symptomatic myeloma should be treated. Even
without symptoms or damage to body organs, myeloma with certain lab
test results that suggest it will soon cause symptoms also requires
treatment. Such lab test results include the amount of plasma cells in the
bone marrow, the amount of abnormal light chain, and the number of
painless bone lesions.

When myeloma isn’t causing symptoms and does not have lab test results
that require treatment, it is called smoldering (asymptomatic) myeloma.
Patients may also have small amounts of M-protein and smaller numbers
of abnormal plasma cells in the bone marrow without any symptoms, a
condition referred to as MGUS (monoclonal gammopathy of
undetermined significance). Some of the most common symptoms of
active myeloma are :

a. Fatigue and feeling weak

Fatigue is severe tiredness despite getting enough sleep and

rest. Fatigue and feeling weak are symptoms of anemia.
Anemia is a condition in which the amount of hemoglobin in
the red blood cells is low. Anemia can be caused by too many
myeloma cells crowding out growing red blood cells in the
bone marrow.

b. Bruising or bleeding easily

Platelets are blood cells that help heal wounds and stop
bleeding. They do this by forming blood clots. Bruising or
bleeding easily is a symptom of having a low number of
platelets. Too many myeloma cells in the bone marrow can
crowd out the cells that make platelets.

c. Frequent infections and fevers

Fever is a sign that your body is trying to fight off an

infection. Frequent fevers and infections are symptoms of
having too few white blood cells, but this can also be due to
 low levels of normal antibodies. A low number of white blood
cells can result from too many myeloma cells in the bone
marrow.

d. Bone damage and pain

Myeloma cells can cause bone damage when they crowd out
normal cells in the bone marrow. They also release chemicals
that begin to break down bone. Areas of bone damage are
called bone lesions and can be very painful. Bone lesions also
weaken bones so they may break (fracture) easily.

Common sites of bone damage from myeloma are the spine,

skull, hip bone, ribs, arms, and collarbone.The most common
fracture site is in the bones (vertebrae) of the spine. Fractures
of the vertebrae can be very painful, but they can also occur
without any pain.

e. Kidney problems
The kidneys are a pair of organs that filter blood to remove
waste, which leaves the body in urine. Increased or decreased
urine output is a symptom of kidney damage. The high levels
of M-proteins made by the myeloma cells can cause kidney
damage.

Myeloma can damage bones, and this bone damage causes

calcium to be released into the bloodstream. Calcium is a
mineral needed for healthy bones. But, high levels of calcium
in the bloodstream can damage the kidneys and cause other
symptoms.
3. Causes of Multiple Myeloma

Multiple myeloma is not known with certainty the cause. Abnormal

plasma cell growth (myeloma) can multiply rapidly and exceed normal
cell growth, then produce antibodies that are detrimental to the body.

There are multiple myelomas in benign form, namely MGUS (monoclonal

gammopathy of undetermined significance). MGUS is a condition when
abnormal antibodies are produced by myeloma cells, but do not cause
damage to the body. However, most cases of multiple myeloma begin with
MGUS. It is estimated that of one hundred people with MGUS, one of
them develops into multiple myeloma each year.

4. Multiple Myeloma Risk Factors

There are several factors that can put a person at risk for multiple
myeloma, including:

 Gender. Cases of multiple myeloma are more common in men than

women.

 Age. Most of myeloma is diagnosed at the age of mid 60 years.

The risk of someone suffering from this disease increases with age.

 Race. Multiple myeloma is more common in black people

compared to white people or Asians.

 Suffer from MGUS.

 Family health history. Someone is more at risk of getting multiple

myeloma if there are family members who suffer from this disease.

 Being obese.
5. Diagnosis of Multiple Myeloma

Detecting multiple myeloma is not easy, because not all cases show certain
symptoms. To find out if someone really has multiple myeloma, the doctor
will conduct a series of tests based on symptoms and associated risk
factors. Tests are carried out to diagnose multiple myeloma and determine
its stage. Some types of tests and procedures that must be undertaken
include:

a. Blood test

Blood tests are performed such as a complete blood count, kidney

function, calcium levels, LDH (lactate dehydrogenase), albumin
and globulin. What was found was a decrease in Hb levels (anemia)
and albumin, a decrease in the number of platelets
(thrombocytopenia), as well as an increase in calcium and globulin
levels.

In addition to detecting abnormal proteins in the blood can be done

an examination called serum protein electrophoresis (SPEP),
immunofixation, free light chain (FLC) assay, and beta-2
microglobulin. LDH and beta-2 microglobulin are used to
determine the stage of multiple myeloma.

b. Urine examination

Similar to blood, urine samples can also be checked for abnormal

proteins. The tests carried out were urine protein electrophoresis,
immunofixation, and free light chain (FLC) assay. In addition, 24-
hour urine collection was performed to detect the amount of
abnormal protein called Bence Jones protein.
 c. Bone marrow aspiration examination

Blood and tissue samples from bone marrow aspirations taken from
the pelvis near the buttocks area are performed to see a picture of
the growth of plasma cells. This procedure is done using a larger
and longer needle, but it is still done with local anesthesia.

d. Scanning

Scans such as X-rays (bone survey examination), MRI, CT scan, or

PET scan (positron emission tomography). Scanning is useful for
detecting abnormalities in the bones associated with multiple
myeloma. Scans are performed on the head, spine, arms, pelvis,
and legs to find out any damage to that part.

From the examination carried out, the doctor can determine the stage of
multiple myeloma. Multiple myeloma is divided into three stages, namely
stage I, stage II, and stage II. This stage is divided based on the
aggressiveness of the disease. The higher the stage, the more aggressive
the disease.

6. Treatment of Multiple Myeloma

Multiple myeloma cannot be cured yet. However, the following types of

treatments can help relieve pain, prevent complications, and keep patients
stable by slowing the progression of multiple myeloma. With treatment,
patients can return to their activities. Some treatments for multiple
myeloma include:

 Drugs

Medications are usually given in the form of tablets, infusions, or a

combination of the two drugs. Some drugs that can be given are
bortezomib, cyclophosphamide, melphalan, lenalidomide,
thalidomide, prednisone, or dexamethasone.
The decision of the type of drug and the dose given is very dependent
on the condition of the patient and the patient's immune system,
because the drugs used will have side effects, ranging from mild to
dangerous, to the patient. Patients under 65 years are usually stronger
to receive more aggressive therapy.

In some patients whose multiple myeloma is asymptomatic (called

smouldering multiple myeloma), it does not require immediate
treatment. However, it is required to monitor the disease until the
initial symptoms appear, in order to get treatment.

In addition to drugs for multiple myeloma, drugs are also given to

treat the symptoms andcomplications that accompany. Pain
medications and bisphosphonate drugs are used to prevent bone
damage and reduce calcium levels in the blood. Erythropoietin can
also be used to treat anemia.

 Bone marrow or stem cell transplantation

In this procedure, the bone marrow infected with cancer cells is

replaced with new bone marrow. Before transplantation, the bone
marrow is cleaned of cancer cells through high-dose drugs for
multiple myeloma. Then stem cells are inserted into the body with the
aim of forming new bone marrow.

 Radiotherapy

Radiotherapy using X-rays and protons is used to destroy cancer cells

and stop the growth of myeloma cells which triggers pain and bone
damage.
  Dialysis

Dialysis is done if damage to the kidneys develops into kidney failure.

 Operation

Surgery is carried out if there are abnormalities in the bone that aim to
repair or strengthen the damaged bone.

7. Complications

Complications of multiple myeloma include:

 Frequent infections. Myeloma cells inhibit your body's ability to

fight infections.

 Bone problems. Multiple myeloma can also affect your bones,

leading to bone pain, thinning bones and broken bones.

 Reduced kidney function. Multiple myeloma may cause problems

with kidney function, including kidney failure. Higher calcium
levels in the blood related to eroding bones can interfere with your
kidneys' ability to filter your blood's waste. The proteins produced
by the myeloma cells can cause similar problems.

 Low red blood cell count (anemia). As myeloma cells crowd out
normal blood cells, multiple myeloma can also cause anemia and
other blood problems.
 CHAPTER III
CONCLUSION

Conclusion

Multiple myeloma is a type of cancer that attacks plasma cells, which is a type of
white blood cells, in a patient's bone marrow. Multiple myeloma is not known
with certainty the cause. there are some certain risk factors increase one's chances
of leaving develop multiple myeloma, including: gender, race (nation), age over
60 years, personal history monoclonal gammopathy with undetermined meaning
(MGUS), multiple history taking myeloma family.

Symptoms of Multiple Myeloma are fatigue and feeling weak, bruising or

bleeding easily, frequent infections and fevers, bone damage and pain, kidney
problems. There is no specific prevention for multiple myeloma. The most
important thing is when you have been diagnosed with MGUS (monoclonal
gammopathy of undetermined significance) or smouldering multiple myeloma,
keep doing routine checks to the doctor so that if you turn into multiple myeloma
can be known from an early stage, so get the right treatment and no further
complications arise. With treatment, the patient's expectation of living with a
controlled disease if found in stage I is an average of 5.5 years and if found in
stage III an average of 2.5 years. After that the disease can worsen and
replacement treatment methods may be needed.

Suggest

I as a writer, apologize for the shortage of this paper. I know that this paper is still
far from perfect. So, I need the suggest from readers for the perfection of this
paper. Hopefully this paper can be useful for readers in general and for writers in
particular.
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GUIDELINES FOR PATIENTS, NCCN. 2019. Multiple Myeloma

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Rajkumar, S. Kumar, S.2018. Multiple Myeloma : update on diagnosis, risk-

stratification, and management.
https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.25117

Chou, Takaaki.2012. Multiple Myeloma : Recent Progress in Diagnosis and

Treatment.
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Singh, Diane Mariah and Raymakers, Elisabeth. What is cancer?

http://www.kznhealth.gov.za/Greys/What_is_cancer.pdf

dr.Marianti.2017.Multiple Myeloma.
https://www.alodokter.com/multiple-myeloma