What Is Cancer?

Grappling With Spinal Cord Pain? Don't Ignore These Symptoms Of Multiple Myeloma

Spinal Cord.Image: Pexels

Multiple myeloma is a type of blood cancer that arises from abnormal or malignant plasma cells. Normally, a healthy plasma cell is found in bone marrow and is responsible for producing antibodies to provide immunity to the person. Multiple myeloma can arise when plasma cells transform into malignant plasma cells which leads to the uncontrolled growth of these abnormal plasma cells, which crowd out healthy blood cells. This can cause bone damage, kidney dysfunction, anaemia, and weakened immunity.

The disease is considered incurable but treatable, with therapies aimed at controlling its progression and improving quality of life. According to GLOBOCAN 2022 data, multiple myeloma (MM) accounted for approximately 0.94% of all new cancer cases globally, with an estimated 187,952 new diagnoses and 121,388 deaths in 2022. The age-standardized incidence rate (ASIR) was 0.22%, and the age-standardized mortality rate (ASMR) was 0.13%.

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Cases of multiple myeloma in India

In India, multiple myeloma is increasingly being diagnosed at a younger age, often a decade earlier than in Western countries. A major challenge in younger patients is the low index of suspicion, as physicians may not immediately consider myeloma when individuals present with non-specific symptoms like back pain, fatigue, or fractures. Common symptoms such as spinal fractures, anaemia, paraplegia, and infections further complicate early detection due to their overlap with other conditions. Many patients first seek care from general physicians, leading to prolonged diagnostic delays before reaching specialized oncology centres.

Multiple myeloma Symptoms

Common Symptoms: Persistent back pain, bone pain, or fractures may occur even with minimal trauma. Spinal fractures can happen without any injury.

Anemia-related symptoms: Fatigue, weakness, and breathlessness on exertion are common symptoms associated with anemia.

Neurological symptoms: Paraplegia, or loss of power in the lower limbs, can make it difficult to stand or move. This can happen due to vertebral body fractures or tumor compressing the spinal cord.

Less common symptoms: Kidney failure may occur due to disease progression. Frequent infections, such as urinary tract infections, lung infections, or sepsis, can also arise due to weakened immunity. It's important to remain cautious if back pain suddenly worsens, changes in pattern, or is accompanied by weakness or neurological issues in the legs.

Advancing therapies in multiple myeloma

Multiple myeloma treatment has significantly advanced with the introduction of targeted therapies, stem cell transplantation, immunotherapy, and CAR T-cell therapy, offering better disease control and prolonged survival. Targeted therapies, including novel agent drugs, work by specifically attacking cancerous plasma cells while minimizing damage to normal cells.

These drugs serve as the first line of treatment, helping to control the disease and reduce symptoms. For deeper remission, autologous stem cell transplantation is often performed, where a patient's own stem cells are used to restore healthy bone marrow after high-dose chemotherapy.

For patients who relapse or do not respond to initial treatments, immunotherapy has emerged as a promising option. Monoclonal antibodies and other immune-based treatments help the body's defense system recognize and attack myeloma cells more effectively. In more resistant cases, CAR T-cell therapy represents a major breakthrough.

This advanced treatment involves extracting the patient's T-cells, genetically modifying them in a laboratory to target myeloma cells, and then reinfusing them back into the body to enhance their cancer-fighting ability.

Genetic profiling plays a crucial role in treatment selection, as certain high-risk mutations require more aggressive therapeutic strategies. However, despite these innovations, a complete cure remains rare, and patients often require long-term or maintenance therapy.

Early diagnosis is crucial to prevent complications and ensure timely intervention. With ongoing innovations in targeted therapies, immunotherapy, and CAR T-cell therapy, the focus remains on improving quality of life and extending survival.

Unique challenges in treatment

India has more younger age patients as compared to western world. Younger multiple myeloma patients face unique treatment challenges. Normally a young patient affected from myeloma looks at a productive and long life. So such patients require treatment strategies that can provide them a prolonged disease free duration and a good quality of life.

Many younger age patients present with aggressive disease, including high-risk genetic mutations, necessitating use of immunotherapies and intensive therapies including stem cell transplantation from the outset. The concept is to use most effective drugs in the initial phases of treatment so that to achieve deeper responses which can lead to prolonged disease free life.

For patients who still relapses (recurrence of myeloma), now a days , we have newer treatment modalities like Bispecific antibodies and CAR T-cell therapy, which can salvage many of such patients.

Despite many advancements in treatment, a complete cure remains uncommon, and most patients experience relapses, requiring continuous therapies to manage the disease over the span of years.

(Dr. Narendra Agrawal is the Unit Head and Sr. Consultant, Hemato-Oncology, Leukemia and BMT at Rajiv Gandhi Cancer Institute And Research Centre (RGCIRC).)

Smoldering Multiple Myeloma: What It Is And How It Progresses

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Treatment Discontinuation In MRD Negative Multiple Myeloma

The following is a summary of "Retrospective analysis of treatment discontinuation in minimal residual disease negative multiple myeloma," published in the March 2025 issue of International Journal of Hematology by Sato et al. 

Minimal residual disease (MRD) negativity is a strong predictor of long-term outcomes in multiple myeloma (MM). Real-world practice considers treatment discontinuation to lower costs and minimize toxicity. 

Researchers conducted a retrospective study on treatment discontinuation in MRD-negative MM, highlighting potential benefits like reduced healthcare costs and fewer adverse events. 

They retrospectively analyzed patients who reached MRD negativity and discontinued treatment. 

The results showed that 39 MM cases were included (17 eligible and 22 ineligibles for autologous stem cell transplantation). The median time to next treatment was 42.4 months. About 10 patients (25%) required additional treatment due to paraproteins or clinical relapse. The cumulative incidence of relapse at 12 and 48 months was 11.7% (95% CI, 4.5–28.2%) and 26.4% (95% CI, 12.8–49.6%), respectively. Multivariate analysis found elevated lactate dehydrogenase (LDH) at first visit and t (4;14) as baseline factors significantly associated with worse outcomes. Of these 8 patients (20%) with international staging system (ISS) = I and no risk factors had no recurrence. 

Investigators concluded that treatment discontinuation in high-risk cases was potentially unsafe, while low-risk cases showed potential for treatment-free remission. 

Source: link.Springer.Com/article/10.1007/s12185-025-03966-6

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