Multiple Myeloma is a plasma cell dyscrasia. It is characterized by the clonal proliferation of plasma cells. Malignant plasma cells proliferate unchecked and produce an abundance of immunoglobulins.
The most commonly produced immunoglobulins are:
- Ig G
- Ig A
- Ig M
- Ig E
- Ig D
In addition, light chains (Kappa, Lambda, and Mu) and heavy chains are also produced.
Symptoms of multiple myeloma?
Multiple myeloma is a type of cancer that affects plasma cells, which are a type of white blood cell found in the bone marrow. Symptoms of multiple myeloma can vary depending on the stage of the disease and the extent of bone involvement. Some common symptoms of multiple myeloma include:
Bone pain: This is one of the most common symptoms of multiple myeloma and can occur in any bone, but is most commonly felt in the back, ribs, and skull.
Fatigue: Constant tiredness or weakness is a common symptom of multiple myeloma.
Anemia: Reduced production of red blood cells can cause anemia and symptoms such as shortness of breath, pale skin, and fatigue.
Loss of appetite and weight loss
Frequent infections: Due to the abnormal growth of plasma cells, the immune system can be impaired.
Kidney problems: Multiple myeloma can cause damage to the kidneys leading to symptoms such as blood in the urine, foamy urine, and swelling in the legs, ankles, or feet.
Hypercalcemia: High levels of calcium in the blood can cause symptoms such as nausea, vomiting, constipation, and confusion.
Numbness or tingling in the fingers and toes
It's important to note that these symptoms can be caused by other conditions as well, so it's always best to consult with a healthcare provider if you are experiencing any of these symptoms to determine the underlying cause.
Summary of symptoms of multiple myeloma:
Patients with multiple myeloma may present with features of bone marrow suppression, renal failure, bony pains, and frequent infections. The classic mnemonic to remember the clinical features of multiple myeloma is "CRAB" which stands for Hypercalcemia, renal failure, anemia, and bony pains.
Drugs to treat Multiple Myeloma:
Drugs that are used to treat multiple myeloma primarily target proliferating plasma cells. However, other supportive drugs are frequently needed by patients including antimicrobials, bisphosphonates, and corticosteroids.
Here is a list of the latest approved drugs used to treat patients with multiple myeloma:
Multiple Myeloma Drugs approved in 2022 |
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Date of Approval |
Generic Name |
Brand Name |
February 28, 2022 [ref] |
Ciltacabtagene autoleucel |
Carvykti |
October 25, 2022 [ref] |
Teclistamab |
Tecvayli |
Drugs approved in 2021 |
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Date of Approval |
Generic Name |
Brand Name |
March 27, 2021 [ref] |
Idecabtagene vicleucel |
Abecma |
March 31, 2021 [ref] |
Isatuximab |
Sarclisa |
Drugs approved in 2020 |
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Date of Approval |
Generic Name |
Brand Name |
December 18, 2020 [ref] |
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August 5, 2020 [ref] |
Belantamab mafodotin |
BLENREP |
August 20, 2020 [ref] |
Here is a list of all the drugs used to treat multiple myeloma and their availability in Pakistan:
Chemotherapeutic Drugs to treat Multiple Myeloma |
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Generic Name |
Brand Name |
Availability in Pakistan |
Melphalan |
Alkeran, Evomela |
Available |
Available |
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Available |
||
Bortezomib |
Velcade |
Available |
Available |
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Available |
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Not Available |
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Not Available |
||
Corticosteroids |
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Generic Name |
Brand Name |
Availability in Pakistan |
Available |
||
Available |
||
Monoclonal Antibodies |
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Generic Name |
Brand Name |
Availability in Pakistan |
Available |
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Available |
||
Available |
||
Isatuximab |
Sarclisa |
Not Available |
Interferon |
||
Generic Name |
Brand Name |
Availability in Pakistan |
Interferon alfa-2B |
Intron A |
Available |
Immunosuppressants |
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Generic Name |
Brand Name |
Availability in Pakistan |
Available |
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Available |
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Available |
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Anti-BCMA Antibodies |
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Generic Name |
Brand name |
Availability in Pakistan |
Belantamab mafodotin |
BLENREP |
Not Available |
Teclistamab |
Tecvayli |
Not Available |
CAR T-Cell Therapies |
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Generic Name |
Brand name |
Availability in Pakistan |
Idecabtagene vicleucel
|
Abecma |
Available |
Ciltacabtagene autoleucel |
Carvykti |
Not Available |
Selective Inhibitors of Nuclear Export |
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Generic Name |
Brand name |
Availability in Pakistan |
Available |
||
Bisphosphonates |
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Generic Name |
Brand name |
Availability in Pakistan |
Not Available |
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Available |
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Colony Stimulating Factors |
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Generic Name |
Brand name |
Availability in Pakistan |
Abseamed, Epoetin Alfa Hexal, Epogen, Eporatio, Epprex, Eprex, Procrit, Retacrit, Silapo |
Available |