Two types of bone marrow cancer are distinguished: Kahler’s disease (multiple myeloma) and Waldenström’s disease (macroglobulinemia). Kahler’s disease is a malignant proliferation of plasma cells in the bone marrow. Waldenström’s disease is a form of cancer that is very similar to multiple myeloma. What are the symptoms and complaints of these forms of bone marrow cancer and what does the treatment of bone marrow cancer look like?
- What is bone marrow cancer?
- Bone marrow
- Kahler’s disease/multiple myeloma
- Symptoms of Kahler’s disease
- Treatment of Kahler’s disease
- Waldenström’s disease/macroglobulinemia
- Symptoms of Waldenström’s disease
- Treatment of Waldenström’s disease
What is bone marrow cancer?
Bone marrow cancer is a form of cancer that originates in the bone marrow and occurs in two ways:
- Kahler’s disease (Morbus Kahler), also called multiple myeloma (MM); and
- Waldenström’s disease or macroglobulinemia.
Bones consist of a hard, compact part and a spongy part. In the spongy part there are many small cavities in which red bone marrow is located. Bone marrow is responsible for the production of different types of blood cells, all of which are vital. Red blood cells (erythrocytes) ensure the transport of inhaled oxygen to tissues and organs in the body. A shortage of red blood cells is called anemia. White blood cells (leukocytes), of which there are different types, fight infections and with a shortage of white blood cells, the risk of infections increases. Platelets (thrombocytes) are also produced in the bone marrow and these cells are involved in blood clotting.
Kahler’s disease/multiple myeloma
Just over 800 people are diagnosed with multiple myeloma every year. Men are affected slightly more often than women. It mainly occurs in people around the age of 70. The disease does not occur under the age of 30. Multiple myeloma is a malignant proliferation of plasma cells that belong to the white blood cells in the bone marrow. It is a life-threatening form of bone marrow cancer that disrupts the immune system against infections. In this form of cancer, the production of red and white blood cells and sometimes platelets can be suppressed. Because there are too few red blood cells, the blood can transport less oxygen to tissues and organs. The lack of platelets causes bleeding.
Fatigue / Source: Istock.com/dolgachov
Symptoms of Kahler’s disease
The symptoms of Kahler’s disease are:
- recurrent infections (especially of the respiratory and urinary tract);
- bleeding (especially nosebleeds and bleeding gums);
- pain in the bones and (sometimes) spontaneous bone fractures.
- loss of appetite and weight loss.
Treatment of Kahler’s disease
There are various treatment options. The treatment depends on the age and condition of the patient. In a vital patient who is younger than 65 years of age, a stem cell transplant will be considered. Chemotherapy destroys all bone marrow cells, including healthy ones. Healthy stem cells from a donor are then administered. These stem cells grow in the empty bone marrow into new red and white blood cells and into platelets. Until then, the patient is very susceptible to infections and will be nursed in isolation so that he cannot come into contact with external germs. If the patient has been treated with stem cells from someone else, after healing he will have to use medications that suppress the immune system to prevent the new immune cells from targeting his own body. Adding a stem cell transplant to ‘regular’ chemotherapy regimens has enabled people to live longer without symptoms.
In patients for whom stem cell transplantation is not an option, lighter chemotherapy is used, often combined with radiation. This treatment temporarily reduces the disease. When the disease reappears, the procedure can be repeated, sometimes by administering a different combination of cytostatics.
Waldenström’s disease is named after the Swedish internist JG Waldenström. It is a rare disease. In the Netherlands it is estimated that there are 60 to 70 new patients per year. Men are more likely to get this disease. The average age at which the disease occurs is 65 years. Waldenström’s disease involves an uncontrolled growth of lymphocytes (certain white blood cells that are closely related to plasma cells). These cells occur in both the bone marrow and the lymph nodes. It can therefore also be referred to as non-Hodgkin lymphoma (lymphoma).
Symptoms of Waldenström’s disease
Patients do not always suffer from symptoms. The symptoms that may occur include:
- fatigue and emaciation;
- night sweats;
- swollen lymph nodes and some organs (spleen and liver);
- ‘viscosity’ of the blood due to the large amount of abnormal proteins (= hyperviscosity);
- nerve damage.
Treatment of Waldenström’s disease
Patients with complaints are eligible for treatment. In patients without complaints, we wait to see how the disease develops; This is called a wait and see policy (no treatment but controlled waiting). When treatment is necessary, chemotherapy and radiation may be used. Supportive treatments can also be performed, for example to counteract the viscosity of the blood.
Both the cancer and the treatments can cause life-threatening complications, including bone marrow abnormalities, bone damage, kidney damage and kidney failure.
The outlook varies greatly from patient to patient. The average survival is somewhere between 7 to 10 years. Patients without symptoms can have a survival of decades. The more symptoms occur or the patient is older than 60 years, the less favorable the prognosis will be.
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