How is amyloidosis related to myeloma?

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How is amyloidosis related to myeloma?

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So amyloidosis is related to myeloma primarily when it's light chain amyloidosis, other forms of amyloidosis have nothing to do with myeloma.

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And this is part of the reason that correct diagnosis is incredibly important, because the treatment focuses on where it's coming from. And if it's a type that has nothing to do with plasma cells and with myeloma, for example, then we should treat it appropriately

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for light chain amyloidosis.

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that's related to multiple myeloma. I almost think of them as

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on the same spectrum.

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They're almost cousins, they're related, but they're different. And what happens in both the light chain amyloidosis and multiple myeloma is that you have sick plasma cells that are in the bone marrow. Those plasma cells are growing too much. They’re synthesizing this abnormal protein, usually light chain protein that's circulating in the blood. But depending on what the cells and what the proteins are doing in the body, that's what determines whether it's multiple myeloma and or amyloidosis.

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In multiple myeloma,

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there is a classic set of problems or forms of organ injury that can take place. So the classic crab criteria, as they're called in the medical textbook, so high blood, calcium, renal insufficiency or kidney problems, basically anemia and bone lesions, those are all cardinal classic symptoms of multiple myeloma. When patients have those things, you call it multiple myeloma.

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On the other hand, when patients have amyloidosis, again, same cells in the bone marrow, same protein in the blood, but when they have light chain amyloidosis, then that protein deposits in the heart and can cause heart failure. It can deposit in the kidneys and cause a protein leakage problem that we call nephrotic syndrome

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can deposit the nerves that regulate blood pressure and cause low blood pressures.

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And so it can cause

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a constellation of symptoms that's completely different from what we've seen

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in multiple myeloma. So, again, in both conditions that are related, because they both come from plasma cells, they have often the same abnormal proteins that are in the blood, but what we call the phenotype or what this actually looks like in an individual with these disorders can be completely different.

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Can someone be misdiagnosed with myeloma and have amyloidosis and vice versa?

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Yes, one can be misdiagnosed with amyloidosis and have multiple myeloma or vice versa.

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some patients actually have both, meaning that they have some features of multiple myeloma. And then they also have trouble related to amyloidosis.

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But sometimes we do see this where somebody has abnormal cells in the bone marrow, they have the abnormal protein in the blood.

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And hematologist oncologist who doesn't do a lot of these disorders sees that and says it's multiple myeloma. And then we see them as amyloidosis or myeloma experts and realize the problem is really amyloidosis. Indeed, they have the cells, they have the protein. But when you look at what's actually bothering the patient and making that patient ill, you realize pretty quickly that the problem is amyloidosis.

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It's not multiple myeloma.

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I think the best way to think about the relationship between one's multiple myeloma and their amyloidosis, if they develop that, is that the disease really starts in the same place.

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The myeloma cells themselves produce the antibody that forms the amyloid. So if a person is getting sick with al amyloidosis, we fire our medical bullets at the multiple myeloma. We give them the darzalex, we give them the REVLIMID, we give them the Velcade. We choose from the array of medicines. When the myeloma goes to sleep and gets to remission, there are no antibodies produced and no amyloid can form.

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So the treatment really is is focused on the myeloma itself. And then we look to see the organ improvement in the heart and the kidneys as no further amyloid forms and the organs can hopefully heal.

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One more thing that I would say about amyloidosis in general is al amyloidosis is the sister disease to multiple myeloma.

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So it's the disease that multiple myeloma patients might be concerned about or read about. However, there are many other forms of amyloid. There are many other proteins that have nothing to do with myeloma that can turn into amyloid and make people sick. So I would strongly encourage any people that are told they have amyloidosis or they might have amyloidosis to really seek out some amyloid expertise because one can easily be misdiagnosed.

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And the treatments for the different types of amyloidosis are entirely different. If it's amyloidosis called Al, Amyloidosis related to myeloma, it might be more chemotherapy, it might be more immunotherapy, it might be a stem cell transplant. If it relates to other protein depositions, it can be targeted therapies with pills or even observation. So, again, I think when it comes to amyloidosis, confusion can reign very easily and expertise truly matters.