How does multiple myeloma develop?

Metaphor that I've been using for a long, long time is a garden. That's because I'm from rural Minnesota. Your bone marrow, functionally, is a garden. Three major crops in the garden. About 20% of the acreage in that bone marrow garden is given over to red blood cell production. The cells that carry oxygen give you your energy. You don't have enough. Then you're called anemic. 60% are infection fighting white blood cell that protect you against the development of infection. About 10% are given over to the production of blood clotting cells, and there are about 10% that are boutique crops that go by a whole host of different names, but they're not relevant to our discussion. But in every normal bone marrow, 1% of their acreage, 1% are cells called plasma cells. They're protein producing cells that help protect your body's immunity in their protein production of those plasma cells. It's an important concept to understand. You get a flu shot. plasma cells will start making antibody proteins to protect you. Your skin your knee when you're four, you're going to have a plasma cell making antibodies to the exposed contaminants. So that's normal. And if you look at the bone marrow in those proportions 60 20 10 and plasma cells one. That's what it is at age four, 14, 24, 84. Those proportions are very, very tightly controlled. No variation. Unfortunately, sometimes malignancy develops. And the characteristic of malignancy of course, is uncontrolled growth of cells. One of those plasma cells loses those growth. Regulatory controls. Usually acquired genetic changes occur and it develops a growth advantage and it starts growing in the garden. That 1% of the acreage. And it'll grow and it'll grow. And we say by definition, if the acreage is greater than 10%, plasma cells, that's defined as multiple myeloma. Average patient with multiple myeloma at the time of diagnosis, that acreage is about 40% on average at the time it's diagnosed, it can go up to 100%. And the consequences of the development of these weeds in the garden are three fold. The first one is as the weeds grow, they start choking off all the normal plants so that they're no longer able to germinate correctly. The first consequence of that is it chokes off the red blood cell plants in that garden. And that consequence is a reduction in production of red cells, a drop in the blood hemoglobin level. You are anemic. So for some patients 70% at the time of diagnosis week tired exertional shortness of breath can't climb the stairs anymore. And the evaluation to the doctors. I'm anemic. Number two is that these weeds don't just stay in the garden. They actually begin to erode into the casing of the garden. Well, what's the casing of the garden I'm talking about? Well, that's the surrounding bone. You go to the supermarket to get a bone for soup. You know, the bones made out of two separate parts. There's a thick, outer white shell on the bone which allows you to actually jump on the bone. You wouldn't break it. And then there's that kind of spongy core that's kind of brown and kind of webby. And that, of course, is the bone marrow. And in a freshly slaughtered animals, bright red, because it's the same color as blood, because that's where the blood is produced. And what ends up happening is these weeds grow. And what ends up happening is these weeds grow. They'll begin to invade the casing, get cortical bone, and start to dissolve and damage it. As you know, bone is is rock hard. But clusters of myeloma cells actually have the consistency of raw liver. And so you replace bone with raw liver. And so you replace bone with raw liver. That bone is weaker. And what'll happen is particularly in bones that are under a lot of weight stress, which is spine and ribs, they're prone to fracture.