The History of Multiple Myeloma

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The History of Multiple Myeloma
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Multiple myeloma refers to cancer of the plasma cells, the white blood cells found in bone marrow. The disease is marked by the growth of abnormal plasma cells that can lead to bone erosion, immune system deficiencies and kidney problems. The disease has existed for thousands of years, but the medical community has begun to understand only it in the past few centuries. In that time, no one has been able to develop a cure, but new treatments have continuously prolonged the life of diagnosed patients, including a number of breakthroughs in recent decades.

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First Cases

Multiple myeloma has probably been around since ancient times, as some American Indian skeletons have shown signs of the disease's presence. The first documented cases, however, occurred in the mid-19th century in London. In 1844, 39-year-old Sarah Newbury succumbed after four years of severe back pain and numerous bone fractures. An autopsy revealed portions of her sternum had been replaced with a red substance. This same substance was found during the autopsy of tradesman Thomas Alexander McBean a few years later.

Discovery

A Russian doctor, Von Rustizky, first used the term multiple myeloma to describe the disease in 1873, describing eight bone marrow tumours he found during an autopsy. The disease still often bears his name in Russia. The disease also was known as Kahler's disease, after one of the most noted early cases in July 1879. Dr. Otto Kahler examined and treated a 46-year-old physician with the disease. Upon the physician's death in 1887, the autopsy revealed those same large red round cell masses in his ribs and vertebrae. Kahler also was able to match the abnormal urinary proteins found in the physician with those discovered in McBean several years earlier. The concept of blood plasma was discovered about this time as well, and Kahler's case generated interest in the disease.

Early Treatments

Doctors treated Newbury and McBean with the crude methods of a rhubarb pill and leeches, respectively, but treatment options quickly improved. In 1947, doctors used urethane, which was standard treatment until research found it helped no more than a placebo. A treatment of melphalan plus prednisone became the standard regimen for several decades, slightly extending patients' lives. Researches developed a number of drugs, including thalidomide, bortezomib and lenalidomide, to treat the disease. Stem-cell transplantation, first conceived in 1957, also has emerged as a treatment.

Diagnosis

In 1975, funding from the National Cancer Institute helped develop the Durie-Salmon Staging System, which was the prevalent method for diagnosing multiple myeloma. This system divided the disease into three stages based on a variety of factors, including calcium levels, a skeletal survey, protein levels and haemoglobin. The International Myeloma Working Group in 2005 published a more simplified International Staging System, which bases the stage on simple microglobulin and albumin measurements. This since has become the predominant diagnosing method.

Search for a Cure

Twin sisters Kathy Giusti, who was diagnosed with multiple myeloma, and Karen Andrews founded the Multiple Myeloma Research Foundation in 1998 to fund research and treatment of the disease. In the next decade, the foundation raised about £71 million to help fund 100 laboratories worldwide. While a cure remains elusive, several advancements have occurred in that time, including new treatments that extend the lives of patients and numerous clinical trials.

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