About the cancers
Monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM) and multiple myeloma (MM)
Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic plasma cell disorders which can progress to multiple myeloma.
Multiple myeloma is a progressive, neoplastic disease and is characterized by high bone turnover, significant bone loss, and pathological fractures, resulting in significant morbidity and a high mortality.
The majority of MGUS patients (75–90%) will not develop myeloma or a related disorder in their lifetime. The risk of progression is 1.1% per year. While MGUS is largely considered a benign condition, a number of studies have shown that patients with MGUS are at increased risk of high bone turnover and fractures even before progression to myeloma.
In the higher risk SMM group (high serum M protein and an abnormal FLC ratio), the risk of progression is 10% per year. Recent studies have indicated that almost all cases of MM are preceded by a precursor state of MGUS or SMM. Such a low risk of disease progression, the potential for drug-related toxicity and the failure to achieve a complete remission would weigh against the use of conventional chemotherapy in patients with MGUS and SMM.
The cornerstone of managing multiple myeloma precursor disease is a ‘‘watch and wait’’ strategy and early intervention with non-toxic compounds could be beneficial.
Chronic lymphocytic leukemia (CLL)
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in the Western world. It involves defective neoplastic lymphocytes with an abnormally long life span. The peripheral blood, bone marrow, spleen, and lymph nodes undergo leukemic infiltration.
Nonspecific symptoms include fatigue and malaise and are usually attributable to the anaemia. Clinical signs include lymphadenopathy, splenomegaly, and hepatomegaly.
There is little published intervention that alters the course of disease for patients with early stage CLL, that is, stage 0 or 1 disease (Rai staging system). These patients are usually monitored in a “watch and wait” modality and commence therapeutic intervention if there is disease progression. This approach may often lead to patient’s anxiety and early intervention with non-toxic compounds may be beneficial.
Immunoglobulin light chain amyloidosis (AL)
Immunoglobulin light chain amyloidosis (AL) along with multiple myeloma (MM), smoldering myeloma (SMM), and monoclonal gammopathy of undetermined significance (MGUS) represent a spectrum of plasma cell dyscrasias (PCDs).
AL is a rare and serious disorder characterized by the deposition of amyloid fibrils in different tissues with a mortality rate of more than 80% within 2 years of diagnosis, particularly if associated with renal or cardiac involvement. AL may coexist with any of the PCDs.
It has been reported that up to 30% of MM patients may have subclinical amyloid deposits. The treatment of AL amyloidosis involves the same chemotherapeutic agents used to treat multiple myeloma. The goal is to reduce or stop the production of monoclonal light chains by reducing or eliminating clonal plasma cells. Once the process of active deposition is halted, amyloid deposits are slowly resorbed by the body. In the case of smoldering myeloma, no treatment will be directed against the plasma cell clone, potentially allowing for unbridled progression of the AL.
These patients are usually monitored in a “watch and wait” modality and commence therapeutic intervention if there is disease progression. This approach may often lead to patient’s anxiety and early intervention with non-toxic compounds may be beneficial.
MDS is not a single disease but a collection of heterogeneous syndromes that share dysplastic morphology and the clinical presentation of variable cytopenias despite a generally cellular bone marrow.
The disease predominates in an elderly population, the median age being approximately 70 years. Many of these patients also have numerous co-morbid conditions which make the use of natural compounds with little or no toxicity highly desirable.
The disease also follows a chronic and insidious phase in many patients, and only a third of the patients actually progress to acute leukemia. Despite this less aggressive course of the disease, it is an incurable and fatal illness for which a stem cell transplant is the only potential curative option.
It is conceivable that intervention with natural compounds in patients whose disease is marked mostly by a variable cytopenia may not only improve the counts, but may also retard the progression of the disease towards acute leukemia.
Lymphomas – Non-Hodgkin’ and Hodgkin’s lymphoma
These two diseases are called lymphomas because they originate in white blood cells called lymphocytes. The body’s lymphatic system, which is part of the immune system, is our natural defence against infection and disease. It is complex and made up of bone marrow, the spleen, the thymus and the lymph nodes which are found throughout the body. Lymph notes are connected by a network of tiny lymphatic vessels.
The difference between Hodgkin’s and non-Hodgkin’s is due to the specific lymphocytes involved. The distinction is made by examining the diseased cells under a microscope. Distinguishing between the two cancers is important because the treatments for Hodgkin’s and non-Hodgkin lymphomas can be quite different.
Non-Hodgkin lymphoma (NHL)
NHL starts in the lymphoid tissue but sometimes the disease can develop outside the lymph nodes, for example, in the stomach. When NHL occurs ouside the lymph nodes, it is called extranodal lymphoma.
There are two main types of non-Hodgkin lymphoma:
B-cell NHL (in the lymph nodes in the neck, head, throat and abdomen).
T-cell NHL (in the lymph nodes in the chest.)
The causes of NHL are largely unknown
This cancer is sometimes called Hodgkin’s disease and it starts in lymphatic tissue. Hodgkin’s lymphoma was first described by Dr Thomas Hodgkin in 1832. The abnormal lymphocyte involved is the B-lymphocyte which isn’t found in other types of lymphomas, which is why the other types are called non-Hodgkin’s lymphoma (see above). The exact cause of Hodgkin’s lymphoma is unknown. However, there is increasing evidence that infections (such as the virus that causes glandular fever) may play a part in the development of Hodgkin lymphoma.
Patients with early stage lymphomas are monitored in a "watch and wait" modality.