From Ancient Mysteries to Modern Breakthroughs: The Fascinating Evolution of Myeloma Through the Ages
March is Myeloma Awareness Month, so let’s dive into the fascinating history of Myeloma. Did you know that myeloma dates to 1800 BC? The discovery of Bence Jones protein, the first case reports, and even the term “multiple myeloma” all play a part in the rich history of this disease. Multiple Myeloma is a type of bone marrow cancer in which abnormal plasma cells produce excessive amounts of an abnormal antibody.
Myeloma can cause bone pain, fatigue, kidney issues, and increased vulnerability to infections. It happens because it interferes with how blood cells are made in the bone marrow. Even though it’s not super common, it can be serious when it does show up. It’s usually found when it’s already far along and can lead to some nasty complications like bone fractures or nerve damage.
An international team of researchers has discovered the first known case of Myeloma in a mummy dating back to around 1800 B.C. This individual, likely from the upper echelons of society in Elephantine, Egypt, was cared for during their illness despite the lack of treatments. Unearthed from Qubbet el-Hawa in Aswan, this finding reveals the long history of Myeloma.
In 1844, Samuel Solly made a breakthrough in medical history by detailing the first well-documented case of multiple Myeloma in a patient named Sarah Newbury. Sarah, a 39-year-old homemaker, had been suffering from severe back pain for four years. Sarah had fractured both femurs upon being carried. Samuel Solly’s diagnosis was “mollities ossium” or “softness of the bone,” and she was treated with fruits, herbs, and opiates. She passed away 5 days later. This case was significant as it led to the discovery of the Bence Jones protein, a key marker in the diagnosis and monitoring of multiple Myeloma.
During the postmortem examination, it was discovered that the cancellous portion of her sternum and both femurs had been replaced by a red substance. Additionally, fractures were found in fractured in her clavicles, radius, humerus, and ulna. This significant case shed light on the clinical presentation and characteristics of Multiple Myeloma.
The initial treatments for myeloma involved some interesting methods, such as rhubarb, leeches, steel, and quinine. While unconventional by today’s standards, these treatments were the best options available at the time. Then, along came Urethane, which was hailed as the first real medication for battling the disease when Swedish physician Professor Nils Alwal started using it in 1947.
Urethane has been said to help patients with myeloma for almost twenty years. People receiving this treatment reported feeling less bone pain, higher hemoglobin levels, and lower protein levels in their blood and urine. However, it turned out that Urethane came with some pretty nasty side effects like significant weight loss, nausea, vomiting, blood disorders, and liver damage. As if that wasn’t enough, further research showed that it was highly carcinogenic and didn’t do much to help patients in clinical trials.
In a study comparing Urethane with a placebo in 83 patients with symptomatic myeloma, the placebo group had a higher median overall survival. Various other cancer medications were also tested on myeloma mouse models, but unfortunately, they were not successful in killing myeloma cells. During this time, the average overall survival for patients with Myeloma was about 6 months.
In 1850, Henry Bence Jones decided to examine the urine of Thomas Alexander McBean, a London tradesman, and found what we now call the Bence Jones protein. However, it wasn’t until 1880 that the term Bence Jones protein was officially coined.
In 1889, Dr. Kahler significantly contributed to the field by describing a unique case involving a 46-year-old physician with myeloma. Dr. Kahler highlighted various symptoms: skeletal pain, albuminuria, pallor, anemia, precipitable urinary protein, and observations during necroscopy. Kahler’s meticulous investigation provided valuable insights into this disease, which is now referred to as Kahler’s Disease, leaving a lasting impact on medical research.
So, when did Kahler’s disease become “multiple myeloma”? The term “multiple myeloma” was first introduced by von Rustizky in 1873. He discovered eight distinct tumors in the bone marrow during an autopsy, which were soft and reddish in color. He dubbed these tumors “multiple myeloma” while working at Professor von Recklinghausen’s institute.
A pivotal moment occurred in 1898 when Weber proposed the theory that the bone marrow is the origin of the Bence Jones protein. This assertion laid a foundational understanding for further research and development in the study of myeloma, influencing treatment strategies and diagnostic approaches. Weber’s work marked a significant milestone in unraveling the complexities of myeloma, shaping the landscape of medical knowledge, and paving the way for advancements in the field.
In 1917, Victor C. Jacobson at Peter Bent Brigham Hospital in Boston discovered Bence Jones proteins in a patient with chronic nephritis. By 1921, Waltman Walters at the Mayo Clinic made further observations, suggesting that these proteins might stem from unusual bone marrow cells. These early findings were crucial for advancing our understanding of Myeloma at a cellular level, highlighting pivotal moments in studying this complex disease.
In 1922, a pivotal moment in myeloma history unfolded when Bayne-Jones and Wilson made a groundbreaking discovery by identifying the two distinct groups of Bence Jones protein, now referred to as the kappa (κ) and lambda (λ) light chain types. This significant milestone marked a crucial step forward in comprehending multiple myeloma proteins. The classification of these protein types proved to be an essential development in the study of Myeloma, paving the way for further advancements in its diagnosis and treatment strategies.
In 1956, Korngold and Lipari connected myeloma protein with Bence Jones protein by identifying their identical light chains, classifying Bence Jones proteins into kappa and lambda. Two years later, Harold Porter from England advanced the field by analyzing antibodies to distinguish their heavy and light chain components. These milestones significantly enhanced our understanding of myeloma proteins.
Myeloma’s story is fascinating and shows how far we’ve come to understand and treat this complex disease. From ancient times to the discovery of myeloma proteins, it’s impressive to see our progress! In our upcoming blog post, I’ll take you through the history of myeloma treatments, from unexpected remedies like orange peels to incredible advancements like CAR-T cell therapy. This rich tapestry of history highlights the creativity and resilience of human efforts, giving us all hope for better treatment in the future!