Multiple myeloma is a type of bone marrow cancer that occurs when plasma cells increase excessively. You can find more information below.
What is multiple myeloma?
Multiple myeloma is cancer that occurs in a type of white blood cell called a plasma cell. Plasma cells help you fight infections by making antibodies that recognize and attack microbes. Multiple myeloma causes cancer cells to build up in the bone marrow and interfere with the production of healthy blood cells. Instead of producing useful antibodies, cancer cells produce abnormal proteins that can cause complications.
Multiple myeloma treatment isn’t always necessary for people who don’t show any symptoms. For people with multiple myeloma who need treatment, a number of treatments are available to help control the disease.
What causes multiple myeloma?
It is not clear what causes myeloma. Doctors think that myeloma starts with an abnormal plasma cell in your bone marrow, the soft, blood-producing tissue that fills the middle of most of your bones.
The abnormal cell multiplies rapidly. Cancer cells accumulate and eventually damage the production of healthy cells. In the bone marrow, myeloma cells produce healthy white blood cells and red blood cells, leading to fatigue and an inability to fight infections.
Myeloma cells continue to produce antibodies like healthy plasma cells, but myeloma cells produce abnormal antibodies that the body cannot use. Abnormal antibodies (monoclonal proteins or M proteins) accumulate in the body and cause problems such as damage to the kidneys. Cancer cells can also damage bones, increasing the risk of bone fractures.
Connection with monoclonal gammopathy
Multiple myeloma almost always begins as a relatively benign condition called monoclonal gammopathy (MGUS).
In the United States, about 3% of people older than 50 have MGUS. Each year, about 1 percent of people with MGUS develop multiple myeloma or a related cancer.
MGUS, like multiple myeloma, is characterized by the presence of M proteins produced by abnormal plasma cells in your blood. However, in MGUS, the levels of M proteins are lower and no damage occurs in the body.
Who is at risk?
Factors that can increase your risk of multiple myeloma include:
- Increasing age: Your risk of multiple myeloma increases as you age, and most people are diagnosed in their mid-60s.
- Gender: Men are more likely to develop the disease than women.
- Black people: Black people are twice as likely to develop the condition than white people.
- Family history of multiple myeloma: If anyone in your family has this condition, the risk of the disease is increased.
- Monoclonal gammopathy (MGUS): Each year in the United States, 1% of people with MGUS develop multiple myeloma.
What are the symptoms of multiple myeloma?
Symptoms of multiple myeloma can vary and may be absent early in the disease. When symptoms do occur, they may include:
- Bone pain, especially in your spine or chest
- Loss of appetite
- mental confusion or confusion
- weight loss
- Weakness or numbness in your legs
- extreme thirst
When should you see a doctor?
If you have symptoms that worry you and do not go away, it is always a good idea to see a doctor.
How is multiple myeloma diagnosed?
In some cases, your doctor may mistakenly detect multiple myeloma when you pass a blood test for another condition. In other cases, your doctor may suspect multiple myeloma based on your symptoms.
Tests and procedures used to diagnose multiple myeloma include:
- Blood tests: Laboratory analysis of your blood can reveal M proteins produced by myeloma cells. Another abnormal protein produced by myeloma cells – beta-2-microglobulin – can be detected in your blood and may give your doctor clues about the aggressiveness of your myeloma. Additionally, blood tests to examine your kidney function, blood cell counts, calcium levels, and uric acid levels can give your doctor clues about your diagnosis.
- Urine tests: Urine analysis can show the presence of M proteins.
- Bone marrow exam: Your doctor may remove a bone marrow sample for laboratory testing. The sample is collected with a long needle (bone marrow aspiration and biopsy) inserted into the bone. In the lab, the sample is examined for myeloma cells. Specialized tests such as fluorescent in situ hybridization (FISH) can analyze myeloma cells to understand their genetic abnormalities. Tests are also done to measure the rate at which myeloma cells divide.
- Imaging tests: Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include an x-ray , magnetic resonance imaging , computed tomography , or positron emission tomography.
Assign a stage and a risk category
If the tests show you have multiple myeloma, your doctor will use the information gathered from the diagnostic tests to classify your disease as stage 1, stage 2, or stage 3. Stage 1 indicates a less aggressive disease and stage 3 indicates an aggressive disease that can affect the bone, kidneys and other organs.
Your multiple myeloma may also be assigned a risk category that indicates the aggressiveness of your disease.
Your multiple myeloma stage and risk category help your doctor understand your prognosis and treatment options.
How is multiple myeloma treated?
If you are experiencing symptoms, treatment can help relieve pain, control complications of the disease, stabilize your condition, and slow the progression of multiple myeloma.
Conditions where emergency treatment is not required
If you have multiple myeloma but are not experiencing any symptoms, you may not need treatment. However, your doctor will regularly monitor your condition for signs that the disease is progressing. This may include periodic blood and urine tests.
If you develop symptoms or your multiple myeloma shows signs of progression, you and your doctor may decide to start treatment.
Standard treatment options include:
- Targeted therapy: Targeted drug therapy focuses on specific abnormalities in cancer cells that allow them to survive. Bortezomib, carfilzomib, and ixazomib are drugs that block the action of a substance in myeloma cells that break down proteins. This action causes myeloma cells to die. Targeted therapy drugs can be administered through a vein in your arm or in pill form. Other targeted therapies include monoclonal antibody drugs that bind to specific proteins found in myeloma cells and cause them to die.
- Biological therapy: Biological therapy drugs use your body’s immune system to fight myeloma cells. The drugs thalidomide, lenalidomide, and pomalidomide increase immune system cells that identify and attack cancer cells. These drugs are commonly taken in pill form.
- Chemotherapy: In the case of multiple myeloma, chemotherapy drugs kill fast-growing cells, including myeloma cells. Chemotherapy drugs can be given through a vein in your arm or taken in pill form. High doses of chemotherapy drugs are used before bone marrow transplantation.
- Corticosteroids: Corticosteroids such as prednisone and dexamethasone regulate the immune system to control inflammation in the body. They are also active against myeloma cells. Corticosteroids can be taken in pill form or administered through a vein in your arm.
- Bone marrow transplant: Also known as a stem cell transplant, a bone marrow transplant is the process of replacing your diseased bone marrow with healthy bone marrow. Before a bone marrow transplant, blood-forming stem cells are taken. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Your new stem cells are then introduced into your body, where they travel to your bones and begin to rebuild your bone marrow.
- Radiation therapy: This treatment uses energy beams such as X-rays and protons to damage myeloma cells and stop them from growing. Radiation therapy can be used to rapidly shrink myeloma cells in a particular area. For example, it can be used when a collection of abnormal plasma cells forms a tumor (plasmacytoma) that causes pain or destroys a bone.
Remember, your doctor will decide which medicine to take and how.
How are treatments used?
What treatments you get will depend on whether you are a good candidate for a bone marrow transplant. This depends on the risk of progression of your disease, your age, and your general health.
- If you are considered a candidate for a bone marrow transplant, your initial treatment will likely include a combination of treatments such as targeted therapy, biologic therapy, corticosteroids, and sometimes chemotherapy. Your stem cells will be collected after a few months of treatment. A bone marrow transplant can be entered right after your cells are harvested, or it can be delayed until after your relapse. In some cases, doctors recommend two bone marrow transplants for people with multiple myeloma. After a bone marrow transplant, you’ll likely receive targeted therapy or biologic therapy as maintenance therapy to prevent myeloma recurrence.
- If you are not considered a candidate for a bone marrow transplant, your initial treatment will likely include combined chemotherapy with corticosteroids, targeted therapy, or biologic therapy.
- If your myeloma recurs or does not respond to treatment, your doctor may recommend that you repeat another procedure that initially helped with treatment. Another option is to try one or more of the treatments that are typically used alone or in combination as first-line therapy. Research into a number of new treatment options is ongoing, and you may be eligible for a clinical trial to gain access to these experimental treatments. You can talk to your doctor about which clinical trials are available.
Multiple myeloma complications
Multiple myeloma complications include:
- Infections: Myeloma cells inhibit your body’s ability to fight infections.
- Bone problems: Multiple myeloma can also affect your bones, leading to bone pain, thinned bones, and broken bones.
- Decreased kidney function: Multiple myeloma can cause problems with kidney function, including kidney failure. Higher levels of calcium in the blood associated with wearing down bones can affect your kidneys’ ability to filter waste from your blood. Proteins produced by myeloma cells can cause similar problems.
- Low red blood cell count (anemia): Since myeloma cells prevent normal blood cells from producing, it can cause anemia and other blood problems.
You may also need treatment for these specific conditions, as multiple myeloma can cause a number of complications. E.g:
- Bone pain: Pain medications, radiation therapy, and surgery can help control bone pain.
- Kidney complications: People with severe kidney damage may need dialysis.
- Infections: Your doctor may recommend certain vaccines to prevent infections such as flu and pneumonia.
- Bone loss: Your doctor may recommend drugs called bisphosphonates, such as pamidronate or zoledronic acid, to prevent bone loss.
- Anemia: If you have persistent anemia, your doctor may recommend medications to increase your red blood cell count.