Multiple Myeloma

What Is Multiple Myeloma?

Multiple myeloma is a blood cancer that develops in the plasma cells. These are a type of white blood cells found in the bone marrow. Bone marrow is the soft, spongy tissue inside bones that creates new cells. Plasma cells make antibodies to protect the body from infection. Plasma cells are an important part of the immune system. 

In multiple myeloma, plasma cells change into cancer cells that grow out of control. The cancer cells crowd out healthy cells. Cancerous plasma cells produce an abnormal antibody called M protein. When M protein builds up in the blood, it can damage the kidneys and other organs. Myeloma cells can eventually collect in the solid parts of bones and form tumors and weakened spots on bones. 

The American Cancer Society explains that most people diagnosed with this cancer are 65 years old or older. It is a rare cancer with about 1 in 9,000 diagnosed in the U.S. each year. 

Multiple myeloma is generally considered an incurable cancer that can cause serious symptoms, such as bone damage, kidney failure, and blood infections. It is treatable, and many patients live more than 10 years with modern treatments.

Types of Multiple Myeloma

• Light chain myeloma: Light chains are proteins made by plasma cells. They usually link to other proteins called heavy chains. These two types of chains create antibodies. Light chain myeloma is an aggressive type of multiple myeloma. In this type, a high number of light chains are created and released into the bloodstream.
• Non-secretory myeloma: This is a rare subtype of multiple myeloma where plasma cells don’t release measurable monoclonal protein (M-protein) into the blood stream. This subtype is difficult to diagnose because standard blood and urine tests are negative.
• Solitary plasmacytoma: This is a rare cancer in the bone or bone marrow. It is usually treated with radiation.
• Extramedullary plasmacytoma: A localized tumor of abnormal plasma cells found in soft tissue. It may cause additional symptoms depending on the location of the tumor. 
• Monoclonal gammopathies: This is a noncancerous condition where plasma cells produce abnormal M proteins. This type can be a precursor to multiple myeloma. 
• Smoldering multiple myeloma: This is a precancerous condition that is the stage between monoclonal gammopathy and multiple myeloma. Low levels of M protein are found in the blood and a higher number of plasma cells are found in the bone marrow. Patients with smoldering multiple myeloma have a higher risk of progressing to myeloma than patients with monoclonal gammopathy of undetermined significance states the Multiple Myeloma Research Foundation.
• Immunoglobulin D myeloma: An aggressive subtype of multiple myeloma that can cause bone damage and amyloidosis (a condition that causes abnormal proteins to build up in the tissues and organs).
• Immunoglobulin E myeloma: A very rare, aggressive subtype of multiple myeloma that can cause anemia, bone lesions, and kidney issues. This type can transform into plasma cell leukemia.

Multiple Myeloma Causes

Multiple myeloma is caused by certain genetic mutations. These mutations are thought to happen spontaneously as people age. The genetic mutations that cause multiple myeloma are not passed down through families. 

Risk Factors for Multiple Myeloma

Anyone can get multiple myeloma, but some groups of people are more likely to be affected:

• Black people are diagnosed about twice as often as other racial or ethnic groups
• Men are more likely to be diagnosed than women
• Most people diagnosed with multiple myeloma are 65 or older

Although the exact causes of multiple myeloma are unknown, other risk factors that may play a role include:

• Exposure to certain chemicals such as benzene
• Exposure to herbicides or pesticides
• Exposure to radiation

Multiple myeloma is generally not considered an inherited disease because it most often develops from mutations that occur during a person’s lifetime. Having a parent or sibling with multiple myeloma may slightly increase risk, but there is not a direct hereditary connection.

Prevention

There is no sure way to prevent multiple myeloma because the exact causes are not fully understood. Many of the risk factors, such as age and genetics, cannot be changed. Eating a nutritious diet and maintaining a healthy weight may help lower risk. If possible, avoid exposure to radiation and chemicals, which can increase multiple myeloma risk.

If you have been diagnosed with monoclonal gammopathy or smoldering multiple myeloma, it’s important to be regularly monitored by a hematologist. If these conditions progress to active multiple myeloma, early intervention can help delay progression. 

Signs and Symptoms

Multiple myeloma symptoms vary for each person. Early stages may not have symptoms. 

Common symptoms include:

• Anemia
• Bone pain, especially in the back or ribs
• Easy bruising or bleeding
• Fatigue
• Fractures
• Frequent infections or fevers
• Frequent urination
• High thirst
• Loss of appetite
• Weakness
• Weight loss

As the disease progresses, patients may experience kidney function may be affected. In addition, hypercalcemia, a high level of calcium in the blood can occur. Severe hypercalcemia can cause cardiac arrest or coma if left untreated.

See a doctor as soon as possible if you have persistent symptoms for more than two weeks. If symptoms are unexplained, it’s important to be evaluated by a cancer doctor who is a specialist in hematology or medical oncology. Early detection and treatment can improve outlook. 

Diagnosis

Many different tests may be used to detect multiple myeloma. If multiple myeloma is found, your doctor may perform additional tests to determine the stage and to help decide the best treatment.

Imaging Tests

Computed tomography (CT) scan: This test combines X-ray images to create detailed images of the inside of the body. A CT scan may also be used to guide a biopsy needle in a specific area.

Magnetic resonance imaging (MRI): MRIs use radio waves and strong magnets to create detailed images of the soft tissues inside the body. This scan can look at bone marrow.

Positron emission tomography (PET) scan: This test uses a small amount of radioactive material in the bloodstream and a camera. Cancer cells absorb a high amount of the radioactive material. A PET scan can see where that material has collected. 

Lab Tests

Blood tests: There are different blood tests that can identify multiple myeloma. A complete blood count (CBC) measures the numbers of red blood cells, white blood cells, and platelets. Your doctor may also test for certain proteins that show how the kidneys are working. Testing for calcium levels can show high levels and a sign of hypercalcemia.

Electrophoresis: This test analyzes a blood or urine sample to look for abnormal antibodies. It is often the first step in diagnosing multiple myeloma.

Urine test: A urine sample is analyzed to check for M protein that has filtered through the kidney. 

Diagnostic Procedures

Bone marrow aspiration and biopsy: Local anesthetic is used to numb the hip area. Then a thin, hollow needle is inserted into the bone to suck out a small amount of bone marrow. The bone marrow tissue is analyzed in a lab to check the appearance, size, and shape of cells. It can determine if myeloma cells are present. 

Needle biopsy: This test may be used if an abnormal area shows up in an imaging test and your doctor suspects a tumor. They will draw out a small sample with a needle. If the abnormal area is deep in the body, a CT scan or MRI may be used to guide the needle.

Multiple Myeloma Stages

When you are diagnosed with multiple myeloma, your doctors will figure out how advanced it is. This process is called staging. Multiple myeloma staging is based on:

• Albumin levels in the blood
• Beta-2-microglobulin (B2M) levels in the blood
• Lactate dehydrogenase (LDH) levels in the blood
• Specific gene abnormalities (cytogenetics) in cancer cells

Multiple myeloma can be stages I-III:

• Stage I: B2M is less than 3.5 mg/L, albumin is 3.5 g/dL or higher. LDH levels are normal and cytogenetics are not considered high risk.
• Stage II: This stage is less specific in multiple myeloma and blood levels are between stage I and III.
• Stage III: B2M is 5.5 mg/L or higher and cytogenetics are considered high risk. LDH levels may be high.

Different types of multiple myeloma have a five-year relative survival rate of 62% to 81%, according to the American Cancer Society. Treatments have improved and newly diagnosed multiple myeloma patients may have a better outlook.

Treatment

Multiple myeloma is considered treatable, but not curable. Advances in immunotherapy, stem cell transplant and targeted therapy have significantly improved survival rates. Many patients achieve long periods of remission. Prognosis depends on stage, genetic risk factors, age and response to treatment.

Treatments for multiple myeloma have become more advanced in the past 20 years. Your treatment will depend on your age, stage of the disease and overall health. If you have no symptoms, you may not need treatment right away. Your doctor will monitor to determine if your condition progresses.

Treatment options may include:

• Chemotherapy: This treatment uses a combination of drugs that are taken by mouth or intravenously to kill cancer cells. Chemotherapy reaches almost all areas of the body.
• Corticosteroids: These drugs may be used in combination with other treatments to increase effectiveness, reduce inflammation and kill myeloma cells. Corticosteroids may also help manage chemotherapy side effects.
• Immunotherapy: This treatment uses the body’s own immune system to find and destroy cancer cells. Chimeric antigen receptor (CAR) T-cell therapy is commonly used. Immune cells called T cells are taken from the blood and genetically altered and multiplied to help them attach to cancer cells. The T cells are then infused back into the blood.
• Radiation therapy: This type of treatment uses high-energy rays from an external beam to kill cancer cells. It may be used in multiple myeloma to treat damaged areas of bone. Radiation may also be used after surgery, especially if the tumor is in a bone.
• Stem cell transplant with high-dose chemotherapy: This process takes healthy stem cells from the blood, which are then reinfused after high-dose chemotherapy. Chemotherapy damages healthy cells and cancer cells, so the stem cells replace the ones that were killed and start making healthy new blood cells.
• Targeted therapy: This type of treatment uses drugs to attack specific parts of the myeloma cells. Proteasome inhibitors (PIs) block proteins from breaking down in cancer cells, which causes the cells to die. Lab-made antibodies are also used to target myeloma cells.

Long-term maintenance therapy with medications may be needed after treatment for multiple myeloma. The goal of maintenance treatment is to keep cancer in remission and prevent relapse. It may also delay progression of multiple myeloma. 

If standard treatments fail, patients with end-stage multiple myeloma may have severe complications and pain from worsening bone lesions, extreme fatigue, kidney failure, and frequent serious infections. These complications may lead to death from pneumonia, sepsis, or cardiac arrest. Care may shift to palliative treatments.

Supportive Treatment for Multiple Myeloma

Supportive treatments focus on improving symptoms rather than treating the cancer directly. Multiple myeloma can cause bone pain, weakened bones and hypercalcemia. You may be prescribed medications to strengthen the bones or help with bone pain. Surgery may be needed to prevent fractures in bones weakened by myeloma.

Lifestyle Management for Multiple Myeloma

In addition to medical treatments, lifestyle changes can help improve quality of life with multiple myeloma. This also may be important to manage the side effects of treatment. Some lifestyle management options for multiple myeloma to support overall health include:

• Avoid infections
• Drink plenty of water to manage kidney issues
• Eat a healthy diet
• Exercise
• Get quality sleep
• Maintain a strong support system
• Quit smoking

There are patient resources available from the Multiple Myeloma Research Foundation and Cancer Care.

Clinical Trials

Clinical trials help determine new treatment options for multiple myeloma. Patients with multiple myeloma have access to clinical trials. Speak with your doctor to find out if a clinical trial may be a good fit for you.

When to See a Specialist

If you or a loved one has symptoms of multiple myeloma, it’s important to be evaluated by a hematologist or medical oncologist. 

National Jewish Health in Denver, Colorado provides expert care for patients with multiple myeloma. Learn more about our Cancer Care program or use the button below to make an appointment.