Multiple Myeloma

Symptoms, Doctors, Treatments, Advances & More

Multiple myeloma is a rare cancer that occurs in bone marrow (soft tissue inside bones) in white blood cells called plasma cells that usually produce antibodies (immunoglobulins) which help the body to fight infection. However, in multiple myeloma the plasma cells become cancerous, producing a protein known by several names, including monoclonal immunoglobulin, monoclonal protein (M-protein), M-spike, or paraprotein. The cancerous plasma cells fill up the bone marrow, eventually spreading to the outside of the bones and weakening them, causing bone fractures. The cancerous plasma cells additionally begin producing high levels of an antibody (immunoglobulin) that increases the viscosity (thickness) of the blood, leading to clotting, which can further cause kidney damage. While levels of one antibody increase, others drop, increasing the risk of infections. Red blood cell counts also drop, causing anemia, while blood calcium levels increase, leading to dehydration, constipation, and confusion.   Types of multiple myeloma include smoldering myeloma, which usually occurs without symptoms, and plasmacytoma, which is marked by abnormal plasma cells that occur in only one bone, causing pain. Multiple myeloma mainly occurs in older people over the age of 60, males, African Americans, people who are obese, and those with a family history of multiple myeloma, or who have been diagnosed with a condition known as monoclonal gammopathy of uncertain significance (MGUS; see more about this condition below.)

Alternative names for multiple myeloma include bone cancer, blood marrow cancer, myeloma, plasmacytoma, plasma cell myeloma, and smoldering myeloma.

While the causes of multiple myeloma are unknown, multiple myeloma usually starts out as a non-cancerous (benign) disorder called monoclonal gammopathy of undetermined significance (MGUS), in which abnormal plasma cells produce M proteins. About one percent of people with MGUS will subsequently be diagnosed with multiple myeloma or another cancer. A recent finding in myeloma cells is that part of chromosome number 17 is missing, which can make the disease more aggressive and progress rapidly. Bone marrow cells called dendritic cells may also produce an excess of a hormone called interleukin-6 (IL-6) which appears to contribute to the development of plasma cell tumors. Risk factors that may lead to the development of multiple myeloma include exposure to the toxic chemical, benzene, pesticides, or radiation. A family history of multiple myeloma increases the risk of developing the disease. People who are overweight or obese also have an increased risk of developing multiple myeloma.

Early multiple myeloma may not have any symptoms. Signs and symptoms of multiple myeloma include bone pain, especially in the ribs or back, bruising easily, bones that easily break (fractures), excessive thirst, frequent urination, loss of appetite, weight loss, weakness and fatigue, nausea and vomiting, frequent infections and fever, weakness or numbness in the legs, prolonged bleeding after minor cuts, difficulty breathing, and confusion.

Treatment for multiple myeloma depends on how far the disease has progressed and whether there are any symptoms. Patients with multiple myeloma who are not currently experiencing any symptoms, known as smoldering myeloma, may not require any treatment. Once symptoms occur, treatments for multiple myeloma can include chemotherapy, stem cell transplant (bone marrow transplant; SCT), radiation therapy, corticosteroids, targeted therapy, and biological therapy. While most treatments for multiple myeloma may control the disease or delay it for years, these treatments are usually not curative. Initial treatment for multiple myeloma is usually a combination of mediations, such as bortezomib (Velcade), corticosteroids (dexamethasone), and lenalidomide. Added therapies for more advanced multiple myeloma may include bisphosphonates, immunoglobulins, chemotherapy, stem cell transplant (bone marrow transplant; SCT), radiation therapy, targeted therapy, and biological therapy. Bisphosphonates – Bisphosphonates are usually given by infusion for multiple myeloma and can decrease the risk of bone fractures and increase survival. Immunoglobulins – Also given by infusion for multiple myeloma, immunoglobulins can help to prevent severe infections. Chemotherapy – Chemotherapy is usually administered via pill or intravenously (through a vein; IV) in high doses for multiple myeloma, usually before stem cell transplant (bone marrow transplant). Stem cell transplant (Bone marrow transplant; SCT) – Stem cells are cells that are taken from blood or bone marrow that, when transplanted (via transfusion), develop into new, healthy blood cells. Before stem cell transplant, high doses of chemotherapy will be administered to kill the cancer cells. If the stem cells are taken from the same patient who later receives them after chemotherapy, this is called autologous stem cell transplant (ASCT). Radiation therapy – Radiation therapy uses beams of X-rays or protons and can be used in multiple myeloma to reduce the size of bone tumors, slow disease progression, and to treat pain. Corticosteroids – Corticosteroids are usually administered intravenously (through a vein; IV) or in pill form, help to control inflammation by regulating the immune system, and can be effective against myeloma cells. Targeted therapy – Targeted therapy is a form of treatment directed at disrupting certain abnormalities within cancer cells to kill them. For multiple myeloma, the targeted therapies bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro) stop myeloma cells from breaking down proteins, which kills the myeloma cells. Biological therapy – Biological therapy is usually administered in pill form and enlists the immune system in attacking myeloma cells and includes medications such as thalidomide (Thalomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst). If multiple myeloma reoccurs after treatment or does not respond to treatment, an additional round of treatment, or combinations of treatments, may be administered. Patients with multiple myeloma should also consider participating in a clinical trial to gain access to new, experimental treatments.

There are a variety of support groups for multiple myeloma: American Cancer Society - https://www.cancer.org/treatment/support-programs-and-services/resource-search.html American Society of Clinical Oncology - https://www.cancer.net/coping-with-cancer/finding-support-and-information/cancer-specific-resources International Myeloma Foundation - https://www.myeloma.org/about-imf Multiple Myeloma Research Foundation - https://themmrf.org/

In most patients with multiple myeloma, the disease progresses slowly for two-to-five years, and then may worsen. One-third of patients with multiple myeloma live longer than five years. Some patients die within three months after diagnosis. Early treatment can help to improve survival for multiple myeloma.

In most patients with multiple myeloma, the disease progresses slowly for two-to-five years, and then may worsen. One-third of patients with multiple myeloma live longer than five years. Some patients die within three months after diagnosis. Early treatment can help to improve survival for multiple myeloma.

If you experience any signs and symptoms of multiple myeloma, such as bone pain, especially in the ribs or back, bruising easily, bones that break easily (fractures), excessive thirst, frequent urination, loss of appetite, weight loss, weakness and fatigue, nausea and vomiting, frequent infections and fever, weakness or numbness in legs, prolonged bleeding after minor cuts, difficulty breathing, and confusion, make an appointment with your doctor as soon as possible. Individuals with a family history of multiple myeloma should speak with their doctor about being screened for the disease.

Multiple myeloma may possibly be prevented by avoiding exposure to radiation, the toxic chemical benzene, and pesticides.