Myeloma

Myeloma is a type of cancer that affects plasma cells. Plasma cells are a type of white blood cell found in bone marrow, which is the soft tissue inside most of your bones that produces blood cells. In the bone marrow, plasma cells make antibodies. These are proteins that help your body fight off diseases and infections.

Myeloma occurs when an abnormal plasma cell develops in the bone marrow and reproduces itself very quickly. The rapid reproduction of malignant, or cancerous, myeloma cells eventually outweighs the production of healthy cells in the bone marrow. As a result, the cancerous cells begin to accumulate in the bone marrow, crowding out the healthy white blood cells and red blood cells.

Like healthy blood cells, cancerous cells try to make antibodies. However, they can only produce abnormal antibodies called monoclonal proteins, or M proteins. When these harmful antibodies collect in the body, they can cause kidney damage and other serious problems.

According to Stanford University, multiple myeloma is rare, accounting for only 1 percent of all cancer cases in the United States. About 4 to 5 people out of 100,000 are diagnosed with this type of cancer each year.

Types of myeloma

There are two main types of myeloma. They’re categorized by their effect on the body:

An indolent myeloma causes no noticeable symptoms. It usually develops slowly and doesn’t cause bone tumors. Only small increases in M protein and M plasma cells are seen.
A solitary plasmacytoma causes a tumor to form, typically in bone. It usually responds well to treatment, but needs close monitoring.

What are the symptoms of myeloma?

The symptoms of multiple myeloma vary depending on the person. Initially, symptoms may not be noticeable. However, as the disease progresses, most people will experience at least one of four major types of symptoms. These symptoms are generally referred to by the acronym CRAB, which stands for:

calcium
renal failure
anemia
bone damage

High levels of calcium in the blood come from affected bones leaking calcium. Too much calcium can cause:

extreme thirst
nausea
vomiting
upset stomach
loss of appetite

Confusion and constipation are also common symptoms of increased calcium levels.

Kidney failure can be caused by high levels of M protein in the body.

Anemia is a condition in which the blood doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body. This happens when cancerous cells outnumber red blood cells in the bone marrow. Anemia often causes fatigue, dizziness, and irritability.

Bone injuries and fractures occur when cancerous cells invade the bone and bone marrow. These lesions appear as holes on X-ray images. They often cause bone pain, especially in the:

back
pelvis
ribs
skull

Additional symptoms of multiple myeloma may include:

weakness or numbness, especially in the legs
unintentional weight loss
confusion
problems with urination
nausea
vomiting
repeated infections
vision loss or vision problems

What causes myeloma?

The exact cause of multiple myeloma is unknown. However, it starts with one abnormal plasma cell that rapidly multiplies in the bone marrow many more times than it should.

The resulting cancerous myeloma cells don’t have a normal life cycle. Instead of multiplying and then eventually dying, they continue dividing indefinitely. This can overwhelm the body and impair the production of healthy cells.

What are the risk factors for myeloma?

People have a higher risk of developing myeloma if they’re:

male
over age 50
African-American
overweight or obese
exposed to radiation
employed in the petroleum industry

Another risk factor for multiple myeloma is a history of monoclonal gammopathy of undetermined significance (MGUS). This is a condition that causes plasma cells to produce M proteins. It usually doesn’t cause any problems. However, MGUS can sometimes develop into multiple myeloma over time.

How is multiple myeloma diagnosed?

Doctors often detect multiple myeloma before any symptoms are present. Routine physical exams, blood tests, and urine tests can uncover evidence of this cancer.

More tests will be needed if your doctor finds signs of myeloma when you don’t have symptoms. Using the following tests, your doctor can monitor the progression of the disease and determine whether you need treatment.

Blood and urine tests

Blood and urine tests are used to check for M proteins. These proteins may be caused by multiple myeloma or other conditions. Cancerous cells also make a protein called beta-2 microglobulin, which can be found in the blood. Blood tests can also be used to assess:

the percentage of plasma cells in the bone marrow
kidney function
blood cell counts
calcium levels
uric acid levels

Imaging tests

X-rays, MRI scans, or CT scans can be used to determine whether bones have been damaged by multiple myeloma.

Biopsy

During a biopsy, your doctor removes a small sample of bone marrow with a long needle. Once a sample is obtained, it can be checked for cancerous cells in a laboratory. Various tests can determine the types of abnormalities in the cells and how quickly the cells are multiplying.

These types of tests are used to determine whether you have multiple myeloma or another condition. If multiple myeloma is found, the tests can show how far it’s progressed. This is known as staging the cancer.

Staging

Multiple myeloma is staged by looking at:

blood cell counts
protein levels in blood and urine
calcium levels in the blood

The results of other diagnostic tests may also be used.

There are two ways to stage multiple myeloma. The Durie-Salmon system is based on the levels of M protein, calcium, and red blood cells as well as the degree of bone damage. The International Staging System is based on the levels of blood plasma and beta-2 microglobulin.

Both systems divide the condition into three stages, with the third stage being the most severe. Staging helps your doctor determine your outlook and treatment options.

How is multiple myeloma treated?

There’s no cure for multiple myeloma. However, there are treatments that can help ease the pain, reduce complications, and slow the progression of the disease. Treatments are only used if the disease is getting worse.

Your doctor is unlikely to suggest treatment if you aren’t experiencing any symptoms. Instead, your doctor will closely monitor your condition for signs that the disease is progressing. This often involves regular blood and urine tests.

If you need treatment, common options include the following:

Targeted therapy

Targeted therapy medications block a chemical in myeloma cells that destroys proteins, causing the cancer cells to die. The drugs that may be used during targeted therapy include bortezomib (Velcade) and carfilzomib (Kyprolis). Both are administered intravenously, or through a vein in your arm.

Biological therapy

Biological therapy medications use your body’s immune system to attack myeloma cells. The pill form of thalidomide (Thalomid), lenalidomide (Revlimid), or pomalidomide (Pomalyst) is usually used to boost the immune system.

Lenalidomide is similar to thalidomide, but it has fewer side effects. It also appears to be more potent.

Chemotherapy

Chemotherapy is an aggressive form of drug therapy that helps kill fast-growing cells, including myeloma cells. Chemotherapy drugs are often given in high doses, especially before a stem cell transplant. The medications may be given intravenously or taken in pill form.

Corticosteroids

Corticosteroids, such as prednisone and dexamethasone, are often used to treat myeloma. They can balance the immune system by reducing inflammation in the body, so they’re often effective in destroying myeloma cells. They can be taken in pill form or given intravenously.

Radiation therapy

Radiation therapy uses strong beams of energy to damage myeloma cells and stop their growth. This type of treatment is sometimes used to kill myeloma cells quickly in a certain area of the body. For example, it may be done when a cluster of abnormal plasma cells form a tumor called a plasmacytoma that causes pain or destroys bone.

Stem cell transplants

Stem cell transplants involve replacing diseased bone marrow with healthy bone marrow from a donor. Before the procedure, blood-forming stem cells are collected from your blood. The multiple myeloma is then treated with radiation therapy or high doses of chemotherapy. Once the diseased tissue can be destroyed, the stem cells can be infused into your body, where they move into the bones and start rebuilding bone marrow.

Alternative medicine

Alternative medicine has become a popular way to cope with the symptoms of multiple myeloma and the side effects of treatment for the condition. While they can’t treat multiple myeloma, you may want to talk to your doctor about:

acupuncture
aromatherapy
massage
meditation
relaxation methods

Discuss any alternative therapies with your doctor before trying them to ensure they’re safe for your health.

What are the complications associated with multiple myeloma?

Multiple myeloma can cause many complications, but they’re usually treatable:

Back pain can be treated with medications or a back brace.
Kidney complications are treated with dialysis or a kidney transplant.
Infections can be treated with antibiotics.
Bone loss can be slowed or prevented with drug therapy.
Anemia can be treated with erythropoietin. This medication stimulates the body to produce more red blood cells.

Coping with multiple myeloma

If you’ve received a multiple myeloma diagnosis, you might find it helpful to do one or more of the following:

Learn more about multiple myeloma

Educate yourself by learning about multiple myeloma so you can make informed decisions about your treatment. Talk to your doctor about your treatment options and the side effects of treatment.

The National Cancer Institute and International Myeloma Foundation can also provide you with more information about multiple myeloma.

Establish a support system

Establish a support system by gathering a group of friends and family members that can lend a helping hand or emotional support when you need it. Support groups can also be helpful and may be found online. If you prefer to meet with a support group in person, visit the American Cancer Society website to find groups in your area.

Set reasonable goals

Stay motivated by setting reasonable goals that give you a sense of control over your condition. Don’t set goals that are too lofty, though. Doing so can lead to exhaustion and frustration. For example, you may not be able to work a full 40 hours per week, but you may still be able to work part time.

Focus on your overall health

Make sure you eat healthy foods and get enough sleep. It can also be beneficial to do low-intensity exercises, such as walking or yoga, a couple of times per week. Keeping your body and mind as healthy as possible can help you cope better with the stress and fatigue you may experience with cancer. To make sure you get enough time to rest and recover, don’t overload your schedule.

What’s the outlook for people with multiple myeloma?

People who’ve recently received a diagnosis of multiple myeloma may not experience symptoms for several years. Once the disease has progressed and symptoms do occur, most people respond well to treatment. However, serious complications can develop, even after years of successful treatment.

An exact timetable for the disease is difficult to predict, but according to the American Cancer Society, the median survival rates for the three stages of multiple myeloma are:

Stage 1: 62 months, which is approximately five years
Stage 2: 44 months, which is approximately three to four years
Stage 3: 29 months, which is approximately two to three years

It’s important to keep in mind that these are general estimates based on previous outcomes of numerous people who’ve had multiple myeloma. Your specific outlook depends on various factors, including your age, overall health, and how well your cancer responds to treatment. Speak with your doctor about your particular situation to learn more about your outlook.