What is Multiple Myeloma?
Multiple Myeloma is a form of cancer that affects the plasma cells in your blood. Plasma cells are a form of white blood cells found in your bone marrow, which is the soft tissue inside your bones responsible for producing blood cells. In the bone marrow, plasma cells produce antibodies. These are important proteins that help your body fend off disease and infection.
Multiple myeloma occurs when abnormal plasma cells develop in the bone marrow and begin to reproduce at an accelerated rate. The rapid reproduction of malignant, or cancerous, myeloma cells creates an imbalance relative to the production of healthy cells in the bone marrow. As a result, the cancerous cells start to accumulate in the bone marrow, displacing the healthy white blood and red blood cells.
Much like normal, healthy blood cells, cancerous cells endeavor to produce antibodies. However, they are only able to produce abnormal antibodies, which are called monoclonal proteins (or M proteins). When these harmful antibodies start to collect in the body, they can cause serious problems such as kidney damage.
According to research out of Stanford University, multiple myeloma is extremely rare, accounting for only 1% of all cancer diagnosis in the United States. For context, approximately 4-5 people out of every 100,000 are diagnosed with this form of cancer each year.
There are two main types of multiple myeloma, and they’re categorized by their effect on the body. An indolent myeloma causes no discernible symptoms. It usually develops very slowly and it rarely causes bone tumors. Only small increases in M protein and M plasma cells are witnessed. A solitary plasmacytoma causes a tumor to form, typically occurring in the bones. These tumors usually respond well to treatment, but as with any form of cancer, this will require close monitoring by a medical professional.
What are the symptoms of Multiple Myeloma?
The symptoms of multiple myeloma vary from person to person. Initially, symptoms may not even be noticeable. However, as the disease progresses, most individuals will experience at least one of four major types of symptoms. These symptoms are generally referred to by the acronym CRAB, which stands for:
- renal failure
- bone damage
High levels of calcium in the blood originates in affected bones leaking calcium into the bloodstream. Too much calcium in the blood can cause a number of health issues including:
- extreme thirst
- upset stomach
- loss of appetite
Confusion and constipation are very 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 throughout the body. This occurs when cancerous cells outnumber red blood cells in the bone marrow. Anemia frequently causes fatigue, dizziness, and irritability.
Bone injuries and fractures can also occur when cancerous cells invade the bone and bone marrow. These lesions appear as porous holes on X-ray images. They frequently cause bone pain, especially in the:
Additional symptoms of multiple myeloma may include:
- weakness or numbness, especially in the legs
- unintentional weight loss
- problems with urination
- repeated infections
- vision loss or vision problems
What causes Multiple Myeloma?
The precise cause of multiple myeloma is currently unknown. However, it begins with one single, abnormal plasma cell which multiplies rapidly in the bone marrow. The resulting cancerous myeloma cells don’t have a normal life cycle. Instead of multiplying and then eventually dying, they continue multiplying and dividing indefinitely. This will eventually overwhelm the body and impair the production of healthy cells.
What are the risk factors for Multiple Myeloma?
Individuals have a higher risk of developing multiple myeloma if they are:
- over age 50
- overweight or obese
- exposed to radiation
- employed in the petroleum industry
Another significant risk factor for multiple myeloma is a known history of monoclonal gammopathy of undetermined significance (MGUS). This is a condition that causes plasma cells to erroneously produce M proteins. It doesn’t always cause any issues, however, MGUS can sometimes develop into multiple myeloma.
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. Additional tests may be required if your doctor finds signs of myeloma, despite a lack of symptoms. By employing the the following tests, your doctor can monitor the progression of the disease and determine whether or not you require treatment:
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 produce 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
X-rays, MRI scans and CT scans can be used to determine whether your bones have been damaged by multiple myeloma.
During a biopsy, your doctor removes a small sample of bone marrow with a long needle. Once a sample has been obtained, it can be examined for signs of 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 process is known as staging the cancer.
Multiple myeloma is staged by examining:
- blood cell counts
- protein levels in blood and urine
- calcium levels in the blood
There are two primary methods used 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 is an important step in the diagnostic process that can help your doctor determine your outlook and treatment options.
How is Multiple Myeloma treated?
There’s no known cure for multiple myeloma at this time. However, there are a number of 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 progressively 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, which often involves regular blood and urine tests.
If you require treatment, common options include:
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 oral form of thalidomide (Thalomid), lenalidomide (Revlimid), or pomalidomide (Pomalyst) is usually employed 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 destroy 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 oral form.
Corticosteroids – Corticosteroids, such as prednisone and dexamethasone, are frequently used to treat myeloma. They can bring balance to the immune system by reducing inflammation in the body, so they’re often effective in destroying myeloma cells. They can be taken in oral form or administered intravenously.
Radiation therapy – Radiation therapy uses strong beams of energy to damage myeloma cells in an effort to halt 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 performed 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 affected tissue can be destroyed, the stem cells can be infused into the body, where they move into the bones and start rebuilding healthy 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 speak with your doctor about:
- relaxation methods
As always, please discuss any alternative therapies with your doctor before trying them to ensure that they’re safe.
What are the complications associated with Multiple Myeloma?
Multiple myeloma can cause a number of health complications, but for the most part 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. Speak with your doctor about your treatment options and the possible 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 – Be sure to eat healthy foods and get an appropriate amount of sleep. It can also be beneficial to perform 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.
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 as follows:
- 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 experienced 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.