27 May 2024

Multiple myeloma is a type of cancer that originates in a type of white blood cell called the plasma cell. Plasma cells help your body fight infections by making antibodies that are made to recognize and attack germs. Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they suffocate out the healthy blood cells. These cancer cells then produce abnormal proteins that cause complications with normal cell development. Each case of multiple myeloma is different, and some patients may not require treatment. Others will require a lot of treatments and may see this cancer recur.

There is no clear trigger or reason that multiple myeloma occurs. These myeloma cells will continue to produce antibodies, but the abnormal cells cannot be used by the body; thusly piling up and accumulating to unsafe levels. Instead, these abnormal proteins, or monoclonal proteins, build up in the body and cause damage to the kidneys and bones.

In many cases, multiple myeloma often begins as a benign condition called monoclonal gammopathy of undetermined significance. In the United States, roughly three percent of those older than fifty have this condition. Every year, one percent of these people develops multiple myeloma or related cancer. These conditions are marked by the presence of M-proteins in your blood.

Risk Factors of Multiple Myeloma

These factors may contribute to lowering your risk of getting multiple myeloma:

  • Increasing age. Your risk of multiple myeloma increases as you age, with most people diagnosed in their mid-sixties.
  • Male sex. Men are more likely to develop the disease than are women.
  • Black race. Black people are about twice as likely to develop multiple myeloma as are white people.
  • A family history of multiple myeloma. If a brother, sister or parent has multiple myeloma, you have an increased risk of the disease.
  • Personal history of monoclonal gammopathy of undetermined significance. Every year one percent of the people with MGUS in the United States develop multiple myeloma.

Signs and Symptoms of Multiple Myeloma

The signs and symptoms with multiple myeloma can differ and be very difficult to spot early on. When signs do occur, this may mean that the cancer has become more developed. These signs and symptoms may include:

  • Bone pain, especially in your spine or chest
  • Nausea
  • Constipation
  • Loss of appetite
  • Mental fogginess or confusion
  • Fatigue
  • Frequent infections
  • Weight loss
  • Weakness or numbness in your legs
  • Excessive thirst

Tests to Diagnose Multiple Myeloma

In many situations, doctors accidentally stumble across multiple myeloma while treating their patient for an entirely different reason. In other cases, your doctor may suspect this condition based off your symptoms and past health history. They may use one or more of these tests to help determine what you are dealing with:

  • Blood tests. Laboratory analysis of your blood may reveal the M proteins produced by myeloma cells. Another abnormal protein produced by myeloma cells — called beta-2-microglobulin — may be detected in your blood and 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. Analysis of your urine may show M proteins, which are referred to as Bence Jones proteins when they’re detected in urine.
  • Examination of your bone marrow. Your doctor may remove a sample of bone marrow for laboratory testing. The sample is collected with a long needle inserted into a bone for bone marrow aspiration and biopsy.

In the lab, the sample is examined for myeloma cells. Specialized tests, such as fluorescence in situ hybridization can analyze myeloma cells to understand their genetic abnormalities. Tests are also done to measure the rate at which the myeloma cells are dividing.

  • Imaging tests. Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include an X-ray, MRI scan, CT scan or positron emission tomography.

Treatment Plans for Multiple Myeloma

If you are not experiencing any symptoms of your multiple myeloma, you may not need treatment. Your doctor will monitor your situation closely for any signs that the disease is progressing. This will involve periodic urine and blood tests. When you do develop symptoms, your doctor may suggest one or more of the following treatments.

  • Targeted therapy. Targeted drug treatment focuses on specific abnormalities within cancer cells that allow them to survive. Bortezomib, carfilzomib, and ixazomib are targeted drugs that block the action of a substance in myeloma cells that breaks down proteins. This action causes myeloma cells to die. Targeted-therapy drugs may be administered through a vein in your arm or in pill form.
    • Other targeted-therapy treatments include monoclonal antibody drugs that bind to the specific proteins present on myeloma cells, causing them to die.
  • Biological therapy. Biological therapy drugs use your body’s immune system to fight myeloma cells. The drugs thalidomide, lenalidomide, and pomalidomide enhance the immune system cells that identify and attack cancer cells. These medications are commonly taken in pill form.
  • 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 a bone marrow transplant.
  • 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. A bone marrow transplant, also known as a stem cell transplant, is a procedure to replace your diseased bone marrow with healthy bone marrow.
    • Before a bone marrow transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow.
  • Radiation therapy. This treatment uses beams of energy, such as X-rays and protons, to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells forms a tumor, or a plasmacytoma, that is causing pain or destroying a bone.

Complications from Multiple Myeloma

While infrequent and uncommon, complications can arise from multiple myeloma. The most often reported complications are:

  • Frequent infections. Myeloma cells inhibit your body’s ability to fight infections.
  • Bone problems. Multiple myeloma can also affect your bones, leading to bone pain, thinning bones, and broken bones.
  • Reduced kidney function. Multiple myeloma may cause problems with kidney function, including kidney failure. Higher calcium levels in the blood related to eroding bones can interfere with your kidneys’ ability to filter your blood’s waste. The proteins produced by the myeloma cells can cause similar problems.
  • Low red blood cell counts or anemia. As myeloma cells crowd out normal blood cells, multiple myeloma can also cause anemia and other blood problems.

If you suspect that you may have multiple myeloma, contact your medical care team to schedule an appointment to begin testing to determine your diagnosis. Early detection is key!

Citations:

American Cancer Society

National Institutes of Health and Human Services

Cancer World