Multiple Myeloma

What is multiple myeloma?

Multiple myeloma is a rare blood cancer that affects your plasma cells. Plasma cells are white blood cells and part of your immune system. Plasma cells (sometimes called B-cells) make antibodies. These antibodies, called immunoglobulins, help fight infection.

Multiple myeloma happens when healthy cells turn into abnormal cells that multiply and produce abnormal antibodies called M proteins. This change starts a cascade of medical issues and conditions that can affect your bones, your kidneys and your body’s ability to make healthy white and red blood cells and platelets.

Some people have multiple myeloma without symptoms but blood tests show signs of conditions that may become multiple myeloma. In this case, healthcare providers may recommend watchful waiting or monitoring your overall health rather than starting treatment. Healthcare providers can’t cure multiple myeloma, but they can treat related conditions and symptoms and slow its progress.

Is multiple myeloma a fatal disease?

There’s no known cure for multiple myeloma. Healthcare providers provide treatments to help people live as long as possible while having quality of life. But there is a possibility for prolonged remission. A remission is time after treatment when you don’t have multiple myeloma signs or symptoms.

Is multiple myeloma a common disease?

Multiple myeloma is rare, affecting about 7 people out of 100,000 people each year. Healthcare providers estimate about 100,000 people in the United States have multiple myeloma.

Who is affected by multiple myeloma?

Multiple myeloma affects more men than women. It affects twice as many people who are Black as it does people who are of other races. Most people with multiple myeloma are diagnosed between 40 and 70. The median age of diagnosis is between 65 and 74.

How does multiple myeloma affect my body?

Some people don’t have symptoms but tests show they have conditions that may become multiple myeloma.

For example, a bone marrow aspiration or bone marrow biopsy may show abnormal plasma cells and genetic mutations, which could mean you have smoldering multiple myeloma (SMM) — an early, precancerous form of multiple myeloma. Likewise, blood and urine tests may show proteins made by abnormal plasma cells. This is a condition called monoclonal gammopathy of undetermined significance (MGUS).

Multiple myeloma symptoms develop over time and may resemble other medical conditions or diseases. Here are some of the conditions linked to multiple myeloma and their causes:

• Anemia: You don’t have enough red blood cells because multiplying abnormal plasma cells don’t leave room for your red blood cells.
• Bacterial infection, particularly pneumonia: Like red blood cells, abnormal plasma cells are multiplying and crowding healthy white blood cells that fight infection.
• Thrombocytopenia: You don’t have enough platelets — the cells that help your blood to clot — because abnormal plasma cells crowd out those platelets and keep your bone marrow from making enough platelets.
• Bone pain/bone fracture: Bone pain and/or fracture can happen if abnormal plasma cells destroy bone tissue, causing a soft spot in your bone. These are osteolytic lesions.
• Kidney problems/failure: Your kidneys filter waste and toxins. Abnormal plasma cells make M proteins that block the filtering process and damage your kidneys.
• Amyloidosis: This disease happens when abnormal proteins (amyloid proteins) build up in your organs.
• Hypercalcemia: This condition happens when damaged or weakened bones release too much calcium into your bloodstream.
• Hyperviscosity syndrome: M proteins — proteins made by abnormal plasma cells — thicken your blood. Your heart has to work harder to pump blood through your body.
• Cryoglobulinemia: Multiple myeloma can make proteins in your blood clump together when it’s cold.

What are multiple myeloma symptoms?

Multiple myeloma causes many symptoms, but bone pain often is the first symptom people notice. Other symptoms include:

• Weakness in your arms and legs and/or a sensation of numbness in your arms and legs. Multiple myeloma can affect the bones in your spine, causing them to collapse and press on your spinal cord.
• Having fatigue — feeling so tired you can’t manage daily activities — and feeling weak. These are signs of anemia.
• Nausea and vomiting. This may be a sign of hypercalcemia.
• Not having an appetite and/or feeling thirstier than usual. These may be signs of hypercalcemia.
• Unexplained weight loss.
• Unexplained fever. This may be a symptom of a bacterial infection.
• Bruising or bleeding more easily. This may be a sign abnormal plasma cells prevent your body from producing enough platelets. Platelets help your blood to clot.
• Feeling confused or “foggy.”

How does a person get multiple myeloma?

Healthcare providers and researchers aren’t sure what causes multiple myeloma. Some potential causes they’re exploring include:

• Genetic mutations:Researchers are investigating links between mutating or changing oncogenes (cells that promote growth) and multiple myeloma. They’ve also found most people who have multiple myeloma don’t have all pieces of a certain chromosome.
• Environmental factors: Some studies show potential connections between multiple myeloma and exposure to radiation or chemicals in pesticides, fertilizer or Agent Orange.
• Having an inflammatory disease or condition: Examples of inflammatory disease include heart disease, Type 2 diabetes and rheumatoid arthritis.
• Having obesity: This is having high levels of body fat.

How do healthcare providers diagnose multiple myeloma?

Healthcare providers diagnose multiple myeloma by doing a physical examination, asking about your symptoms and asking about your family medical history. They may do several tests to confirm a diagnosis. Based on what they learn, they’ll then decide the condition’s classification so they can determine the cancer’s stage, or the cancer tumor(s) size or location.

What tests do healthcare providers use to diagnose multiple myeloma?

Healthcare providers may do blood tests, imaging tests and urine tests to confirm you have multiple myeloma and, if you do, whether your disease is in early or late stages. Here’s information on specific tests:

• Complete blood count (CBC): This test measures your red and white blood cell numbers, the amount of hemoglobin in your red blood cells and your red blood cell concentration level.
• Blood chemistry test: This test shows your creatine levels (how well your kidneys work), albumin levels (this is a protein), calcium levels and lactic dehydrogenase levels (LDH). LDH is a tumor marker. A tumor marker is a substance in cancerous cells or healthy cells responding to cancer.
• Quantitative immunoglobulin test: This blood test measures the levels of certain antibodies in your blood.
• Electrophoresis: This test looks for M proteins in your blood.
• Urine tests: Healthcare providers may ask you to collect your urine at home over a 24-hour period so they can test for Bence Jones protein, another sign of multiple myeloma.
• X-rays: Healthcare providers use X-rays to look for bones damaged by multiple myeloma.
• Computed tomography (CT) scan: This is another way to look for bone damage.
• Magnetic resonance imaging (MRI): This test uses radio waves and strong magnets to create detailed images of your bones and spine. Healthcare providers may use this test to look for plasmacytomas. These are single groups of abnormal plasma cells.
• Positron emission tomography (PET) scan: This is another test for plasmacytomas.
• Bone marrow biopsies: Healthcare providers may do bone marrow biopsies to analyze the percentage of normal and abnormal plasma cells in your bone marrow. They may also test your bone marrow sample for changes in your DNA that may drive cancer growth.

How do healthcare providers stage multiple myeloma?

Healthcare providers stage multiple myeloma and other cancers to learn about the cancer’s size and location. Cancer staging lays the foundation for treatment. The staging process for multiple myeloma starts with placing the condition in one of four classifications:

• MGUS: Blood tests show small amounts of M protein. About 1 % to 2% of people with MGUS develop multiple myeloma.
• Solitary or isolated plasmacytomas: These are single groups of abnormal plasma cells.
• SMM: This is a pre-cancerous form of multiple myeloma. People who have SMM may have mild symptoms along with tests showing small amounts of M protein in their blood and an increased number of plasma cells in their bone marrow.
• Multiple myeloma: This classification means tests show multiple groups of abnormal plasma cells, high M protein levels in blood or urine and a high percentage of abnormal plasma cells in bone marrow. People in this classification often have anemia, hypercalcemia, kidney failure and osteolytic lesions.

Healthcare providers use the Revised International Staging System (R-ISS) to stage multiple myeloma. The RISS system is based in part on blood tests that show the levels of albumin, beta-2 microglobulin and lactate dehydrogenase. Healthcare providers also consider tests for specific gene abnormalities.

What are multiple myeloma treatments?

Healthcare providers treat multiple myeloma based on your symptoms and the extent of your disease. For example, people who have MGUS usually don’t need treatment, but their healthcare provider will closely monitor their overall health. They may also develop a treatment plan so they can move quickly if symptoms do develop.

Some treatments healthcare providers may use if you have symptoms caused by multiple myeloma include:

• Pain medications:People often have significant bone pain.
• Antibiotics:A weakened immune system can lead to more infections. Your doctor may prescribe antibiotics to clear up these infections.
• Steroids: High doses of steroids can kill cancer cells and reduce inflammation.
• Chemotherapy: Healthcare providers use chemotherapy to reduce the number of abnormal plasma cells.
• Immunotherapy:This treatment stimulates your immune system so it develops more cancer-fighting cells.
• Radiation therapy: This treatment kills cancer cells and reduces bone tumors.
• Stem cell transplants: Stem cells are specialized cells in your bone marrow or blood that can help produce healthy new plasma cells. Healthcare providers typically recommend autologous stem cell transplants. This treatment replaces damaged or unhealthy stem cells with healthy stem cells from your body. Rarely, you may receive healthy plasma stem cells from a donor. This is an allogenic stem cell transplant.

What is the life expectancy of multiple myeloma?

Some people live 10 years or more with multiple myeloma. As with most types of cancer, early diagnosis and treatment help people live longer. In this case, 78% of people who have single plasmacytoma are alive five years after diagnosis. The overall five-year survival rate for people with multiple myeloma ranges from 40% to 82%. These numbers are based on the Revised Multiple Myeloma International Staging System (R-ISS).

It’s important to remember that statistics like these are averages that don’t take factors like age or overall health into consideration. If you have multiple myeloma, your healthcare provider is your best resource for information about your specific situation.

Can multiple myeloma be prevented?

No, there’s no known way to prevent multiple myeloma. Researchers are investigating ways to keep SMM from becoming active multiple myeloma.

How do I take care of myself?

Multiple myeloma affects people in different ways. For example, people with MGUS or SSM — pre-cancerous forms of multiple myeloma — won’t need immediate treatment. They’ll need regular checkups and tests. If you’re in remission from multiple myeloma, your healthcare provider will recommend a checkup schedule and tests based on your specific situation.

If you’re living with multiple myeloma, there are steps you can take to support your overall health:

• Eat healthy foods every day. Multiple myeloma may affect your appetite, so you may want to eat four or five small meals throughout the day.
• If you smoke, try to stop.
• Get enough rest.
• Protect yourself from infection. Ask your healthcare provider for ways to prevent infection.
• Get some exercise, but talk to your healthcare provider first.
• Pay attention to your emotional health. It makes sense if you feel depressed about your situation. Talk to your healthcare provider if sadness and depression last for more than two weeks or interfere with your daily activities.
• If you’re in remission, you’re probably relieved you’ve finished treatment, but worried your cancer will come back. Talk to your healthcare provider about your situation so you know what to expect.