What is multiple myeloma?
Multiple myeloma (also known as Kahler’s disease) is a kind of blood cancer that causes the body to produce abnormal plasma cells. The plasma cells become cancerous and multiply.
Plasma cells are white blood cells. They are part of your immune system. In a healthy person, the plasma cells are in the bone marrow, which is soft tissue inside the bones. They produce healthy proteins called antibodies, an important part of our immune system that find and attack germs and prevent our body from infections.
As the cancerous plasma cells multiply, they:
- Build up in the bone marrow (spongy material inside your bones), weakens the bone and results in bone pain and fractures.
- Produce excessive abnormal antibodies (called M protein) that can accumulate in the organs, especially in the kidneys, and can affects the function of kidneys.
- Accumulate in the bone marrow, outnumber the normal blood cells and limit your body’s ability to make healthy blood cells (platelets, red and white blood cells).
People with low grade multiple myeloma may not have any symptoms at first. This condition is called smoldering multiple myeloma. As the cancer progresses, it can lead to bone pain, a weakened immune system, bone loss and other health problems. Though now good treatments are available to control myeloma, presently there is no cure available for multiple myeloma. Doctors can treat symptoms and may be able to fully control the disease or slow the production of cancerous cells.
Who does multiple myeloma affect?
The majority of people with multiple myeloma are over age 65. The risk of developing the condition increases as you get older.
You have an increased chance of developing the condition if you are:
- Over age 65.
- African American.
- A person with a first-degree relative with multiple myeloma (in some cases).
- Exposed to radiation, pesticides and other chemical.
People who have a disorder called monoclonal gammopathy of undetermined significance (MGUS) are at the risk of developing multiple myeloma. MGUS is a pre-cancerous condition which increases plasma cells in the body. These cells produce abnormal proteins which are detected in the urine and blood of patients. People with this condition usually don’t have any symptoms and don’t need treatment, but need close monitoring.
How common is multiple myeloma?
Multiple myeloma is rare. Eight out of 100,000 people are diagnosed with multiple myeloma in the United States every year. In 2017, there were an estimated 140,779 people in the U.S. who had this type of blood cancer. Most people with multiple myeloma are over 65.
Symptoms and Causes
What causes multiple myeloma?
The exact cause of the multiple myeloma is still unclear. Genetic abnormalities called mutations along with the environmental factors, such as exposure to radiation or certain chemicals, chronic inflammation or infections might play a role in this cancer.
What are the symptoms of multiple myeloma?
The first symptom many people notice is bone pain, usually in the back, hips or ribs. As the disease progresses, symptoms include:
- Decreased bone density, bone pain and bones that fracture (break) easily.
- Fatigue, low energy and weakness.
- Nausea, vomiting and weight loss.
- Unexplained fever.
- Increased infections.
- Weakness or numbness in the limbs.
- Skin that bruises or bleeds easily.
- Reduced appetite and increased thirst.
- Confusion or “fogginess.”
Diagnosis and Tests
How is multiple myeloma diagnosed?
To diagnose multiple myeloma, your provider will examine you and ask about your symptoms. For many people, the condition was diagnosed while visiting their provider for another reason (like a bone fracture).
Confirming a diagnosis usually requires:
- Blood tests: These tests detect the level of proteins and calcium in your blood. They measure how many healthy red and white blood cells you have. They also help your doctor see how far the cancer has progressed.
- Urine tests: Your doctor may ask you to collect your urine at home over a 24-hour period. This test detects a specific type of protein (Bence Jones protein) that is often present in people with multiple myeloma.
- Bone marrow biopsy: During this test, a medical specialist removes some of your bone marrow and sends it to a lab to check for abnormal plasma cells. After numbing the area (usually the hip bone), the specialist inserts a long, thin needle and removes (aspirates) some of the bone marrow. This is done to confirm the diagnosis of multiple myeloma by looking for percentage of abnormal plasma cells in the bone marrow. Certain genetic tests are performed to look for changes in the DNA called mutations which drive cancer cell growth.
- Imaging studies: Computed tomography (CT) scans, positron emission tomography (PET) scans, magnetic resonance imaging (MRI) and X-rays allow your doctor to see detailed images of your bones and soft tissues. These imaging studies show damage to bones and organs.
Management and Treatment
How is multiple myeloma treated?
Treatment depends on the severity of the condition. People who don’t have any symptoms may not need treatment but they do need regular monitoring for progression. If you don’t need treatment right away, your doctor will watch your health and develop a treatment plan if the cancer progresses.
For people with more advanced multiple myeloma, treatment usually includes a combination of several medications. These drugs destroy cancerous cells, reduce infection and relieve pain. Your doctor may also recommend radiation therapy or a stem cell transplant. Treatment may include:
- Medications that destroy cancerous cells: Proteasome inhibitors, HDAC inhibitors and chemotherapy drugs work in different ways to kill cancer cells or stop them from multiplying. Doctors usually give these medications through a vein (with an IV) or as a pill.
- Immunotherapy drugs: Your doctor may prescribe medicines that boost your immune system and help your body fight cancerous cells.
- Steroids: In high doses, steroids can kill cancer cells while decreasing inflammation.
- Antibiotics: A weakened immune system can lead to more infections. Your doctor may prescribe antibiotics to clear up these infections.
- Radiation therapy: This treatment uses high-energy X-rays to target tumors that grow from a buildup of plasma cells.
Stem cell transplant for multiple myeloma
Some patients with multiple myeloma need stem cell transplantation. In the process to control cancer by using strong doses of chemotherapy to kill cancer cells, normal bone marrow cells get damaged as a side effect.
So after chemotherapy, the patient’s own stem cells — collected beforehand — are infused back in the body like a blood transfusion. This infusion helps normal bone marrow to recover and become stronger again: In two to three weeks, these stem cells in your blood help produce healthy new cells in your bone marrow. Stem cells are specialized cells that can develop into different types of blood cells. In rare cases, you may receive stem cells from a donor rather than from your own blood.
What are the complications of multiple myeloma?
Multiple myeloma can cause problems throughout the body. As it progresses, complications may include:
- Bone problems: When plasma cells multiply in the bones, they cause bone lesions (also called lytic lesions). The lesions can make bones thin and weak, then slowly break down. These weakened bones might fracture easily, making it challenging to move.
- Increased risk of infection: When plasma cells build up, your body makes fewer healthy blood cells. White blood cells fight germs. Having too few white blood cells and low level of healthy immune proteins makes you more vulnerable to infection.
- Kidney problems: The kidneys’ job is to filter toxins and waste from your body.
Multiple myeloma proteins can clog the filter and tubes in the kidney, can make it hard for your kidneys to work as they should, leading to kidney failure.
- Anemia: Having fewer red blood cells causes anemia. Red blood cells are also made in the bone marrow. The bone marrow in patients with multiple myeloma is making abnormal plasma cells in excess, instead of normal cells. The production of red blood cells gets hampered in myeloma, leading to anemia. Symptoms of anemia include feeling tired, weak, difficulty with breathing and dizziness.
- Hypercalcemia: This condition occurs when too much calcium accumulates in the blood because bones are being destroyed and calcium is released from the bone. Hypercalcemia can cause vomiting, constipation, confusion and extreme thirst.
- Amyloidosis: In this condition, abnormal sticky proteins are produced by the abnormal plasma cells. These proteins accumulate in the organs and are commonly detected in the kidney, heart, liver, skin and nerves. This buildup of abnormal proteins causes damage to these vital organs and nerves. Amyloidosis causes exhaustion, diarrhea, purple spots over the skin, heart failure, kidney failure and swelling (commonly in the legs).
Can multiple myeloma be prevented?
There isn't prevention for multiple myeloma because it's caused by genetic changes which start spontaneously in the body, or are triggered by environmental toxins. A healthy lifestyle is recommended in general.
Outlook / Prognosis
What is the outlook for people with multiple myeloma?
A large number of many good, highly effective drugs are now available for the treatment of multiple myeloma. Myeloma can be controlled quickly with treatment and be kept in control for many years. The outlook varies based on age and how far the cancer has progressed. Although there is no cure for multiple myeloma, many people can successfully manage the condition by working closely with their doctor. The survival rate for people with multiple myeloma has increased significantly in recent years. Thanks to new treatments a patient can live for more than five to 10 years.
Your doctor may recommend a form of long-term chemotherapy called maintenance treatment. These therapies are designed to help to keep the cancer in remission for longer periods. “Remission” means the decrease or disappearance of disease and resolution of signs/symptoms of cancer. Some medications used in long-term chemotherapy can cause serious side effects. Talk to your doctor about these treatment options.