What Is Multiple Myeloma?
Multiple myeloma is a form of cancer resulting from the overproduction of a single clone of plasma cells, a type of white blood cell produced in the bone marrow. Plasma cells proliferate in the marrow, infiltrate adjacent bone tissue, and may spread throughout the skeleton, resulting in bone pain and fractures of fragile, brittle bones. (Some patients develop a single plasma cell tumor, known as a plasmacytoma, in a bone or elsewhere.) Proliferation of plasma cells interferes with the formation of red cells (causing anemia), platelets (increasing the risk of bleeding), and white cells (increasing susceptibility to infection). Myeloma also involves the production of large amounts of a type of immunoglobulin (antibody) termed myeloma protein.
Although there usually is no cure for multiple myeloma, treatment can prolong life and improve the patient’s quality of life. Without treatment, the disease is usually fatal within two years of diagnosis.
Who Gets Multiple Myeloma?
Overall incidence of multiple myeloma has increased over the past few decades. Multiple myeloma is the second most common cancer of the blood and accounts for about 1% of all cancer diagnoses.
According to the World Health Organization (WHO), multiple myeloma and lymphomas (other cancers of the lymphatic system) are the eighth most common type of cancer worldwide, excluding non-melanoma skin cancer. The National Cancer Institute (NCI) reports that about 27,000 cases of multiple myeloma occur each year in the United States. Multiple myeloma is more common in men, in people over the age of 65, and in African Americans.
- Bone pain, especially along the spine, but also the ribcage and hips, that worsens with movement.
- Unexplained bone fractures. The collapse of affected vertebrae may cause loss of height and compression of the spinal cord, which may result in the inability to urinate and pain or paralysis of the legs.
- Fatigue, paleness (pallor), and shortness of breath, due to associated anemia.
- Frequent bacterial infections, due to a weakened immune system.
- Increased bruising and bleeding (for example, from the nose or gums).
- Headache and visual disturbances.
- Symptoms of hypercalcemia (high blood levels of calcium), which include generalized discomfort; muscle aches or weakness; arthritic joint pain; heartbeat irregularities; constipation, nausea, vomiting, and loss of appetite; and fatigue, lethargy, confusion, depression, psychosis, or other mental changes. Untreated, the hypercalcemia may result in coma and death.
- Symptoms of kidney failure.
- The cause of multiple myeloma is unknown, although genetic factors may play a role. Research has shown that the disease begins as a change (mutation) in genetic material called DNA (deoxyribonucleic acid) within plasma cells. Multiple myeloma cells also may contain abnormalities in DNA components called chromosomes.
- Multiple myeloma risk factors include the following:
- African American race
- Age over 65
- Exposure to radiation (e.g., from x-rays, handling radioactive materials, or living near or working in nuclear energy production facilities)
- Family history of multiple myeloma (e.g., having a close relative, such as a sibling or parent, with the disease)
- Male gender
- Monoclonal gammopathy of unknown significance (MGUS)—a condition characterized by the presence of M proteins in the blood without other evidence of multiple myeloma.
Early signs and symptoms of multiple myeloma (e.g., back pain, bone pain, chronic infection) often are vague and nonspecific; therefore, diagnosing the condition can be difficult. In some cases, multiple myeloma is diagnosed when x-rays are taken after an injury. Diagnosis includes the following:
- Patient history and physical examination to determine family history of multiple myeloma and other types of cancer, personal history of radiation exposure, and signs of bone pain, tumors, and swelling in the organs.
- Blood tests for myeloma protein, calcium levels, and measurement of the number of red cells, platelets, and white cells.
- Urine examination for myeloma protein.
- Bone marrow aspiration or biopsy, usually taken from the hip.
- X-rays of the skull, chest, spine, or other pain sites.
Once multiple myeloma has been diagnosed, detailed tests are performed to evaluate the extent of the disease (called staging). Information about the stage of the cancer is used to develop a treatment plan and determine the expected outcome (prognosis).
Multiple myeloma treatment depends on several factors, including the stage of the disease and the overall health and age of the patient. The goal of treatment is to reduce symptoms and prolong survival:
- Stay as active as possible to maintain bone strength. Because bones may be brittle, your doctor or physical therapist should supervise any program of activity.
- A combination of chemotherapeutic and targeted agents, often including corticosteroids (usually prednisone), is used to destroy cancerous cells.
- Radiation therapy is effective for plasmacytomas.
- Radiation is also used to relieve bone pain and spinal cord compression.
- Surgery may be necessary to repair bone fractures.
- Plasmapheresis, a procedure that filters excess waste products out of the blood artificially, may be performed in the event of an increase in the blood viscosity due to excess protein, produced by myeloma cells (hyperviscosity syndrome).
- Analgesics are administered to reduce pain.
- Antibiotics may be prescribed to treat associated bacterial infections.
- Stem cell transplantation (SCT) is often used to treat multiple myeloma in patients younger than 70 to 80 years of age who are otherwise healthy. In stem cell transplantation, high-dose chemotherapy is used to destroy bone marrow cells (i.e., myeloma cells, normal blood cells) and healthy stem cells (blood-forming cells in the bone marrow and lymphatic tissue) are then transplanted through a vein. The transplanted stem cells then begin to produce healthy blood cells.
- Generally, younger patients, patients with Stage I multiple myeloma, and patients without additional medical conditions have a more favorable prognosis than older patients, patients with advanced disease (Stage III multiple myeloma), and patients with other health concerns or chronic illnesses.
- Overall, the 5-year survival rate for patients with multiple myeloma is about 50%. However, recent improvements in treatment options may result in a better prognosis for many patients.
Multiple myeloma cannot be prevented. Healthy lifestyle choices, such as eating a low-fat, well-balanced diet, exercising regularly, and not smoking, can help lower the risk for many types of cancer, including multiple myeloma. Avoiding exposure to chemicals (e.g., in metal, rubber, treated wood, pesticides) and viruses (e.g., hepatitis, HIV) that are associated with an increased risk for the disease and exposure to radiation can also reduce the multiple myeloma risk.
When To Call Your Doctor
Call a doctor for bone pain or for the emergency symptoms of hypercalcemia or kidney failure.
Reviewed by Todd Gersten, M.D., Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network.