Definition and Overview

Multiple myeloma, often simply referred to as myeloma, is a type of cancer that affects protein-producing plasma cells in the bone marrow that help the body fight infections. In this condition, the plasma cells multiply uncontrollably and crowd healthy cells, including the white and red blood cells. When the overproduction of plasma cells lead to spillage out of the bone marrow to other parts of the body, organ damage results. Multiple myeloma can lead to the weakening of the immune system and can lead to kidney and bone problems, as well as anemia.

Symptoms of Multiple Myeloma

The symptoms of multiple myeloma are usually unnoticeable until the cancer is in its advanced stages. Among common signs and symptoms include the following:

  • Bone problems that may include pain in the bone, bone weakness, and brittle bones

  • Low blood counts indicating shortage of red blood cells (anemia), white blood cells (leukopenia) or low blood platelet count (thrombocytopenia); signs include bruising, weight loss, loss of appetite, unexplainable fatigue

  • Abnormally high levels of calcium in the blood (hypercalcemia), which can cause dehydration, severe constipation, and frequent urination

  • Nervous system problems due to weakened bones in the spine or spinal cord compression; signs include severe back pain, muscle weakness, and numbness

  • Hyperviscosity (thickening) of the blood leading to confusion and dizziness

  • Kidney Problems when spillage of plasma occurs in the kidneys leading to leg swelling, weakness and shortness of breath

  • Increased risk for infection; myeloma patients are prone to infections due to lower resistance

Causes and Risk Factors

Just like many cancers, the exact reason why plasma cells become malignant is yet to be identified. However, research and various studies suggest several risk factors that contribute to the development of myeloma, which include the following:

  • Genetic or hereditary factors, including genetic abnormalities such as c-myc oncogenes

  • Environmental exposure to certain chemicals including insecticide, herbicides, benzene, hair dyes and radiation

  • Lifestyle choices, including smoking and alcohol

Furthermore, studies have found that individuals aged 65 or older, males, of African-American descent, and those who are overweight and obese are more likely to develop myeloma. Those who have plasma cell-related diseases such as MGUS (monoclonal gammopathy of uncertain significance) and plasmacytoma are also at higher risk of developing this condition.

When to See a Doctor

If you notice any signs and symptoms specified above, it is always best to seek medical attention immediately. The aforementioned symptoms do not always indicate myeloma, as there is a spectrum of diseases with similar symptoms. If your general practitioner sees the need for further diagnosis, you will be referred to an oncologist, a doctor who specializes in the diagnosis and treatment of cancer.

Tests and Diagnosis

If symptoms point to multiple myeloma, a series of tests will be performed to confirm the diagnosis. Blood and urine tests, x-ray of the bones and bone marrow biopsy are among the common tests suggested for myeloma.

  • Blood Tests: to determine whether there are abnormalities in the amount of protein (plasma cells) or if there is unusual stickiness of the blood

  • Bone marrow aspiration biopsy: a bone marrow sample is obtained to check the absence or presence of chromosomes (cytogenic testing), assess the concentration of cells in the marrow, and evaluate the presence of abnormally-invasive cellular elements

  • Imaging tests such as X-ray of the bones to identify skeletal abnormalities and lesions, MRI of the spine, CT or positron emission tomography (PET)

  • Urine tests to check for M proteins

If all tests have definitively confirm multiple myeloma, all data and information from the diagnostic tests will be used by your oncologist to determine the stage and risk category of your cancer - stage 1, 2, 3, or 4 by order of increasing risk. Stage 1 indicates a non-aggressive form of plasma cell cancer while Stage 3 indicates an aggressive myeloma, which may affect the bone, kidneys, and other organs. This staging system is important to help you to fully understand your prognosis and determine the best treatment plan.

Treatment for Multiple Myeloma

Unfortunately, there is still yet to be a standard cure for multiple myeloma. However, there are various treatment options that can enable a myeloma patient to resume to almost-normal daily life. These options include the following:

  • Targeted Therapy, which involves drug treatment such as bortezomib (Velcade) and zarfilzomib (Kyprolis), that target specific abnormalities in myeloma cells to prevent them from surviving or spreading

  • Chemotherapy to kill myeloma cells

  • Biological Therapy, an approach that uses drugs like thalidomide and pomalidomide to enhance the body’s natural immune system to identify and attack cancer cells
  • Radiation Therapy that uses beams of energy to target and damage myeloma cells and stop their proliferation
  • Stem Cell Transplantation, a treatment procedure that allows the replacement of diseased bone marrow with a healthy set after chemotherapy
  • Corticosteroids such as prednisone to help regulate the immune system and control inflammation

Oncologists often suggest a combination of treatments, depending on the risk and projected progress of your disease, your overall health and age. The oncologist will carefully plan a treatment solution that will best fit your needs and will lay down the pros and cons, including possible side effects, to help you decide and prepare for treatment.

Since multiple myeloma may also cause a range of complications in other organs or parts of the body, additional drugs and treatment may be recommended. These may include surgery for bone pain, pain medications, medications for prevention of bone loss, medications for anemia, vaccines to prevent infection or dialysis for severe kidney damage. After treatment, it is important to continue to see your oncologist for follow-up appointments. This would mean regular visits as well as routine tests to determine whether more treatment is necessary.

References:

  • National Cancer Institute: PDQ Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment. Bethesda, Md: National Cancer Institute. Date last modified: March 12, 2014. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/myeloma/healthprofessional.

  • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Multiple Myeloma. Version 2.2014. Available at: http://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf.

  • Rajkumar SV, Dispenzieri A. Multiple myeloma and related disorders. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2013:chap 104.

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