Multiple myeloma is a fairly uncommon cancer that affects plasma cells, a type of white blood cell in the spongy inner part of some bones (the bone marrow). The abnormal plasma cells — myeloma cells — cause several problems, by:
- Forming bone tumors (plasmacytoma)
- Preventing the marrow from making enough healthy blood cells, leading to dangerously low counts of red blood cells (anemia), platelets (thrombocytopenia) or white blood cells (leukopenia)
- Weakening bones (particularly in the spine), by producing signals that speed up the normal breakdown of old bone without replacing it
- Producing useless antibodies that can harm the kidneys
Multiple myeloma remains a challenging disease, but treatment options have greatly increased over the past decade and survival rates are up. Research continues on promising new approaches, including genetic analysis of individual tumors and targeted therapies, for individualized care.
Multiple Myeloma Treatment
Our team of specialists is highly experienced and ready to work with you to create a personalized treatment plan. In making recommendations, the team considers:
- Your age and overall health
- The cancer’s stage
- Test results, include genetic analysis of the tumor
- How the cancer responds to initial treatment
- Whether the cancer is newly diagnosed or has returned (recurred)
- Your preferences and goals
Some cases of multiple myeloma don’t cause symptoms and might only need careful monitoring (watchful waiting) until the condition worsens. If treatment is recommended, it’s usually done in stages:
- Kill as much as cancer as possible, with one or more approaches:
- Anti-tumor steroid (corticosteroid)
- Targeted therapy
- Destroy any remaining cancer with high-dose chemotherapy and a restorative stem cell transplant
- Provide follow-up therapy to keep the cancer in remission, using the same therapies as stage 1
We may also recommend radiation to treat painful bone damage that is not responding to chemotherapy.
Multiple Myeloma Supportive Care
In addition to primary treatments, we might also recommend:
- Bisphosphonate drugs to slow the destruction of bone
- Physical therapy to relieve bone problems, or surgery to place metal rods or plates to support bones and prevent or treat fractures (learn more about our cancer rehab)
- Injection of donated antibodies to prevent infections
- Blood transfusions to relieve anemia and related symptoms
- A procedure called plasmapheresis to remove myeloma proteins that are thickening the blood and interfering with circulation
Multiple Myeloma Risk Factors
We don’t know what causes most cases of multiple myeloma, and most cases develop in patients with no known risk factors. But risk factors that have been identified include:
- Age: Almost everyone who is diagnosed is over 45, and most are over 65.
- Race: African-Americans are twice as likely to get the disease as whites.
- Medical History: You face a higher risk if you have a personal history of other plasma cell disorders, such as plasmacytoma (a single tumor rather than several) or monoclonal gammopathy of undetermined significance (MGUS)
- Radiation and Chemical Exposure: So far, studies have found an association — but no strong connection — between multiple myeloma, radiation or chemicals and certain occupations, such as working in agriculture, petroleum, leather or cosmetology.
Multiple Myeloma Symptoms
Multiple myeloma does not always cause symptoms. But other patients may experience:
- Bone pain, especially in the back or ribs
- Bones that break easily
- Unexplained fevers
- Frequent infections
- Unusual bruising or bleeding
- Trouble breathing
- Arm or leg weakness
- Too much calcium in the blood (hypercalcemia), which can cause:
- Appetite loss
- Nausea or vomiting
- Feeling thirsty
- Frequent urination
- Muscle weakness
- Confusion or trouble thinking
Other conditions can cause these symptoms, too, so it’s important to see a doctor.
Multiple Myeloma Diagnosis
Successful multiple myeloma treatment depends on a complete and accurate diagnosis. Each of our patients receives a thorough evaluation so we can create an individualized plan. We diagnose multiple myeloma with:
- History and Physical Examination: We complete a thorough examination and take a full personal and family medical history.
- Blood and Urine Work: We may take a blood sample to test your complete blood count (CBC), blood chemistry and other factors.
- Biopsy: We use a hollow needle to remove a small sample of bone marrow, blood and bone from the hipbone or breastbone. The samples are studied under a microscope and may get other testing, including analysis for genetic changes.
Additional tests may include:
- MRI: Magnetic resonance imaging uses a powerful magnetic field and radio waves to create detailed 3D images at higher contrast than CT scans — useful for clarifying other test results.
- Skeletal Bone Survey: X-rays of all the bones are taken, to find damaged areas.
- Bone Densitometry: A special X-ray measures bone density.