Multiple Myeloma

Multiple myeloma is a type of blood cancer that affects the functioning of a type of white blood cells in the bone marrow called plasma cells.

Multiple myeloma is a type of blood cancer that forms in your plasma cells, or white blood cells in your bone barrow. When your plasma cells are functioning normally, they produce antibodies, which are blood proteins that your immune system uses to fight off harmful germs, like infections, viruses, and bacteria.

But, the plasma cells in people with multiple myeloma become cancerous and begin to grow abnormal antibodies. Abnormal antibodies can sometimes grow out of control and limit the growth of healthy cells. If left untreated, those antibodies can cause damage your red blood cells, kidney, bones, and immune system.

Unfortunately, many people with the condition may not even notice symptoms because multiple myeloma quietly lurks until your healthcare provider discovers it during a routine blood test. In some cases, people with the condition may begin to experience bone pain and fatigue.

In either case, a diagnosis of multiple myeloma can be scary and unsettling. An early diagnosis of multiple myeloma can help you get treatment in the early stages of the condition, reduce symptoms, slow disease progression, and prolong survival while preserving your quality of life. In fact, data collected between 2012 and 2018 showed that the five-year relative survival rate is nearly 60% for people with multiple myeloma.

Multiple myeloma is a rare type of cancer, representing less than 2% of all cancer diagnoses in the United States. According to 2019 data from the National Cancer Institute, about 159,800 people have multiple myeloma. 

Types of Multiple Myeloma

Each type of multiple myeloma differs depending on which form of abnormal antibodies they are producing. Your healthcare provider may classify your multiple myeloma into one of four types: Typical, Bence Jones, non-secretory, or immunoglobulin gamma (IgM).

Typical Myeloma

Typical myeloma is the most common form of multiple myeloma. People with typical myeloma may have plasma cells that produce one of the following antibodies:

  • IgG kappa or epsilon 
  • IgA kappa or epsilon
  • IgD
  • IgE
  • IgM

Bence Jones Myeloma

Bence Jones myeloma, also referred to as light chain myeloma, affects 15% to 20% of people with multiple myeloma. People with Bence Jones myeloma have cancerous plasma cells that produce proteins called kappa or epsilon. Kappa and epsilon proteins may cause damage to the kidneys and nerve cells.

Non-Secretory Myeloma

People with non-secretory myeloma may produce little or no abnormal antibodies. Non-secretory myeloma is rare and generally only affects 1% to 5% of people with multiple myeloma.

Immunoglobulin Mu (IgM) Myeloma

People with IgM myeloma produce too many IgM antibodies. This type of myeloma is very rare, affecting less than 1% of people with multiple myeloma. In some cases, IgM myeloma may cause damage to both your bone marrow and your lymph nodes.

Multiple Myeloma Symptoms

The majority of people with multiple myeloma may not even notice any symptoms before receiving a diagnosis. If your condition worsens, you may begin to experience some symptoms such as:

  • Bone pain: This type of pain mainly occurs during an advanced stage of cancer. You may feel bone pain in your chest, arms, and legs. In some cases, moving your body too much can worsen bone pain.
  • Bone loss and fractures: Bone loss may happen if cancerous cells spread to the bone. If your cancer cells metastasize (spread), they can form tumors and lystic lesions (a type of bone destruction) in your bones. Bone loss and destruction can thus increase the risk of fractures.
  • Hypercalcemia: Bones pack a lot of calcium. If your bones break down, they can release an excess amount of calcium into your blood. High blood calcium levels, also called hypercalcemia, may cause symptoms like nausea and vomiting, frequent urination, and excessive thirst.
  • Anemia: People with multiple myeloma may experience fatigue. Fatigue often occurs due to anemia, which is a condition that occurs when your body does not have or make enough red blood cells to carry oxygen from your blood to other parts of the body. Anemia in people with multiple myeloma is common and affects nearly 75% of people with the condition.
  • Kidney damage: Kidney damage or failure is one of the first noticeable symptoms of multiple myeloma. An abnormal amount of proteins and calcium in the blood may cause damage to the kidneys. 
  • Hyperviscosity syndrome: This condition causes your blood to thicken and makes it difficult for your blood to move freely in and around your blood vessels. Hyperviscosity syndrome happens when there are too many proteins in the blood. Symptoms may include bleeding in the nose and mouth and heart failure.
  • Neurological damage: Multiple myeloma may cause fractures in your spine, which can damage nerve cells. Damaged nerve cells may cause neurological symptoms like numbness, tingling, pain, or muscle weakness. Loss of bowel or bladder control may also occur. 
  • Frequent infections: Plasma cells are essential for proper immune system functioning. That said, multiple myeloma may weaken your immune system when plasma cells become cancerous. A weak immune systems makes it harder for your body to fight off infections and make you more vulnerable to harmful germs.
  • Bruising: If cancerous cells build up underneath the skin, you may start to notice bruise-like bumps on your body.

What Causes Multiple Myeloma?

The cause of multiple myeloma is unknown. Research suggests these risk factors may increase your likelihood of developing the condition:

  • Being over the age of 65
  • Exposure to radiation or harmful chemicals such as herbicides or insecticides
  • A family history of multiple myeloma
  • Having other conditions that also affect the plasma cells

How Is Multiple Myeloma Diagnosed?

For many people with multiple myeloma, routine blood tests are one of the first signs that your body is producing abnormal antibodies. If your healthcare provider suspects you have multiple myeloma, they may further analyze your blood samples or order additional blood tests.

The "CRAB" criteria may also indicate you have multiple myeloma. CRAB is an acronym for:

  • Calcium (higher than usual in the blood)
  • Renal (liver) failure
  • Anemia
  • Bone disease

However, not everyone with multiple myeloma has all of these issues at the time of diagnosis.

While blood tests are most commonly used for diagnosis, some abnormal proteins can show up in urine tests and bone loss may be noticeable on X-rays.

Your healthcare provider or oncologist (a doctor who specializes in cancer) will likely use a bone aspiration (removing a sample of bone marrow) and a biopsy (taking a sample of skin tissue) to confirm a diagnosis of multiple myeloma. They may also use imaging tests like an X-ray, MRI, or CT scan, which can help determine if the cancer has spread and where.

Stages of Multiple Myeloma

If you receive a diagnosis for multiple myeloma, your provider will evaluate your blood tests, imaging exams, or bone or skin tissue to stage your condition. The stages of multiple myeloma include:

  • Stage 1: This is also known as monoclonal gammopathy of undetermined significance (MGUS). During stage 1, your blood tests may show less than three grams of abnormal antibodies per deciliter of blood. People with MGUS do not typically have symptoms of multiple myeloma yet. If you have MGUS, you may not meet the "CRAB" criteria or have any damage to your organs.
  • Stage 2: This is also known as smoldering myeloma. With smoldering myeloma, your blood test yields more than three grams of abnormal antibodies per deciliter of blood. People with smoldering myeloma may also not notice any symptoms or meet the "CRAB" criteria. However, about half of people with smoldering myeloma will develop multiple myeloma within five years.
  • Stage 3: This happens when smoldering myeloma progresses into multiple myeloma. People in stage 3, will have more than three grams of abnormal antibodies per deciliter of blood. You may meet one or more of the "CRAB" criteria and have organ or tissue damage.

Treatments for Multiple Myeloma

Currently, there is no cure for multiple myeloma. But, treatments can help slow disease progression, manage symptoms, and improve your quality of life.

Typically, multiple myeloma can progress slowly. If you are in stage 1 or stage 2, you might not need treatment immediately. In this instance, your healthcare provider may monitor your disease progression closely by setting up check-ins and blood tests every three months.

People in stage 3 may require immediate treatment. The good news: there are many different treatment options available. Your healthcare provider, oncologist, and any other specialist on your care team will conduct tests to determine the kind of multiple myeloma you have. They may also determine whether your cancer has any genetic mutations. If genetic mutations are present, you may benefit from specific treatments.

Common treatments for multiple myeloma include:

  • Immunomodulators: These medicines help your immune system target and destroy cancerous cells.
  • Proteasome inhibitors: People with multiple myeloma have an abnormal amount of antibodies. Proteasome breaks down those antibodies in your cells and cause them to spread. Using a proteasome inhibitor can prevent the spread of cancer cells.
  • Monoclonal antibodies: These are proteins that target antigens on cancerous cells. Antigens are substances that help produce abnormal antibodies. 
  • Nuclear export inhibitor: In your cells, the nuclear export transfers proteins out of the nucleus. The nucleus of a cell contains the genetic material that produces harmful proteins. Inhibitors can prevent protein build up and kill off cancer cells.
  • Chemotherapy: This is a drug treatment that aims to kill fast-growing cancer cells. Chemotherapy may control or stop the progression of multiple myeloma in some people. 
  • Corticosteroids: Some corticosteroids, like prednisone, can be combined with chemotherapy treatment to improve symptoms. These are generally available in pill form.
  • Stem cell transplantation: Your healthcare provider may use yours or a donor's bone marrow stem cells for a transplant. Transplants do not cure multiple myeloma but can slow disease progression. 
  • CAR-T therapy: This is a type of immunotherapy. CAR-T therapy uses genetically-modified cells to target and attack cancerous cells. 

In most cases, a combination of treatments can be helpful in targeting multiple myeloma and reducing symptoms.

How to Prevent Multiple Myeloma

There are no known therapies that can stop MGUS or smoldering myeloma from progressing into multiple myeloma.

However some researchers are in the process of studying prevention methods. In a publication in the journal Lancet Haematology, a working group of researchers have found preliminary evidence that preventing infections can slow the progression of multiple myeloma. Infections are currently one of the primary risk factors for developing multiple myeloma. 

According to the International Myeloma Society, the following actions can prevent infections:

  • Being vaccinated against common viruses and bacteria
  • Receiving antimicrobial prophylaxis, which helps prevent infections before surgeries
  • Taking infection control measures (e.g., hand hygiene, using personal protective equipment, and disinfecting shared surfaces)
  • Replacing antibodies in people who are at risk of developing the disease 

Although there is no way to fully prevent multiple myeloma from developing, these strategies may help slow disease progression.

Co-Occurring Conditions

Multiple myeloma is comorbid with several conditions, which means that other disease can co-occur with a multiple myeloma diagnosis. The reason people with multiple myeloma can experience other conditions is because this cancer affects the blood and several different organs. Some of the most common conditions that co-occur with multiple myeloma include:

  • Hypercalcemia: High blood calcium levels
  • Anemia: Low levels of red blood cells
  • Kidney issues: Damage or failure in the functioning of the kidneys
  • Hyperviscosity syndrome: Protein build up that causes your blood to thicken

Living With Multiple Myeloma

Living with multiple myeloma can be difficult. You may feel sad, frustrated, or hopeless when you receive your diagnosis. These feelings are normal. It can be hard to live with symptoms and go in for treatment.

However, a team of healthcare providers can help make your condition feel more manageable. Some evidence suggests that partaking in regular light exercise, eating a nutritious diet, and getting enough sleep can help ease symptoms.

You may also find it helpful to seek out support from your family, friends, and other people with multiple myeloma to help make your condition feel less overwhelming. If you feel as though your diagnosis is weighing on your emotional well-being, you may consider asking your healthcare provider for a referral to a mental health counselor.

A Quick Review

Multiple myeloma is a type of blood cancer that targets plasma cells, which are white blood cells found in your bone marrow. With multiple myeloma, the plasma cells produce an abnormal amount of antibodies. If untreated, those antibodies can cause painful symptoms and cause damage to your blood and organs.

You may not notice any symptoms in the early stages of multiple myeloma. Healthcare providers typically only discover multiple myeloma once abnormalities appear on routine blood work. You may need imaging tests and bone aspiration to confirm a diagnosis.

Feeling scared or anxious is normal if you receive a multiple myeloma diagnosis. Early diagnosis, medical treatments, and lifestyle strategies can help slow the disease's progression and manage symptoms.

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Sources
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