What is Multiple Myeloma?

Multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Plasma cells help you fight infections by making antibodies that recognize and attack germs.

Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells. Rather than produce helpful antibodies, the cancer cells produce abnormal proteins that can cause kidney problems.  Multiple myeloma is considered rare, affecting 20 to 200 thousand people in the US per year. 

Symptoms of Myeloma

Symptoms may not develop until later on, but they include:

• Bone pain
• Frequent infections
• Nausea
• Constipation
• Loss of appetite
• Fatigue
• Weight loss
• Weakness or numbness in your legs

What Causes Myeloma

It is unclear what causes myeloma but here is what we do know:

1. Begins with one abnormal plasma cell in the bone marrow
2. This cell quickly multiplies
3. The abnormal cancer cells accumulate and overwhelm heathy blood cells
4. As myeloma cells try to produce antibodies, like healthy plasma cells would, the antibodies made are also abnormal
5. Because the body can’t use the abnormal antibodies, they build up and cause damage in the body
6. The abnormal antibodies are known as  monoclonal proteins, or M proteins

Myeloma Risk Factors

• Age: the average age of diagnosis is about 65.  As you get older the risk of multiple myeloma increases
• Race: African Americans are about two times as likely to develop the disease compared to white people
• Gender: Men are more likely to develop myeloma that women are
• History of MGUS (monoclonal gammopathy of undetermined significance): 1% of people in the US with MGUS will develop the disease yearly

Diagnosing Myeloma

To diagnose multiple myeloma a series of lab tests can be done.  These exams include blood, urine, bone marrow and imaging tests.

Blood tests 

Blood tests may pick up M proteins produced by myeloma cells, notifying a doctor that something is off.  A second abnormal protein related to the disease and produced by the abnormal plasma cells is called beta-2-microglobulin.   Together these two blood tests can give a doctor clue as to the cause of your symptoms.  Other blood tests to analyze organ function, and red blood cell counts may also be beneficial for diagnosis.

Urine tests

A urine test can also show M proteins, an indicating factor you may have multiple myeloma.  When these M proteins are found in the urine they are actually called Bence Jones proteins. 

Bone marrow test:  

If multiple myeloma is highly suspected, a bone marrow sample can be taken and sent to a pathologist for a more definitive answer. This sample is acquired through biopsy, then analyzed to see if there are in fact myeloma cells, as well as how quickly they are dividing.

Imaging tests:

Because bone issues like pain, thinning or breaking, imaging tests like x-ray, MRI, CT or a PET scan may be recommended.  These tests are done to identify the side effects of multiple myeloma, not give a definitive diagnosis.  

Effects of Myeloma

The disease can have many harmful effects within the body.  These include damage the bones, immune system, kidneys, and red blood cells.    You can experience any of the following complications:

• Back or bone pain
• Reduced kidney function
• Bone problems like thinning or breaking bones
• Frequent infections due to myeloma cells blocking normal white blood cells
• Low red blood cell count (anemia) due to myeloma cells crowding out normal blood cells
• Weight loss

Myeloma Treatment Options

There is a wide array of treatments currently available for multiple myeloma, although sadly there is no cure.  These treatments aim to get people who suffer from the disease back to their regular lives.  If you are not experiencing any symptoms or complications from the disease, you may not be treated until those present themselves. Here are some of the treatments available

• Targeted therapy: focuses on specific abnormalities within the cancer cells to kills myeloma cells
• Biological therapy: enhances your own immune system to fight against and kill the abnormal cells
• Chemotherapy:  kill fast-growing cells, typical of cancer cells
• Corticosteroids: control inflammation in the body and regulate the immune system
• Radiation therapy: uses beams of energy to damage faulty cells and hinder their growth.  Usually used to shrink cancer cells in a specific area
• Stem-cell transplant: a procedure to replace bone marrow affected by multiple myeloma, with healthy bone marrow