Multiple myeloma is the most common type of cancer that forms in plasma cell, a type of white blood cell. Plasma cells aid the body to fight infections by producing antibodies that identify germs and attack them. The bones and bone marrows are the primary sites where myeloma cells (cancer cells) are produced. As these abnormal cells accumulate in the bone marrow, they crowd out healthy blood cells. And instead of producing antibodies that are helpful to the body, myeloma cells produce abnormal proteins that can harm the kidneys.
When myeloma cells build up, they not only diminish* healthy blood cells in the bone marrow, but also weaken and damage bones. Myeloma cells produce a substance that fuels osteoclasts, which dissolve bone and speed up its destruction that causes bone pain, fractures and infection.
Signs and Symptoms
In most cases, patients with myeloma experience at least a few symptoms at the time of their diagnosis. The most common one is severe and persistent back pain – a lot more excruciating than ordinary back pain. Paraproteins or myeloma cells in the marrow may cause damage to the organs and tissues, characterized by CRAB: Calcium in the blood, or Renal damage, or Anemia or Bone damage.
Bone Damage Causes Calcium Levels in the Blood to Rise
- Itchy skin
- Loss of appetite
- Lethargy, fatigue or depression
- Frequent urination
- Feeling dehydrated or thirsty
- Being confused
- Renal/Kidney damage
- Swelling/fluid retention
Accumulation of Myeloma Cells in the Bone Marrow Causes Anemia
- Easily gets tired
- Shortness of breath
Other Symptoms that Damage the Bones
- Bone pain
- Fractures, thinning of bones
Causes and Risk Factors
- Age – The risk of multiple myeloma increases* with age. Most people diagnosed with multiple myeloma are 65 years old and above.
- Gender – Men are slightly more at risk of developing multiple myeloma than women.
- Race – African Americans are twice as likely as white Americans to develop this disease.
- Radiation exposure – People who were exposed to an atomic bomb blast’s radiation had a higher risk of multiple myeloma.
- Family history – Multiple myeloma is likely to run in families. A person is 4 times more at risk of developing multiple myeloma if someone in the family i.e. sibling or parent has the disease. However, this is rare.
- Obesity – According to a study conducted by the American Cancer Society, obesity or being overweight increases* a person’s risk of developing multiple myeloma.
- Smouldering or indolent multiple myeloma – this is also known as asymptomatic myeloma as it does not show any symptoms. A person with smouldering or indolent multiple myeloma has M-protein level in the blood of 30 g/L or more. The blood cells in the bone marrow are also made up of 10% or more plasma cells. It causes kidney failure, hypercalcemia, bone lesions and anemia.
- Active multiple myeloma – symptoms include M-proteins in the urine or blood, more than 10% plasma cells found in the bone marrow, anemia, hypercalcemia, kidney failure, weakened areas of bones (osteolytic lesions) and/or a tumour containing myeloma cells (plasmacytoma) in the soft tissue or bones.
- Solitary plasmacytoma of the bone – roughly 50% to 60% of people with solitary plasmacytoma are likely to develop multiple myeloma. This type of multiple myeloma develops when cancer cells build up in one place and form a single tumor. It is sometimes referred to as “Stage 1 Myeloma”.
- Multiple solitary plasmacytomas – this occurs when separate plasmacytomas occur in soft tissues or bones.
Tests and Diagnosis
Generally speaking, multiple myeloma is diagnosed based on the doctor’s physical examination, the patient’s symptoms and test results.
To diagnose this disease, the following tests and diagnosis can be done:
- Biopsy results of a plasma cell tumour OR at least 10% of the cells in the bone marrow consist of plasma cells AND at least one of the following:
- Poor kidney function
- Anemia/Low red blood cell counts
- High blood calcium level
- An abnormal parts in the bones or bone marrow on an MRI scan
- Imaging studies showing holes in bones from tumor growth; OR
- Bone marrow containing 60% or more plasma cells
Treatment and Medications
Chemotherapy and Other Drugs for Multiple Myeloma
This is used to control or destroy cancer cells. As multiple myeloma often spreads extensively, this treatment can be helpful for it enters the blood stream and gets into all areas of the body. These drugs can be given in a muscle or vein, or can be taken by mouth. Chemo drugs include Cyclophosphamide (Cytoxan®), Etoposide (VP-16), Doxorubicin (Adriamycin®), Liposomal doxorubicin (Doxil®), Melphalan, Vincristine (Oncovin®) and Bendamustine (Treanda®). Combinations of these drugs are more effective than any single drug.
Must Watch – New treatments for multiple myeloma – Mayo Clinic
Corticosteroids play a big role in treating multiple myeloma. These drugs can be combined with other drugs and also used to help lessen vomiting or nausea in people who undergo chemotherapy. Prednisone and dexamethasone are the common types of corticosteroids.
Proteasome inhibitors help stop enzyme complexes (proteasomes) in cells from breaking down proteins, which are vital for keeping cell division under control.
Stem Cell Transplant
For younger myeloma patients who are in good health, stem cell transplant has become a known treatment.
Precaution and Self Care
As multiple myeloma’s risk factors are not yet fully understood, there is still no known way to prevent this disease. However, multiple myeloma screening exams are important precautionary measure.
- Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC (July 2009). “Multiple myeloma”. Lancet 374 (9686): 324–39. doi:10.1016/S0140-6736(09)60221-X. PMID 19541364.
- “SEER Stat Fact Sheets: Myeloma”. NCI Surveillance, Epidemiology, and End Results Program. Retrieved 18 August 2014.
- International Myeloma Working Group (2003). “Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group”. Br. J. Haematol. 121 (5): 749–57.
- Longo, Dan (2012). Harrison’s Principles of Internal Medicine 18th Edition. Mc Graw Hill Medical. p. 938. ISBN 978-0-07-174889-6.