Multiple Myeloma

What is multiple myeloma?

Normally, healthy cells grow and divide in a way that keeps a body functioning. Sometimes, as is the case with cancer, cells develop abnormalities and grow out of control.

Multiple myeloma is cancer found in plasma cells, a type of white blood cell found in bone marrow, which is important for immune response. Myeloma means a malignant tumor of the bone marrow. When cancerous plasma cells accumulate in the bone marrow, they can crowd out healthy cells. These cells can form tumors in bones throughout the body or interfere with the cells that keep bones and the body healthy and strong.

This form of cancer is rare, affecting less than 1% of people in the United States. It typically affects those around the age of 65. If untreated, it can cause severe, life-threatening complications including kidney and bone problems.

Types of myelomas

There are several sub-types of myelomas, some being more aggressive and some being less aggressive.

• Multiple myeloma involves multiple sites at the time of diagnosis and is the most common sub-type.
• Plasmacytoma is an accumulation of malignant plasma cells found most often in the bones but also in the muscle, skin or lung. A single tumor is called “solitary plasmacytoma.” A tumor outside of the bones is called an “extramedullary plasmacytoma.” The plasmacytoma is often treated with radiation therapy alone, although it may recur or later develop into myeloma.

What causes multiple myeloma?

Research has shown no clear cause for this cancer, although several risk factors have been identified.

Age is the most significant risk factor, as most people with myeloma are over the age of 65. Men are slightly more likely to develop this cancer than women, and African-American individuals are twice as likely as Caucasian individuals to develop the disease.

Symptoms of multiple myeloma

Signs and symptoms of multiple myeloma can vary by individual. In early stages in the disease, symptoms may not be noticeable. Smoldering myeloma is the term used when, early in this cancer, no symptoms or problems are presented. Individuals with smoldering myeloma have no bone or organ damage and normal blood counts, calcium levels and kidney function.

Over time, symptoms can include:

• Bone pain, particularly in the spine
• Weakness and fatigue
• Weight loss and loss of appetite
• Nausea
• Constipation
• Confusion or mental fogginess
• Frequent infections
• Excessive thirst
• Weakness or numbness in arms and legs

Along with symptoms, side effects of the loss of blood cells and excessive proteins can include kidney damage, anemia, excessive bleeding and decreased ability to fight off infections.

Diagnosing multiple myeloma

For those without symptoms, the first sign of an issue is often found when a blood or urine test is done for another condition, and a higher than normal level of protein is found.

Diagnosing multiple myeloma typically involves a combination of blood and urine testing along with imaging studies (X-ray, MRI, PET scan, for example). It may also include a bone marrow biopsy or density test.

A combination of test results, along with patient history, can help in making a diagnosis along with identifying locations affected and the stage of the disease. The staging degree to which the cancer has progressed is a significant factor in determining a personalized treatment plan.

Multiple myeloma treatment options

Those with smoldering myeloma will likely undergo regular monitoring until treatment is recommended, often called watchful waiting. This often involves periodic blood and urine tests. If symptoms are present, treatment typically involves a combination of symptom management and techniques to slow progression. Multiple myeloma is not curable.

Corticosteroids or steroids are medications used to regulate the immune system to control inflammation in the body. They can help other treatments work better and are also active against myeloma cells.

Proteasome inhibitors are drugs that stop enzyme complexes (proteasomes) in cells from breaking down proteins important for controlling cell division. They may also be prescribed to patients after undergoing stem cell transplants for maintenance therapy.

Immunotherapy, sometimes called biologic therapy, refers to a class of treatment utilizing a person’s immune system to attack cancer cells. It is relatively new as an option for multiple myeloma, first approved in 2015. There are a number of immunotherapies, each working in a slightly different way. One of the foremost treatments is immunomodulatory drugs (IMiDs). They work by adjusting several aspects of the immune system. They can improve function of normal immune cells, prevent certain types of growth signals for cancer cells, and directly and indirectly kill myeloma cells. IMiDs are sometimes prescribed with other drugs or treatments to improve effectiveness.

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation therapy is particularly effective in treating areas of bone damaged by myeloma that have not responded to chemotherapy and/or other treatments.

Chemotherapy is a systemic cancer treatment that uses strong drugs to stop the growth of cancer cells. Often these drugs are combined with other types of drugs like corticosteroids to further change a patient’s immune response.

Targeted therapy is a type of chemotherapy that marks, or targets, certain traits or weaknesses of a cell. By blocking these traits, targeted drug treatments can cause cancerous cells to die.

Stem cell transplants infuse healthy stem cells into a patient’s body to replace stem cells that have been damaged by disease, chemotherapy or radiation. Patients with multiple myeloma often have one or two transplants, 6 to 12 months apart (called tandem transplant).

In addition to the above, since multiple myeloma can cause other health complications, treatment may be needed for those specific conditions (bone pain, bone loss, infections, etc.).

Risks & side effects of multiple myeloma treatment

Risks and side effects of multiple myeloma treatment vary depending on the course of action chosen.

Radiation therapy and chemotherapy can damage healthy tissue. Oncologists can control these side effects with medications, diet changes and lifestyle management. Over time and after treatment, these side effects disappear. Sometimes long-term side effects, such as infertility due to chemotherapy drugs, may remain.

Side effects from a stem cell transplant are similar to those from chemotherapy and radiation, only more severe. Medication can also cause side effects including birth defects, fatigue, anxiety, constipation or other sensations.