CONDITIONS

Multiple Myeloma

What Is Multiple Myeloma

Multiple myeloma is a form of cancer that is caused by the malignant and abnormal growth of plasma cells.

Plasma cells are immune cells typically found in the bone marrow that specialize in the production of antibodies, proteins that help the body to fight off infection. When plasma cells undergo rapid abnormal growth, they can form tumors called plasmacytomas. Multiple myeloma is characterized by the presence of multiple tumors. The presence of only one plasmacytoma would suggest a different disease known as isolated plasmacytoma.

 

What Causes Multiple Myeloma

Multiple myeloma is characterized by the presence of multiple malignant plasma cell tumors known as plasmacytomas. Plasma cells are formed when B lymphocytes mature in response to an infection.  Lymphocytes are one of five types of white blood cells. Mature lymphocytes all look quite alike, but are actually incredibly diverse with respect to their individual functions. The two main types of lymphocytes are:

  • B  lymphoctyes—or B-cells. B cells are produced in the bone marrow—hence the B.
  • T lymphocytes—or T-cells

Researchers are not yet sure of what causes the abnormal replication of plasma cells found in multiple myeloma patients. One of the leading theories on the cause of multiple myeloma is that the cancerous growth of plasma cells is triggered by a DNA mutation. Recent studies have found that mutations to certain oncogenes, parts of DNA that control cell replication, can cause the cancerous division of plasma cells.

 

Risk Factors For Multiple Myeloma

According to the American Cancer society, there are several factors that can affect your risk of developing multiple myeloma:

  • Age. The majority of patients diagnosed with multiple myeloma are 65 years of age or above.
  • Sex. Multiple myeloma is slightly less common in women than it is in men.
  • Ethnicity. African Americans are more than twice as likely to develop multiple myeloma than white Americans. The reason for this is not yet known.
  • Radiation exposure. Individuals who have been exposed to radiation, especially radiation from an atomic bomb blast, develop multiple myeloma at a much higher rate. The level of radiation necessary to increase the risk of multiple myeloma is not yet known.
  • Pre-existing plasma cell diseases. Individuals with plasma cell diseases such as monoclonal gammopathy of undetermined significance (MGUS) or solitary plasmacytoma are at a much higher risk of developing multiple myeloma.
  • Certain genetic markers. Multiple myeloma patients have been found to have similar genetic abnormalities, such as translocations (switching of genes) within the myeloma cells, missing segments of the thirteenth chromosome, and mutations of the MYC and RAS genes.

Diagnosing Multiple Myeloma

Multiple myeloma can often be difficult to diagnose. An accurate diagnosis of multiple myeloma will most likely involve a combination of several different diagnostic techniques. Current diagnostic criteria for multiple myeloma requires the presence of at least one major and three minor criteria. According to the Multiple Myeloma research foundation, the major and minor criteria are as follows:

Major Criteria:

  • Plasmacytoma (plasma cell tumors as demonstrated on evaluation of biopsy specimen)
  • 30% plasma cells in a bone marrow sample
  • Elevated levels of proteins called M Proteins in the blood or urine

Minor Criteria:

  • 10-30% plasma cells in a bone marrow sample
  • Minor elevations in the level of M protein in the blood or urine
  • Areas of severe bone loss called osteolytic lesions, which can be seen on x-rays
  • Low levels of antibodies (not produced by the cancer cells) in the blood

The following diagnostic tests may be used in reaching a multiple myeloma diagnosis:

  • Bone marrow biopsy to confirm or rule out the presence of malignant plasmacytomas (plasma cell tumors).
  • Blood tests to look for low levels of blood cells and proteins including red blood cells, white blood cells, hemoglobin, and platelets.
  • Urine tests to detect elevated levels of M proteins, which may be a sign of multiple myeloma.
  • Imaging techniques such as CAT scans, PET scans, MRIs, and X-rays in order to detect osteolytic lesions (areas of bone loss) or plasmacytomas (plasma cell tumors).

Symptoms of Multiple Myeloma

According to the American Cancer Society, the following are the most common signs of multiple myeloma:

  • Bone pain especially in the back, hips, and skull
  • Bone weakness (either widespread or at the site of the plasmacytoma) which may cause bones to break or fracture easily
  • Anemia (low red blood cell count). Symptoms of anemia include:
    • Weakness
    • Dizziness
    • Shortness of breath
  • Leukopenia (low white blood cell count) which may cause frequent infection
  • Thrombocytopenia (low blood platelet count) which may cause frequent and serious bleeding
  • Hypercalcemia (high levels of blood calcium). Symptoms of hypercalcemia include:
    • Extreme thirst
    • Frequent urination
    • Dehydration
    • Constipation
    • Abdominal pain
    • Loss of appetite
    • Weakness
    • Drowsiness
    • Confusion
  • Nerve damage, the signs of which include:
    • Sudden or severe pain
    • Numbness
    • Muscle weakness
  • Kidney damage, the signs of which include:
    • Weakness
    • Shortness of breath
    • Itching
    • Swelling of the legs

Prognosis

The prognosis for multiple myeloma patients largely depends on the stage of the disease upon diagnosis. Unfortunately, multiple myeloma often does not produce noticeable symptoms until it has reached later stages of the disease.

According to the American Cancer Society, the median survival rates (average amount of time lived after diagnosis) for specific stages of multiple myeloma are as follows:

  • Stage I – 62 months
  • Stage II – 44 months
  • Stage III – 29 months

It is important to remember that these statistics are only median statistics – meaning that there are many cases in which patients live both longer and shorter than the listed time. The doctor for a patient with multiple myeloma will be able to give the most accurate and personalized prognosis for that specific case.

Living With Multiple Myeloma

Receiving a diagnosis of multiple myeloma can be extremely difficult. The following tips can help you live easier with multiple myeloma:

  •  Consider all options for treatment, including alternative and complementary therapies. Consult with your doctor about all possible treatment options and consider his or her recommendations. Independent research may help you feel more confident in your decision, but beware of taking information from unreliable sources. Internet forums and other non-professional sources may not always be accurate sources of knowledge.
  • Educate yourself on the side effects for each treatment method. For tips on managing treatment-related side effects, visit the Multiple Myeloma Research Foundation
  • Eat a balanced diet and exercise, this well help your body remain strong throughout treatment.
  • Drink plenty of water. Water is essentially for helping your body process the stresses of treatment.
  • Join a support group online or in your community.
  • Talk to trusted family and friends. Be honest with those that you love, but remember that who you choose to share your condition with is ultimately your decision.

Screening

Multiple myeloma is not a universally screened-for disease because it rarely occurs in patients below the age of 65 and often is difficult to detect in its early stages. Patients above the age of 65 should visit a doctor for regular checkups and report and symptoms they may be experiencing.

Prevention

Because the causes of multiple myeloma are unknown, there are no known methods of prevention.

Medication And Treatment

There are many different options available for multiple myeloma. These include:


Drug Therapy. Drug therapies for multiple myeloma can either be aimed at slowing the replication of cancerous cells or killing the cancerous cells altogether. According to the Multiple Myeloma Research foundation, the following are the most common drug therapies used to treat multiple myeloma patients. Drug therapy may include taking one drug or a combination of several.

  • Immunomodulatory drugs, which helps to stimulate the immune system and inhibit the growth of cancerous cells. These include:
    • Lenalidomide
    • Pomalidomide
    • Thalidomide
  • Proteasome inhibitors, which work by inhibiting the function of proteasome, a protein that helps to regulate cell death. These include:
    • Bortezomib
    • Carfilzomib
  • Chemotherapy, which works to kill off cancerous cells through the intravenous or oral administration of potent anti-cancer agents.
  • Corticosteroids, which help to decrease inflammation in the body. These include dexamethasone and prednisone
  • Biophosphonates, which can help to improve the overall health of a patient’s bones, which can often be weakened by multiple myeloma.

Stem Cell Transplants.  In stem cell transplantation, the patient is given a high dose of chemotherapy to kill off the cancerous cells and then infused with healthy stem cells with the aim of replacing those that have been killed. Stem cells are most commonly harvested from the patient’s blood after he or she has been given medications that stimulate the growth


Radiation Therapy, which uses high-energy radiation to kill or damage cancerous cells.


Surgery. Orthopedic surgical intervention can help to reinforce or repair bones that have been damaged by multiple myeloma. Surgical intervention can help a patient maintain or regain mobility. Not all patients are eligible for surgery, so be sure to consult your doctor about surgical options.

 

Complementary and Alternative Treatment

Though there is little clinical research to support alternative treatment methods for multiple myeloma, there are several methods that many claim to be beneficial. These include:

Acupuncture. Acupuncture is a form of traditional Chinese medicine in which small needles are inserted at points around the body to restore the flow of bodily energy. It has been proven to reduce overall stress, stimulate the immune system, and reduce bodily inflammation. Acupuncture can be used as either a complimentary therapy (i.e., to reduce side effects of chemotherapy) or as an alternative therapy (to boost the immune system to fight off cancer cells).

Mind/body techniques, which help to strengthen the mind and body connection in order to reduce anxiety, stress, and improve overall health. These include:

  • Yoga
  • Meditation
  • Tai Chi

When To Contact A Doctor

If you experience any of the symptoms of multiple myeloma,  contact your doctor immediately.

If you are undergoing treatment of multiple myeloma and experience any of the following symptoms, contact your doctor immediately:

  • Fever
  • Shortness of breath**
  • Confusion
  • Dizziness
  • Numbness or tingling**
  • Rash or changes to the skin color
  • Chest pain**
  • Persistent or worsening cough
  • Sudden changes to mood or thought patterns

**If you are experiencing any of these symptoms, call emergency services. These may be signs of stroke or heart attack.

Questions For A Doctor

You may want to ask your doctor the following questions after receiving a multiple myeloma diagnosis:

  • Are there other possible causes for my symptoms?
  • What are the available treatment options?
  • What are the side effects?
  • What is my prognosis?
  • What can I do to help in treatment and recovery?
  • Should I be concerned about passing this on to my family or children?
  • What caused my multiple myeloma?
  • What stage is my multiple myeloma?