Multiple Myeloma

Multiple myeloma is a cancer that begins in plasma cells, a type of white blood cell. These cells are part of your immune system, which helps protect the body from germs and other harmful substances. Normally, plasma cells help 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. In time, myeloma cells collect in the bone marrow and in the solid parts of bones.

Multiple myeloma is a relatively uncommon cancer in the United States. It may run in families. Men are slightly more likely to develop multiple myeloma than women.

Multiple myeloma may not cause signs or symptoms for a long time and is often not found until it is advanced. Myeloma tumors can weaken the bone, cause too much calcium in the blood, and damage the kidneys and other organs. Bone pain is a common symptom of advanced multiple myeloma. Other signs and symptoms include frequent infections, anemia, bleeding, numbness or tingling, and weakness.

Treatment for multiple myeloma is not always necessary. If you are not experiencing signs and symptoms, you may not require treatment. If signs and symptoms develop, a number of treatments can help control your multiple myeloma, including chemotherapy, stem cell transplantation, radiation, or targeted therapy.

Signs and symptoms of multiple myeloma can vary and, early in the disease, there may be none. When they do occur, common symptoms include:

• bone pain, often in the back or ribs
• broken bones
• weakness or numbness in the legs
• weight loss
• frequent infections and fevers
• feeling very thirsty
• frequent urination
• nausea
• constipation
• loss of appetite
• mental confusion
• fatigue

The exact cause of multiple myeloma is not known. In general, cancer begins when a series of genetic mutations occur within a cell, causing the cell to grow and multiply out of control. It is not clear what causes the initial genetic mutations that lead to multiple myeloma, though researchers have identified genetic variations that are related to multiple myeloma. Having other plasma cell diseases increases the risk of multiple myeloma.

It is difficult to diagnose multiple myeloma early. Often, multiple myeloma causes no symptoms until it reaches an advanced stage. Sometimes, it might cause vague symptoms that at first seem to be caused by other diseases. Rarely, multiple myeloma is found early when a routine blood test shows an abnormally high amount of protein in the blood.

If you have symptoms that suggest multiple myeloma, your doctor will likely order blood tests, urine tests, x-rays of the bones, and a bone marrow biopsy. If tests indicate that you have multiple myeloma, your doctor will use the information from the diagnostic tests to classify your disease as stage 1, stage 2 or stage 3. Stage 1 indicates a less-aggressive disease and stage 3 indicates an aggressive disease that may affect bone, kidneys, and other organs. Multiple myeloma may also be assigned a risk category, which indicates the aggressiveness of your disease. The stage and risk category help your doctor understand your prognosis and your treatment options.

A diagnosis of multiple myeloma can be stressful for you and for your family and friends. There are several steps you can take to maintain control of your health and well-being.

Learn about myeloma in order to make decisions about your care. Write down questions to ask your doctor. Ask your health care team for information to help you better understand your disease.

Surround yourself with a support network. Close friends or family can help you with everyday tasks, such as getting you to appointments or treatment. If you have trouble asking for help, learn to be honest with yourself and accept help when you need it.

Seek out other people with cancer. Ask your health care team about cancer support groups in your community. Sometimes there are questions that can only be answered by other people with cancer. Support groups offer a chance to ask these questions and receive support from people who understand your situation.

Take time for yourself. Eat well, relax, and respect the limits that you may feel. Continue to work and engage in hobbies as you are able.

If you have multiple myeloma but you are not experiencing any symptoms, you may not need treatment. However, your doctor will regularly monitor your condition for signs the disease is progressing.

If you develop signs and symptoms or your multiple myeloma shows signs of progression, you and your doctor may decide to begin treatment, which can help relieve pain, control complications of the disease, stabilize your condition, and slow the progress of the disease.

There is no cure for multiple myeloma, but treatments can usually allow you to return to near-normal activity. Standard treatment options for multiple myeloma include:

Targeted therapy. Targeted drug treatment focuses on specific abnormalities within cancer cells that allow them to survive. Bortezomib (Velcade) and carfilzomib (Kyprolis) are targeted drugs that block the action of a substance in myeloma cells that breaks down proteins, which causes myeloma cells to die.

Biological therapy. Biological therapy drugs use your body's immune system to fight myeloma cells. Drugs such as thalidomide (Thalomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst) enhance the immune system cells that identify and attack cancer cells.

Chemotherapy. Chemotherapy drugs kill fast-growing cells, including myeloma cells. High doses of chemotherapy drugs are used before a stem cell transplant. Common chemotherapy drugs used for multiple myeloma include melphalan, Vincristine (Oncovin), cyclophosphamide (Cytoxan), etoposide (VP-16), doxorubicin (Adriamycin), liposomal doxorubicin (Doxil), and bendamustine (Treanda).

Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, regulate the immune system to control inflammation in the body. They also are active against myeloma cells.

Stem cell transplantation. A stem cell transplant is a procedure that replaces diseased bone marrow with healthy bone marrow.

Radiation therapy. Radiation therapy uses beams of energy, such as X-rays, to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area.

Multiple myeloma can dissolve, weaken, and even break bones. Drugs called bisphosphonates can be used as part of a treatment plan to help bones stay strong and prevent further bone damage. The standard bisphosphonates for treating bone problems in people with myeloma are pamidronate (Aredia) and zoledronic acid (Zometa).