Multiple Myeloma

Definition

Multiple myeloma is a cancer that starts in the bone marrow. It results from the abnormal growth of plasma cells. Plasma cells are white blood cells that normally help fight infections. In multiple myeloma, a group of plasma cells:

• Make abnormal proteins that collect in blood and urine
• Can form into a tumor and destroy the bone around it

These events can lead to bone pain, kidney damage, and a weak immune system.

Bone Marrow Sites in Adults.

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Causes

Cancer happens when cells in the body divide without control or order. If cells keep dividing, a mass of tissue forms. These are called growths or tumors. If a tumor is cancer it is called malignant. Tumors can invade nearby tissues and spread to other parts of the body.

The exact cause of multiple myeloma is unknown. It is likely due to immune problems, genes, and the environment.

Risk Factors

Multiple myeloma is more common in people 65 years old or older. It is also more common in people who are Black. Other things that may raise the risk are:

• Having MGUS—an abnormal protein in the blood
• Exposure to nuclear radiation, petroleum products, or pesticides

Symptoms

Symptoms of early stage multiple myeloma include:

• Persistent, often severe bone pain that:
  • Is most common in the back
  • Can also occur in the limbs or ribs
• Tiredness

When the disease gets worse, symptoms may include:

• Increasing tiredness and weakness
• Broken bones
• Repeat infections
• Nausea and vomiting
• Constipation
• Problems urinating (peeing)
• Abnormal bleeding
• Headache, vision problems, or confusion

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done.

Imaging tests will look for bone problems. These may include:

• X-rays
• MRI scan
• CT scan
• PET/CT scan

Other tests will help make the diagnosis, including:

Blood and urine tests—to look for certain proteins

Bone marrow aspiration and biopsy—to look for abnormal cells in bone marrow, blood, and bone.

Tests are used to find the stage of the cancer. Multiple myeloma is staged 1 to 3. Stage 1 is less aggressive than stage 3. The number of tumors in the bone are also used to assess the outlook.

Treatment

The goal of treatment is to ease pain, manage problems, and slow the progress of multiple myeloma. Complete remission is rare.

Some people have slow-growing myeloma without symptoms. They may not need treatment right away. The doctor will wait and watch for signs that need treatment.

If treatment is needed, it will depend on the symptoms and the stage. Options may include one or more of the following:

• Chemotherapy (chemo)—drugs to kill cancer cells. Chemo may be given by pill, injection, or IV. Some healthy cells may be killed in the process. Chemo is often used with corticosteroids.
• Immunotherapy—drugs to help the immune system fight the cancer.
• Corticosteroids—drugs to adjust the immune system and ease some side effects of chemo.
• Targeted therapy—drugs that target weaknesses in the cancer cells and cause them to die.
• Radiation therapy—to kill cancer cells and shrink tumors. External beam radiation therapy may be given to ease bone pain. It is not considered a cure.

Some people may have a peripheral stem cell transplant. Young, healthy blood cells will replace bone marrow cells that are damaged by cancer. This procedure depends on the person's age, health, and cancer outlook.

Other treatments may include:

• Plasmapheresis—to exchange plasma in the blood. Plasma is the liquid part of blood that does not contain cells. After plasma is removed, fresh plasma or a plasma substitute is added back to the blood. This treatment removes the abnormal proteins from the blood.
• Bisphosphonates—drugs to slow the process of bone loss.
• Surgery—to remove a tumor that causes pain or other problems. This may be done if radiation does not help.

Other treatments may be needed for anemia, infections, or kidney problems.

Prevention

There are no current guidelines to prevent multiple myeloma.