A cancer that starts in plasma cells, a type of white blood cell that makes antibodies to fight infection. The cancer cells build up in the bone marrow and crowd out healthy blood-forming cells. They also make abnormal antibodies called paraproteins, which are found in the urine and can cause damage to bones.
Symptoms
When multiple myeloma is in its early stages, it often does not cause symptoms. It might be discovered when a health care professional does blood or urine tests for another condition and finds a higher than normal level of a certain protein. The protein is made by myeloma cells. It might also be found in a bone marrow biopsy or as a result of the use of an imaging test called an MRI or CT scan. Symptoms of multiple myeloma include bone pain, especially in the back and ribs; low calcium levels (which can lead to kidney failure); a lowered immunity that causes repeated infections; bruising easily; and being very tired.
In multiple myeloma, malignant plasma cells build up inside the bones’ bone marrow. They crowd out healthy plasma cells that make red blood cells and white blood cells that fight infections. This reduces the number of healthy cells and leads to anemia, which can cause fatigue. It also reduces the amount of healthy plasma that makes antibodies, which helps the body fight infection. This can lead to an increased risk of broken bones.
X-rays and blood and urine tests can show signs of myeloma, including areas of bone damage. Blood tests can find the M proteins that myeloma cells make and help the health care team decide how serious the condition is. These may include a creatine kinase test, an electrophoresis test and a test to measure how much calcium is in the blood. Urine tests can also be done to see if there is a lot of Bence Jones proteins in the urine.
Some people might have a form of multiple myeloma that does not produce symptoms, called smoldering multiple myeloma or monoclonal gammopathy of undetermined significance (MGUS). The same blood and urine tests can be used to diagnose this.
Researchers do not know what causes multiple myeloma, but some things increase the chance of getting it. These include being male, age (most people are diagnosed in their late 60s), and a family history of it. Other risk factors include having a weakened immune system due to illness or treatment, such as having HIV or AIDS; and having exposure to radiation or certain chemicals, such as pesticides, fertilizer or Agent Orange.
Diagnosis
Plasma cells are a type of white blood cell that makes antibodies (proteins) that fight viruses and bacteria. They’re found in the bone marrow, the spongy inside of bones where blood cells are made. When you have multiple myeloma, abnormal plasma cells build up in the bone marrow and crowd out healthy red blood cells. This causes anemia, which can make you feel tired and weak. It also affects the production of normal white blood cells, which help fight infections and prevent clotting problems.
Sometimes health care professionals find signs of multiple myeloma during a routine exam or when they’re testing for another problem. In other cases, symptoms like an unexplained fever or bruising and bleeding more easily lead doctors to check for the disease. The first step is a blood test to look for the M proteins myeloma cells make. These proteins are a sign that the plasma cells have changed from being normal to cancerous.
The test also checks for low levels of healthy red blood cells and platelets, which are needed for blood clotting. Your doctor may also order a urine test to check for high calcium levels caused by myeloma protein damage to the kidneys.
Other tests can include a computed tomography (CT) scan and magnetic resonance imaging (MRI), which use radio waves and strong magnets to create detailed images of your bones and spine. These scans can show areas of damaged bone and pinpoint plasmacytomas, which are single groups of abnormal plasma cells. Your healthcare team may also want to do a bone marrow biopsy, in which they insert a needle into a bone, usually in your hip, to get a sample of the marrow and check for cancerous cells.
Doctors haven’t found a way to avoid getting multiple myeloma, but certain factors increase your risk. These include being male and having a family history of the disease. Black people have twice the risk of developing myeloma, and some studies suggest a link between myeloma and exposure to radiation or chemicals such as pesticides, fertilizer and Agent Orange.
Treatment
There are different treatment options for multiple myeloma, depending on your age and the type and stage of your cancer. Treatment also depends on the medicines you take and how well your body responds to them. Your hematologist-oncologist (a cancer doctor who treats blood disorders) will discuss your treatment options and recommend a plan.
Multiple myeloma starts when there’s a buildup of abnormal plasma cells, called myeloma cells, in the bone marrow. This interferes with the normal production of red cells and platelets, causing anemia. It can also cause high levels of calcium in the blood and damage bones. Myeloma cells also make a protein that leads to kidney damage, and they overproduce a certain type of antibody.
A variety of chemotherapy and immunotherapy medicines are used to treat multiple myeloma. These include lenalidomide, pomalidomide and carfilzomib, which are similar to thalidomide; and bortezomib and daratumumab, which are like thalidomide. These drugs kill myeloma cells and help your body to make healthy red and white blood cells.
You may have high-dose chemotherapy with melphalan and a bone marrow transplant using your own blood stem cells or a stem cell from another person. Stem cell transplant resets your immune system and can stop multiple myeloma from coming back.
After a bone marrow transplant, you might have other treatments that target specific chemicals in myeloma cells or block their actions. These might include targeted therapy and other forms of immunotherapy.
Other possible treatments include bisphosphonates, which help to slow bone breakdown and reduce pain from myeloma-related osteoporosis. You might take these as pills or a shot. It’s important to see your dentist before taking these medicines, because they might affect the health of your teeth and jaw.
People with multiple myeloma are more likely to get infections, so they should avoid close contact with other people and be up-to-date on recommended vaccines. In addition, they should protect their skin from cuts and scrapes.
Prevention
There’s no way to prevent multiple myeloma. It’s a cancer of plasma cells, which produce disease- and infection-fighting antibodies in the blood. In myeloma, the plasma cells overproduce these antibodies, which interfere with the normal functioning of red and white blood cells and cause kidney problems, bone pain and thinning of the bones (osteoporosis).
There are many things that increase your risk for multiple myeloma. These include being black (myeloma occurs twice as often in African Americans than in other races) and having a family history of the disease. People with a condition called monoclonal gammopathy of undetermined significance, or MGUS, have a higher chance of developing myeloma.
Having a low red blood cell count and being overweight (obesity) also increases your risk. Having a viral infection, such as hepatitis B or C virus or HIV, also raises your risk. People who have had an organ transplant or take medicines that suppress the immune system have a greater risk of multiple myeloma.
While the exact causes of multiple myeloma aren’t known, there are some ways to reduce your risk. Eat a healthy diet with lots of fruits and vegetables. Drink plenty of water and stay hydrated. Avoid alcohol and smoking, if you haven’t already quit.
There’s no way to prevent myeloma if you have MGUS. But close monitoring of your condition is important, and you should tell your doctor if you develop any new symptoms.
You can help researchers find better treatments by taking part in a clinical trial. For example, our Mayo Clinic doctors have several studies open to people with MGUS and precursor conditions that can lead to myeloma. You can learn more about these studies by visiting the website of the PCROWD or PROMISE study groups.
If you have a precursor condition, such as MGUS or an abnormal M protein level but no signs or symptoms, it’s not likely that you’ll ever develop multiple myeloma. But it’s very important to get regular screening for any new health issues, especially bone pain or a weakened immune system. Your doctor can order the right tests for you.
