What Is Multiple Myeloma?
Multiple myeloma is cancer that affects certain white blood cells called plasma cells. It represents about one percent of all cancers all over the world. Approximately four to five out of every 100,000 people are diagnosed with it each year.
How Does Multiple Myeloma Develop?
The human body is made up of tiny building blocks called cells. Normal cells grow and multiply when the body needs them, and die out when the body does not need them.
Cancer is made up of abnormal cells that grow whether or not the body needs them. Multiple myeloma is cancer that begins in the plasma cells, a type of white blood cell. Plasma cells make proteins that help the body fight disease. These cells are in the soft inner part of our bones, called the bone marrow. Multiple myeloma starts when plasma cells become abnormal. It's also known as myeloma or plasma cell myeloma.
Effects of Multiple Myeloma
Cancerous plasma cells are called myeloma cells. Myeloma cells crowd normal bone marrow, so there is not enough room for the bone marrow to make as many healthy cells. Several kinds of blood problems may result.
• Low red blood cell count. This condition is called anemia. We diagnose anemia through a blood test. Anemia can cause tiredness as well as other problems.
• Low white blood cell count. This condition is neutropenia. It weakens the body's defenses against infection.
• Low platelet count. This condition is called thrombocytopenia. It may lead to bleeding. Although this cancer starts in blood cells, it also affects the bones. Myeloma cells can harm the bone structure. Bones may become weak and more likely to break.
Multiple Myeloma and Hypercalcemia
Because they destroy bone, myeloma cells can cause the calcium that’s stored in the bone to be released into the bloodstream. This can lead to too much calcium in the blood, called hypercalcemia. Hypercalcemia can harm the heart, nerves and kidneys. Signs of hypercalcemia include:
• Frequent urination
• Frequent thirst
• Muscle weakness
Multiple Myeloma and Kidney Function
Myeloma can also affect the kidney. Myeloma cells make large amounts of abnormal proteins called M-proteins. These M-proteins circulate in the blood and can overwork the kidneys, so they cannot function properly.
Multiple Myeloma Symptoms
The symptoms of multiple myeloma may resemble other bone disorders or medical problems. Always consult your doctor for a diagnosis.
Each individual may experience symptoms differently. Myeloma cells and antibodies may cause symptoms including:
• Bone pain
• Fractures in bones
• Weight loss
• Repeated infections
• Problems with urination
• Weakness or numbness in legs
• Back pain
• Rib pain
Multiple Myeloma Diagnosis
If you experience any of the above symptoms, we will order a number of different tests to confirm a diagnosis, including imaging scans and a biopsy.
Risk Factors for Multiple Myeloma
There is no way to know for sure if you're going to get multiple myeloma. There is also no known way to prevent it. Certain factors increase your likelihood of developing this type of cancer.
Doctors do not know what causes multiple myeloma. The risk factors that have been found only slightly raise your chance of getting this type of cancer. However, it’s important to tell your doctor if you are having symptoms of multiple myeloma and any of the following risk factors.
• Age over 65: Growing older increases the chance of developing multiple myeloma. Most people with myeloma are diagnosed after age 65. People younger than 35 are rarely affected with the disease.
• Men: Men are slightly more likely to develop multiple myeloma than women.
• Family history: You are more likely to get multiple myeloma if a parent or a sibling has it. Researchers are studying families in which more than one person has multiple myeloma. However, such families are extremely rare.
• Work with chemicals: Exposure to petroleum products may raise your risk of getting multiple myeloma. If you use industrial chemicals at work, be sure to follow the guidelines for working with them safely.
• Exposure to high levels of radiation: People who have been exposed to high levels of radiation, such as the survivors of the atom bomb, may have a higher risk for multiple myeloma. But while researchers have suggested that exposure to radioactivity may be a risk factor, it actually accounts for a very small number of cases.
• History of plasma cell disease: Certain plasma cell diseases such as solitary plasmacytoma and MGUS (monoclonal gammopathy of undetermined significance) can develop into multiple myeloma. A plasmacytoma is a collection of abnormal plasma cells found in one location instead of throughout the bone marrow, soft tissue or bone. People who have MGUS have the same abnormal proteins, called
M-proteins, as people with myeloma, except there is no cancer.
• Being overweight or obese: Being overweight or obese may increase your risk for developing multiple myeloma.
Diagnosing Multiple Myeloma
Sometimes, we find myeloma during a routine visit, even if you don't have symptoms. If you're having symptoms of multiple myeloma, your doctor will ask you about:
• Your health history
• Your family's history of cancer
• Your other risk factors
We may also perform certain tests to check if you have multiple myeloma. You may need more than one of these tests:
• Bone marrow aspiration biopsy
Multiple Myeloma Treatment
Once we confirm a diagnosis, we will tailor a treatment plan that meets your needs. Your specific treatment will depend on many factors, including your age, general health and severity of your condition.
Your Multiple Myeloma Treatment Plan
Your care team will determine your specific treatment for myeloma bone disease based on:
• Your age, overall health and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures or therapies
• Expectations for the course of the disease
• Your opinion or preference
Multiple Myeloma Treatment Options
Each type of treatment for multiple myeloma has a different goal. These are the main treatment options and their goals. You may have more than one of these treatments.
We may use treatment with bisphosphonates to strengthen your bones and make it harder for the myeloma cells to grow.
Chemotherapy is the use of anticancer drugs to shrink or kill cancerous cells and reduce cancer spreading to other parts of the body.
Goal: To control the cancer for as long as possible.
Radiation therapy uses high-energy radiation to kill or shrink cancer cells, tumors and non-cancerous diseases.
Goal: To ease symptoms and help with bone pain. Radiation can also prevent or treat a fracture in the area of the bone weakened by the cancer. We can also use it to cure a single collection of myeloma cells, called plasmacytoma.
Bone Marrow Transplant for Cancers
A bone marrow transplant is a method of replacing the blood-forming cells that were destroyed by cancer treatment. Prior to your transplant, we will use high doses of chemotherapy and radiation to kill as many of the cancer cells as possible. These kill almost all your bone marrow and the cancerous cells in it. Then you receive healthy, new stem cells, which allow healthy blood cells to grow.
This may be called a bone marrow transplant or a peripheral blood stem cell transplant, depending where we take the stem cells from. Stem cells can also be taken from:
• Your own bone marrow before transplant (autologous)
• A sibling or unrelated donor (allogeneic)
Goal: To help the bone marrow recover and continue to make healthy blood cells.
If you want to learn more about Bone Marrow Transplantation please click here
Watchful Waiting: Smoldering Myeloma
Watchful waiting is when we closely monitor your condition without giving any treatment until symptoms appear or change.
Goal: To monitor or check cancer that is growing very slowly and that is unlikely do any harm. This kind of myeloma is called smoldering myeloma. Sometimes, the treatments for multiple myeloma can cause more harm than living with it. Your doctor may recommend watchful waiting if you don't have damage to your kidneys or bones and you have little or no anemia.
You'll likely see your doctor about every three months for checkups. At that time, you'll have blood and urine tests and perhaps X-rays. These tests check to make sure the cancer is not starting to actively attack your body. If it is, you'll start active treatment.
Specialized Treatments for Multiple Myeloma
Among the specialized treatments for multiple myeloma are:
• Combination chemotherapy
• High dose chemotherapy followed by bone marrow transplantation or autologous peripheral blood progenitor transplant
Chemotherapy and Radiation
Combination chemotherapy that targets the myeloma cells is the primary treatment for multiple myeloma. You can receive chemotherapy treatments at the infusion center at the Stanford Cancer Center. Patients with multiple myeloma may also receive radiation therapy designed to help control the growth of tumors in the bones and relieve pain caused by these tumors.
Clinical Trials and Research
Hematology Program doctors actively study new investigational therapies for patients with multiple myeloma. For example, Lu Daopei hospital doctors participated in clinical trials for a new drug called BCMA. Hematology Program doctors often make new therapies available to their patients. See clinical trials and research for more information.
Multiple Myeloma Staging
Before we decide on treatment options, we will need to know the extent, or stage, of the multiple myeloma. We will look at the results of blood tests, imaging tests and bone marrow tests to determine the stage of the cancer. Once we determine the stage, we can plan the most effective treatment for multiple myeloma.
There are two systems to stage multiple myeloma:
• Durie-Salmon System of Staging
The Durie-Salmon system is the traditional system used to stage multiple myeloma. It is based on four different factors:
1. The amount of abnormal monoclonal immunoglobulin in the blood or urine. A large amount of monoclonal immunoglobulin is a sign that many malignant plasma cells are in the blood making this abnormal protein.
2. The amount of calcium in the blood. High blood calcium levels are also related to advanced bone damage. Bone normally contains a lot of calcium and bone destruction releases calcium into the blood.
3. The amount of bone damage seen on X-rays. If there are many areas of bone damage, that is a sign of an advanced stage of multiple myeloma.
4. The amount of hemoglobin in the blood. Hemoglobin is the part of the red blood cell that carries oxygen. Low hemoglobin levels are a sign that the myeloma cells are taking up much of the bone marrow, and there is not enough space left for the normal marrow cells that make red blood cells.
• Stages in the Durie-Salmon System
There are three different clinical stages of multiple myeloma in the Durie-Salmon system. Stage I indicates the smallest amount of tumor. Stage III indicates the largest amount of tumor.
• Stage I: X-rays and blood tests indicate that only a small number of myeloma cells are present in the body. Most people with this stage do not have symptoms. Your doctor may say that you have a "low tumor burden" at this stage.
• Stage II: The myeloma cells have spread through the body a little bit. Your doctor may say that you have an "intermediate tumor burden" at this stage.
• Stage III: X-rays and blood tests indicate that many cancer cells are present in the body. Your doctor may say that you have a "high tumor burden" at this stage.
• International Staging System
The International Staging System is a newer system now used by many doctors to classify multiple myeloma. This system divides myelomas into three stages based only on the blood levels of beta-2 microglobulin and albumin.
• Stage I: The beta-2 microglobulin level is less than 3.5 milligrams/liter (mg/L) and the albumin level is 3.5 grams/deciliter (g/dL) grams or higher.
• Stage II: Neither stage I or III, meaning that either:
• The beta-2 microglobulin level is between 3.5 and 5.5 (with any albumin level), or
• The albumin is below 3.5 while the beta-2 microglobulin is less than 3.5
• Stage III
: The beta-2 microglobulin level is greater than 5.5.
(The content above extract from stanfordhealthcare.org)