What is multiple myeloma: A patient’s guide to the disease
A cancer diagnosis like multiple myeloma can feel scary. Learning more about this form of cancer can help. Studies and treatments for multiple myeloma continue to grow and enable patients to thrive. Read on to learn more about causes, symptoms, and treatments for multiple myeloma.
What is multiple myeloma?
Multiple myeloma is a cancer of the plasma cells, which are a type of white blood cell in the bone marrow that make immunoglobulins. Immunoglobulins, or antibodies, fight bacteria and viruses.
Myeloma, which is the name for an affected plasma cell, usually occurs in several areas of the body, which is why you often hear the disease called multiple myeloma. The marrow of the skull, spine, shoulders, rib cage, pelvis, and hips are most commonly affected. Extremities and lower arms and legs are rarely affected.
Typically, myeloma is diagnosed after age 65. Fewer than 10% of cases are diagnosed before the age of 40, and in extremely rare cases, myeloma is diagnosed in children. The lifetime risk of developing myeloma is 1 in 132, and men are slightly more likely to be affected.
Symptoms of multiple myeloma
One of the frustrations of this cancer is that it can go undetected. Many patients don’t experience symptoms; others experience any of these wide-ranging symptoms:
bone pain or weakness
infections
kidney problems
low blood counts, including anemia
high calcium levels, which leads to issues like extreme thirst, constipation, and weakness
nerve damage and spinal cord issues
Because it occurs in plasma, myeloma also may cause symptoms related to the blood, including unusual bleeding — frequent nosebleeds and heavy periods, for example. Others might experience hyperviscosity, or thickened blood. Hyperviscosity may lead to issues like headaches, dizziness, or blurred vision.
Diagnosing myeloma
Diagnosing multiple myeloma usually starts with blood, urine, and imaging tests. The key indicators of multiple myeloma are referred to as the CRAB criteria, which are:
calcium elevation
renal dysfunction
anemia
bone damage
But in recent years, research into asymptomatic multiple myeloma in the early stage known as smoldering multiple myeloma (SMM) has led to identification of biological markers that can identify the disorder before the CRAB criteria are present. These are discovered through biopsy or MRI and include:
60% or more plasma cells in the bone marrow
the ratio of abnormal to normal proteins in bone marrow plasma
at least one 5 mm or greater bone lesion
Diagnostic tests for myeloma also will identify the progression of the disease along its three stages according to the concentration of particular proteins and enzymes, and whether certain high-risk chromosomes are present. Stage I refers to the slowest-growing, most treatable stage of the disease, and stage III is the most aggressive.
Causes and risk factors
Unfortunately, multiple myeloma is unrelated to avoidable risk factors, and its cause isn’t known. Genetics can play a role, but they make up just a small part of the story. Here are some of the known risk factors:
being older than 65
being male (men are slightly more likely to develop myeloma)
being Black (twice as many Black people than White people are diagnosed)
having radiation and chemical exposure — asbestos, benzene, and pesticides may play a role
having another plasma cell disorder
Treatment
Multiple myeloma doesn’t always require treatment. Early, nonaggressive types may require only regular monitoring through blood and urine tests. If symptoms become worrying or testing shows disease progression, treatment becomes necessary. High-dose chemotherapy followed by a bone marrow transplant is the preferred treatment, but it isn’t right in every case. To be candidates for transplant, patients must be relatively young (under age 65) and in good physical condition otherwise.
The high-dose chemotherapy required for the process is the source of most side effects, including nausea and vomiting, hair loss, skin rashes, and fever. Medications may lessen some of these.
Many patients are not candidates for bone marrow transplants. Other treatment options include:
targeted therapy through medications that kill cancer cells by blocking chemicals they need to survive
immunotherapy, which boosts the body’s ability to find and attack cancer cells
radiation therapy to shrink and kill cancer cells with X-rays, protons, or other energy sources
corticosteroids, which reduce inflammation and lessen effects of chemotherapy
CAR-T cell therapy, which spurs your immune system by removing T cells and other white bloods cells, treating them to recognize a marker on myeloma cells, and then re-introducing them to your body, where they then kill cancer cells
Prognosis
As with most forms of cancer, prognosis for multiple myeloma patients is closely tied to when the disease is diagnosed and how aggressive it is. Average survival rates are just that — an estimate — and how any particular patient responds to treatment varies according to a range of factors, like age and whether or not other health challenges are present.
Relative survival rates have been improving since the mid-1990s. Overall, the relative 5-year survival rate for myeloma patients stands at 59.8%. That rate jumps to 79.5% for patients whose cancer is identified while it is still localized, or stage I. Most patients are not diagnosed until the cancer has spread, and for these patients the relative 5-year survival rate is 59%.
Working closely with healthcare providers and taking every possible lifestyle precaution may help outcomes. Research shows that considerations like diet, exercise, and sleep become more important while you’re treating cancer and can positively impact how your body fights the disease and your overall well-being.
Living with multiple myeloma
Patients face big decisions after diagnosis, and support can really help address fears, questions, and challenges that arise. Connect with others facing myeloma in our Inspire Myeloma Support Community.
Sources
https://medlineplus.gov/multiplemyeloma.html
https://www.cancer.org/cancer/types/multiple-myeloma/detection-diagnosis-staging/signs-symptoms.html
https://www.nhs.uk/conditions/multiple-myeloma/symptoms/
https://imf-d8-prod.s3.us-west-1.wasabisys.com/resource/patient-handbook.pdf
https://www.cancer.net/cancer-types/multiple-myeloma/stages
https://www.mskcc.org/cancer-care/types/multiple-myeloma/multiple-myeloma-risk-factors
https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/diagnosis-treatment/drc-20353383
https://www.nature.com/articles/s41408-021-00560-x
https://www.myeloma.org/patient-caregiver-information
Disclaimer
Member comments have been lightly edited for length and clarity. This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.
