Frequently Asked Questions About Multiple Myeloma
Your doctor is the best source for information about multiple myeloma and what it means for you. But here are some frequently asked multiple myeloma questions to get you started.
Multiple myeloma is a type of blood cancer. It affects plasma cells, which are a type of white blood cell that grow in the bone marrow. Healthy plasma cells make antibodies to help your body fight infection. Cancerous myeloma cells grow out of control in the bone marrow, forming tumors that destroy bone tissue. The overproduction of myeloma antibodies can clog the circulation (hyperviscosity syndrome). Myeloma cells can also form tumors in other body tissues.
As myeloma cells accumulate in the bone marrow, they crowd out other normal cells. This results in low levels of normal red blood cells, white blood cells, and platelets. It also means your body can’t produce normal antibodies to fight infections. Instead, myeloma cells make large amounts of an abnormal antibody, called M protein. When M protein levels get high enough, they can damage the kidneys and cause the blood to be too thick.
Like most other cancers, scientists do not fully understand what causes multiple myeloma. It begins with plasma cells multiplying faster than normal. Genetic changes in the cells can trigger faster and uncontrolled growth, but the reason these DNA changes occur is unknown.
A family history of multiple myeloma in a parent or sibling is a risk factor for the disease, indicating heredity plays a role. However, having a family history of this cancer does not mean you will develop it for sure. It means you inherited a genetic predisposition to developing it. One of the main risk factors for multiple myeloma is age. It most commonly affects people 65 years of age and older. The average age at diagnosis is 70 years. It is a rare disease in people under the age of 35. There are also other risk factors including:
African American race
Exposure to radiation or certain chemicals
Other plasma cell diseases that can be precursors to myeloma including MGUS (monoclonal gammopathy of undetermined significance)
Remember, having these risk factors does not automatically mean you will get myeloma. And people without any risk factors can develop the disease. Talk with your doctor to learn about your risks.
Myeloma is often diagnosed at an advanced stage. Early in the disease, there may not be any symptoms. In fact, many people have myeloma for years without any symptoms. This is smoldering myeloma. Doctors generally do not treat myeloma until signs and symptoms begin.
When they develop, symptoms tend to be vague and become more noticeable as the disease progresses. Bone pain is one of the most common multiple myeloma symptoms. The pain is due to damage from the myeloma cells growing out of control in the bone marrow and invading the bone tissue. This damage weakens the bone, making fractures more likely. Other common symptoms include frequent infections, unusual bleeding, fatigue, appetite loss, and unintended weight loss. You may also experience shortness of breath, dizziness, confusion, and weakness, tingling or numbness.
There are various clues in simple blood and urine tests that can point to multiple myeloma. To confirm a diagnosis of multiple myeloma, doctors use a bone marrow biopsy. This involves removing a sample of bone marrow and examining it under a microscope to look for myeloma cells. Doctors then use imaging exams to find out how much bone damage myeloma cells have caused. Imaging exams can also help doctors find all areas where the cancer is actively growing.
Once symptoms develop and your doctor recommends treatment, it typically involves three stages:
Consolidation therapy to eliminate any remaining cancer cells. This second phase usually consists of high-dose chemotherapy followed by stem cell transplant.
Maintenance therapy to keep the disease in remission for as long as possible. Like the first phase, chemotherapy at lower doses, biologic therapy, and targeted therapy are treatment options.
There are also supportive treatments (palliative cancer care) to help relieve the symptoms of multiple myeloma and its treatment. This includes treatments for anemia, bone pain and damage, infections, and hyperviscosity—when the blood becomes too thick from excessive amounts of M protein.
Currently, multiple myeloma is not curable, but it is often controllable. Stem cell transplant and maintenance therapy can eliminate the cancer temporarily. Sometimes, this temporary remission can even last for years. But eventually, myeloma will return. The goal of maintenance therapy is to prolong the amount of time people are free of myeloma, preserve a high quality of life, and ultimately, extend survival.
It is common for people with a cancer diagnosis to seek a second opinion. In fact, sometimes health insurance companies will require a second opinion for cancer care. There can be many other reasons for wanting another doctor to review your case. A second opinion can give you a different perspective. It can also reinforce the information you already have and help you feel more confident about your treatment decisions. It will help you make an informed decision about your care.
Your primary care doctor is the best place to start if you want a second opinion. In most cases, a short delay from getting a second opinion is not likely to affect your treatment outcome.
There are many currently active areas of research in multiple myeloma and its treatment. Scientists continue to study the disease process to understand how myeloma starts and grows. This research is helping to identify new targets for drug therapy. Researchers are also studying the genetics of myeloma cells and how they can harness the immune system (immunotherapy) to fight them. In addition, studies are looking at better ways to use drugs and stem cell transplants to improve response and remission. There are also several new drugs in various phases of clinical trials.
If you are interested in participating in a clinical trial, talk with your doctor. Find out if you qualify for a trial and ask how you might benefit. Together, you and your doctor can decide if it’s the right decision for you.