Multiple Myeloma: 6 Things Doctors Want You to Know

Even though nearly 33,000 Americans are diagnosed with multiple myeloma each year, many people are not familiar with this form of blood cancer. In multiple myeloma, a type of white blood cell known as plasma cells multiply too rapidly in the bone marrow. Because the marrow is where blood cells form, cancerous cells can crowd out healthy blood cells while damaging the delicate inner bone. These cells can also spread to distant parts of the body. Recent research into multiple myeloma has been very successful and oncologists say there are many promising new therapies today that treat the disease more effectively than ever before. Here’s what three multiple myeloma specialists want you to know about this uncommon blood cancer.

Plasma cells are a type of white blood cell that helps the body fight infection. In multiple myeloma, the plasma cells make an abnormal substance known as a monoclonal protein. But having monoclonal proteins in your blood does not mean you have multiple myeloma. A diagnosis of monoclonal gammopathy of undetermined significance, or MGUS, just means your blood contains a monoclonal protein that is not harming your body, at least not yet. “All myeloma patients started with MGUS, but not all patients with MGUS will develop myeloma,” says Dr. Alan Feiner, a hematologist-oncologist at Rocky Mountain Cancer Center in Denver, Colo. “About one third of MGUS patients will eventually develop multiple myeloma, but MGUS usually causes no problems.”

Multiple myeloma occurs most often in people in their 60s and above. Men are slightly more likely than women to develop it, and the disease is more than twice as likely to develop in African Americans as in Caucasians. What do these risk factors have in common? You can’t change or control them. “Patients often wonder if they did something to cause the multiple myeloma or if their kids will develop it, too,” says Gurvinder Shaheed, MD, hematologist-oncologist for Mercy Medical Group in Sacramento, Calif. “I reassure them there is nothing they could have done differently.”

Multiple myeloma symptoms can be vague and often don’t occur until later in the disease. These symptoms often include bone pain, fractures, high blood calcium levels, fatigue, infections, and kidney failure. “Multiple myeloma is not a bone cancer, but much of the damage it causes is related to the bones in some way,” says Dr. Feiner. “People are often diagnosed because pain in their backs, hips or rib cages sends them to their doctor or they become anemic because normal red blood cells have been crowded out of the bone marrow by myeloma cells.” On the other hand, some people are diagnosed before they experience any symptoms at all. This is because blood tests you may have as part of a routine physical can reveal high levels of monoclonal protein, which is one sign of MGUS and myeloma.

In order to diagnose multiple myeloma, doctors need to perform blood tests to check for proteins and imaging to assess bone health. You’ll also need a bone marrow biopsy, a procedure in which the doctor uses a large, hollow needle to withdraw bone marrow cells from your hip. If you’re diagnosed with multiple myeloma before symptoms have developed, your doctor may recommend close monitoring without any immediate treatment. This strategy is known as watchful waiting. “When evaluating patients, our first question is whether they have multiple myeloma, and our second question is whether they need to be treated at this time,” says Scott W. Hall, MD, a hematologist-oncologist with Christiana Care Hospitals in Newark, Del. “We base these decisions on symptoms and genetic testing of the cancer cells that shows how aggressive the disease is likely to be in that patient.”

There is good news about multiple myeloma treatments on two fronts: the treatments are generally effective and they’re often well tolerated. Initial treatment typically consists of chemotherapy. “Unlike for some other forms of cancer, multiple myeloma chemotherapy often consists of pills taken at home, not IVs [intravenous infusion], and people don’t throw up or lose their hair,” says Dr. Hall. “And the pace of research is astounding, with four new multiple myeloma drugs approved in just the last two years.” When deciding which therapy regimen is right for you, your oncologist will consider your age and overall health, as well as lifestyle factors and your personal preferences.

Overall, the future is bright for people with multiple myeloma. “People with multiple myeloma are living longer than ever before and we’re moving toward being able to say we can cure them, but we’re not there yet,” Dr. Shaheed says. “On the other hand, our treatments today will get up to 95% of patients into remission with no evidence of cancer. Then, when the disease returns, we still have many more treatments we can try.” These additional treatments often include a stem cell transplant in which their own diseased bone marrow is removed from the body, then reintroduced following high-dose chemotherapy.