Understanding Multiple Myeloma
Multiple myeloma is often described as a blood cancer or bone marrow cancer. This is a different type of cancer from those that affect specific areas of the body such as the lung or breast, which are solid cancers or tumors. Multiple myeloma affects the plasma cells in your blood, which circulate throughout your body. This makes the disease particularly hard to treat, since there is no one solid target. It is not a common type of cancer. Most people diagnosed are in their mid-sixties or older, but it can strike at any age. Learn basic multiple myeloma facts, how it is diagnosed and its treatment.
Your blood is made up of several different populations of cells, including plasma cells. These cells are a type of white blood cell produced in your bone marrow that create antibodies that help your body fight infections. If you have multiple myeloma, abnormal plasma cells proliferate in the bone marrow and as they build up, there is less room for healthy plasma cells to develop.
The cancerous cells also destroy other cells, like those in the bone. Eventually, the cancer cells move from your bone marrow and spread throughout your body. Researchers don’t know yet what causes multiple myeloma but those at higher risk of developing this type of cancer include people who:
Are over 65 years old
Have relatives who have multiple myeloma
Have an abnormal blood protein called monoclonal gammopathy of undetermined significance (MGUS)
There are no obvious symptoms in its early stages, so multiple myeloma is usually diagnosed once it is in the advanced stages. Symptoms may include:
Bone pain all over but may be worse in the spine or chest
Frequent or recurrent infections
It can take a long time before myeloma is discovered. Occasionally, it is discovered by accident, through a routine blood test or because you have a fracture and the X-rays show unusual findings. Generally a diagnosis is made based on your medical history and symptoms, and the results of some or all of these tests:
Blood tests to measure your red blood cells, white blood cells, and platelets, as well as other blood components.
Urine tests to determine how well your kidneys are functioning
X-rays and other imaging tests, such as magnetic resonance imaging (MRI), computed tomography scans (CT) and positron emission tomography (PET) scans to verify bone structure and to look for weaknesses in the bone
Once you have a diagnosis of multiple myeloma, your oncologist will stage it, which indicates how advanced the disease is. There are three stages, with stage three being the most advanced.
Multiple myeloma is not curable. Treatment focuses on slowing progression of the disease and managing symptoms. In the early stages, if you are not experiencing any symptoms, your oncologist may take a watchful waiting approach if you are not at high risk of rapidly progressing disease. You will be monitored regularly for any changes but until then, no treatment is required. Once treatment is required, there are a few options. They include:
Chemotherapy: Chemotherapy drugs kill the cancer cells or keeps them from reproducing. Chemotherapy affects both the cancer cells and healthy cells, so there can be serious side effects. You will be monitored closely throughout your treatment.
Corticosteroids: Prednisone and dexamethasone, two corticosteroids, are often given to patients with multiple myeloma. They act by reducing inflammation in your body. They may be given alone but they are often combined with chemotherapy.
Targeted therapy: Targeted therapy is a new approach for some types of cancers. The ones used to treat multiple myeloma include bortezomib (Velcade), carfilzomib (Kyprolis), ixazomib (Ninlaro) and elotuzumab (Emplicit). One advantage to targeted therapy is these drugs do not attack healthy cells so they may have fewer side effects than traditional chemotherapy agents.Radiation therapy: If you are experiencing bone pain, radiation therapy to the bone area may help reduce this pain.Bone marrow or stem cell transplant: In order to receive a bone marrow transplant, also called a stem cell transplant, you must undergo high-dose chemotherapy that will destroy the diseased bone marrow. Once this occurs, you are given donor bone marrow, intravenously. Once in your blood system, the cells make their way to your bone and begin to multiply.
Multiple myeloma can affect different parts of your body, causing different types of complications. The most common complications include:
Frequent infections: Both the disease itself and the treatment, such as chemotherapy, can reduce your ability to fight infections.
Thinning of the bones and fractures: The growing cancer cells can weaken the bone structure, making them more prone to breaking.
Kidney dysfunction: As your bones break down, they release extra calcium into your bloodstream, which your kidneys may not be able to filter out. Uric acid levels may also go up, causing kidney stones. These can result in kidney problems, leading to kidney failure.
Anemia: The myeloma cells grow in number as your disease progresses. As this happens, there is less space for the red blood cells, which you need to transport iron and other nutrients throughout your body. As the red blood cells decrease, you can develop anemia.
Multiple myeloma cannot be cured but with newer treatments, life can be prolonged. Following your treatment plan may help relieve symptoms and the disease’s progress, and attending follow-up visits with your medical team may help identify problems associated with the disease, allowing for treatment adjustments as needed.