About Multiple Myeloma
Multiple myeloma (MM) is a type of bone marrow cancer with complex pathophysiology. It can lead to bone, blood, kidney, and neurological problems. The causes of the genetic mutations that lead to abnormal growth of plasma cells associated with MM are not fully understood, but there are several risk factors associated with the development of the disease:
Non-modifiable risk factors (factors a person cannot change or control) include:
- Age: Most cases of MM are diagnosed in people over the age of 65.
- Race: MM occurs more often in people who are Black than in people of other races.
- Sex assigned at birth: MM develops more in males than in females.
- Genetics: Having a family history of MM or related conditions like solitary plasmacytoma or monoclonal gammopathy of undetermined significance (MGUS) increases the risk.
Modifiable risk factors (factors a person potentially can change or control) include:
- Obesity: Being overweight or obese is a significant modifiable risk factor for MM.
- Radiation exposure: Exposure to radiation, such as during cancer treatment, may increase the risk.
- Chemical exposure: Exposure to certain chemicals like benzene or pesticides might also increase the risk.
It's important to note that while these risk factors may increase the likelihood of developing MM, they do not guarantee its development. If you have concerns about your risk for MM, it is best to consult with your healthcare professional for personalized advice.
In the early stages of multiple myeloma, some people may not experience any symptoms. However, if symptoms do occur, common symptoms include:
- Bone pain: Persistent or frequent pain in the bones, especially in the hips, spine, or chest.
- Fatigue: Feeling tired or weak
- Weakness or numbness in arms and legs
- Unexplained weight loss
- Unexplained fever
As multiple myeloma progresses, additional symptoms may arise. These mayinclude:
- Weakened bones that can lead to bone fractures or spinal cord compression.
- Anemia: A reduction in red blood cells, leading to fatigue and weakness.
- Thrombocytopenia: A reduction in platelets, leading to bruising or bleeding more easily.
- Frequent infections: A reduction in healthy white blood cells, leading to decreased ability to fight infections.
- Elevated blood calcium levels: Can cause various symptoms such as nausea and vomiting, increased thirst and urination, brain fog or confusion, and kidney problems.
It's important to note that these symptoms may not be exclusive to multiple myeloma and can be associated with other conditions as well. If you experience any concerning symptoms, it's best to consult with your healthcare professional for an accurate diagnosis.
To diagnose multiple myeloma, doctors commonly perform the following examinations, tests, and procedures:
- Personal and family medical history: Doctors will ask about your symptoms, medical history, medications, and any family history of the condition.
- Physical examination: A thorough physical examination will be conducted to check for any signs or symptoms of multiple myeloma.
- Blood tests: These tests can detect abnormal proteins, such as M proteins, which may indicate multiple myeloma. Other tests may check the health of your kidneys, levels of electrolytes, minerals, and other proteins in the blood, and signs of inflammation or tumors.
- Urine tests: Urine tests can measure the presence of abnormal proteins and assess kidney function.
- Imaging tests: X-rays, MRIs, and PET scans can help evaluate bone damage and detect plasmacytoma tumors.
- Bone marrow biopsy: This procedure involves taking a sample of bone marrow to examine for the presence of cancer cells.
After multiple myeloma is diagnoses, the healthcare provider will determine the classification and stage of disease. These are important consideriations when planning treatment. The following are the classifications used for multiple myeloma:
- Monoclonal gammopathy of undetermined significance (MGUS): Monoclonal protein (M protein) is found in low amounts in the blood. About 2% of people with MGUS develop multiple myeloma.
- Solitary plasmacytomas: A single group or tumor of abnormal plasma cells is found.
- Smoldering multiple myeloma (SMM): Abnormal plasma cells are found in the bone marrow and M proteins are increase in the blood, but a person doesn’t experience symptoms. SMM is considered precancerous for multiple myeloma.
- Multiple myeloma: Multiple groups or tumors (plasmacytomas) of abnormal plasma cells are found, there is a high level of M protein in the blood or urine, and a high level of abnormal plasma cells in the bone marrow. People usually are symptomatic and have anemia, high blood calcium, kidney problems, and bone problems.
Multiple myeloma is then assigned a stage based on blood protein level indicators of how quickly multiple myeloma is growing.
- Stage 1 – Multiple myeloma is growing slowly
- Stage 2 – Multiple myeloma is growing more quickly
- Stage 3 – Multiple myeloma is aggressive and growing rapidly
It's important to note that these are general diagnostic approaches. Your doctor will determine which specific examinations, tests, and procedures are necessary based on your individual case.
Multiple myeloma is currently not curable but can be put into long-term remission. The goals of treatment for multiple myeloma are to slow the progression of the disease, manage symptoms, reduce complications, and improve overall survival.
In some cases where multiple myeloma is slowly growing and not causing symptoms (smoldering multiple myeloma), the healthcare team may recommend not treating right away. This is called watchful waiting. The healthcare team will monitor the condition closely and treatment may be started with symptoms occur.
For multiple myeloma treatment, options and their mechanisms of action include:
- Chemotherapy: The goal of chemotherapy is to slow or stop the growth of cancer cells. It may be used in different phases of MM treatment, such as induction (to reduce the amount of cancer in the body), consolidation (to eliminate remaining cancer cells after a stem cell transplant), or maintenance (to keep MM in remission).
- Targeted therapy medications: These medications block specific chemicals in myeloma cells, causing them to die. They are usually given intravenously and help destroy cancerous cells.
- Immunotherapy (also called biologic therapies): These medications help boost the immune system's ability to fight myeloma cells. Chimeric antigen receptor T-cell (CAR-T cell) therapy is an example of a type of immunotherapy.
- Immunomodulating drugs: These drugs are often used in maintenance therapy to help keep MM in remission. An example is corticosteroids, which help control inflammation in the body and work against myeloma cells.
- Radiation therapy: This uses energy beams to kill cancer cells and shrink growths of myeloma cells. In multiple myeloma, radiation therapy may be used for myeloma tumors, call plasmacytomas. Radiation therapy also may help reduce bone pain by shrinking plasmacytomas in bone.
- Stem cell transplant (also called bone marrow transplant): This procedure involves replacing damaged bone marrow with healthy stem cells. It can be part of consolidation therapy to eliminate remaining cancer cells.
- Supportive medications: Medications may be given to help reduce the symptoms of multiple myeloma. Examples include:
- Pain medication for bone pain
- Antibiotics to prevent or treat infections
- Health behavior changes: Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and avoiding smoking and excessive alcohol consumption, can support overall treatment goals for MM.
It is important to note that specific treatment recommendations depend on individual factors such as disease stage, symptoms, and response to previous treatments. Always consult with your healthcare professional for personalized advice. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.