What Is Multiple Myeloma? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Multiple myeloma is a cancer that affects plasma cells, a type of white blood cell found primarily in bone marrow (the soft, inner tissue of bones).

Multiple myeloma has no cure, but treatments are available to help put the cancer into remission.

Symptoms of multiple myeloma vary from person to person. Some people may not have any symptoms at all, especially when the cancer is at an early stage. When symptoms occur, they can be vague or similar to those of other health conditions or aging.

• Bone pain, most often in the spine, pelvis, or ribs
• Thrombocytopenia, or low levels of platelets in the blood, which can cause increased bruising and bleeding
• Bone fractures
• Fatigue
• Weakness
• Frequent infections
• Weakness or numbness in the legs
• Excessive thirst
• Constipation
• Nausea
• Loss of appetite

• Age Multiple myeloma is most often diagnosed in adults over age 65.
• Gender Men are at a slightly higher risk than women.
• Race Black Americans are almost twice as likely to get multiple myeloma as white Americans.
• Family History Having a close relative with multiple myeloma increases a person’s odds of developing it. However, most people with multiple myeloma have no family history of the disease.
• Obesity People who are overweight or have obesity are at a higher risk.

Precursors to Multiple Myeloma

• Monoclonal Gammopathy of Undetermined Significance (MGUS): This is a precancerous condition in which abnormal proteins, called M proteins, are found in the blood, with no other symptoms or signs of myeloma present. MGUS is typically monitored, but not treated unless it progresses to myeloma.
• Smoldering Multiple Myeloma (SMM): This precancerous stage shows a higher level of M proteins than MGUS, but still without the symptoms of active myeloma. The risk of SMM progressing to active myeloma is higher than with MGUS, so closer monitoring is needed. In some high-risk cases, treatment is considered to delay progression.

• Complete blood count
• Urine analysis
• Bone marrow biopsy
• Fluorescence in situ hybridization (FISH), a procedure that allows researchers to locate the positions of specific DNA sequences on chromosomes
• Low-dose computed tomography (CT) scan
• Positron emission tomography (PET)
• Magnetic resonance imaging (MRI)
• X-rays

• Hypercalcemia (high calcium levels in the blood)
• Kidney damage
• Anemia (low red blood cell counts)
• Bone lesions
• Bone marrow where at least 60 percent of the cells are cancerous plasma cells (No other criteria are needed to make a diagnosis in this case.)
• A large ratio between kappa and lambda free light chains (small protein components of antibodies), in which one is over 100 times higher than the other
• More than one focal lesion (an abnormal area that signals the development of a small hole in the bone) on an MRI

Staging indicates how much cancer is in the body, where it is, and whether it has spread. Doctors stage multiple myeloma to help determine the best treatment plan and estimate prognosis.

• The amount of albumin, a protein made by the liver, in the blood
• The amount of beta-2-microglobulin, a type of protein that is a tumor marker, in the blood
• The amount of lactate dehydrogenase (LDH), an enzyme, high levels of which can indicate more severe disease.
• Chromosomal abnormalities

Based on the findings, the disease can be categorized into three stages:

Current treatments aim to relieve symptoms, prolong periods of remission, and extend survival. Oncologists have many ways to treat multiple myeloma and will typically use more than one treatment at a time.

Induction Therapy

Three-drug regimens (triplet therapy) generally include:

• Proteosome Inhibitors Proteasome inhibitors stop enzyme complexes (proteasomes) in your cells from breaking down certain proteins that are important for controlling cell division. These drugs affect tumor cells more than normal cells.

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• Immunomodulatory Drugs These work by activating certain cells in the immune system, preventing myeloma cell growth, and by directly killing myeloma cells.
• Steroids In high doses, steroids can kill multiple myeloma cells. They can also decrease inflammation, relieve pain and reduce side effects from other treatments.

Stem Cell Transplantation

• Stem cells are collected from your blood and stored for later use. Most transplants for multiple myeloma are autologous stem cell transplants (ASCT), in which a person’s own stem cells are removed and later transplanted back into the bloodstream. Stem cells from a donor (allogeneic transplants) are used primarily in research.
• You will undergo high-dose chemotherapy (with a drug called melphalan) to kill any remaining cancer cells.
• Your saved stem cells are infused back into your bloodstream.
• You will go on maintenance therapy, typically with an oral immodulatory drug called lenalidomide.

Other Treatments

Other treatments that may be used to treat multiple myeloma include:

• CAR T-Cell Therapy CAR T-cell therapy involves genetically engineering a patient’s own T-cells (a type of white blood cell) to allow them to recognize and attack cancer cells.

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• Chemotherapy Chemotherapy is used during the stem cell transplant process. It is rarely used on its own to treat multiple myeloma.

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• Radiation Therapy Radiation uses high-energy rays to kill cancer cells. It’s often used to target areas of bone damaged by multiple myeloma, or in the case of a solitary bone plasmacytoma, in which the disease has only presented as a single bone lesion and has not spread to the bloodstream.

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• Surgery This is sometimes used to stabilize bones that have deteriorated due to the effects of multiple myeloma or to relieve spinal cord compression.

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• Novel Therapies Some of the newest drugs used to treat multiple myeloma do not fit the classification of any existing drugs. These new drugs work in different ways than drugs in the other classes — that is, they have novel mechanisms of action.

The type of multiple myeloma also makes a difference. People with smoldering multiple myeloma may remain symptom-free for many years before the disease begins to take a toll. Conversely, patients who have a form of myeloma with a high-risk genetic feature may have a poor prognosis.

• Low Blood Counts As myeloma cells multiply in bone marrow, they leave less space for red blood cells, white blood cells, and platelets. Low red blood cell levels, a condition known as anemia, can result in fatigue and weakness. A drop in your white blood cell count can decrease the body’s ability to fight disease. Lack of platelets can lead to significant bruising and bleeding, even from minor scrapes or cuts.
• Bone and Calcium Issues Myeloma cells can accelerate the breakdown of old bone and slow the buildup of new bone. This can lead to osteoporosis, raising the risk of fractures. Bones may become so fragile that even normal activities, like coughing and walking, may be enough to lead to a broken bone.
• Suppressed Immune System Myeloma cells interfere with both the quality and quantity of infection-fighting white blood cells, raising the risk of infection.
• Kidney Damage An antibody produced by myeloma cells can harm the kidneys and lead to kidney failure.

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• Neuropathy Proteins secreted by myeloma cells may damage motor and sensorimotor nerve cells by stripping their myelin sheaths and by causing degeneration of axons, the long threadlike parts of nerve cells along which impulses are conducted from the cell body to other cells. Neuropathy may also be a consequence of spinal damage caused by the disease.

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• Eye Problems M proteins can thicken the blood and slow down blood flow in the small blood vessels of the retina, leading to various eye problems.

Multiple myeloma accounts for less than 2 percent of cancers nationwide, but it is the most common blood cancer among Black Americans.

Black Americans are also underrepresented in clinical trials for new and potentially promising treatments for multiple myeloma. This could be due to clinical trial availability by location, the cost, or inherent racism built into the system, such as a patient not being told about a clinical trial that they qualify for because a physician assumes they won’t be interested.

If you’ve been diagnosed with multiple myeloma, you may want to seek support to help you understand and cope with your condition. The following organizations are among those that provide information as well as medical, emotional, and financial support for people with multiple myeloma:

International Myeloma Foundation (IMF)

The IMF provides resources, including over 160 patient support groups, that can help patients access information on treatments, including clinical trials, as well as other support.

Leukemia & Lymphoma Society

The Leukemia & Lymphoma Society offers support groups for patients and caregivers, financial assistance, nutrition advice, and more for people with blood cancers, including multiple myeloma.

• Multiple myeloma is a cancer of the plasma cells, a type of white cell found in the bone marrow.
• Symptoms are not always present, but when they are they include bone pain and fractures, weakness, and fatigue.
• Risk factors for multiple myeloma include being over 65, being male, and having obesity. Black Americans are almost twice as likely to be diagnosed with multiple myeloma and face obstacles to getting care compared to White Americans.
• Treatment for multiple myeloma includes stem cell transplantation, chemotherapy, and a variety of medications.

Additional reporting by Christina Frank and Kaitlin Sullivan.