Multiple Myeloma

What is Multiple Myeloma?

Multiple myeloma is a cancer of the plasma cell. Normal plasma cells are a type of white blood cell that helps make up your immune system. They are located within the bone marrow - the spongy interior of bones that produces blood cells. When your body is fighting an infection, plasma cells produce antibodies (proteins) which attack viruses and bacteria.

If a plasma cell becomes cancerous, it multiplies rapidly. This is multiple myeloma. The malignant plasma cells may crowd out normal blood-forming cells within the bone marrow, reducing the production of healthy blood cells. Additionally, rather than producing infection-fighting antibodies, the cancer cells begin to produce an abnormal antibody called a monoclonal protein (m protein) or paraproteins. In the urine, they are called Bence Jones proteins. These proteins do not fight against infection.

Symptoms

Multiple myeloma often does not have early symptoms. This can make it difficult to diagnose in the beginning stages. Symptoms of multiple myeloma may include:

• Fractures: Myeloma cells trigger the destruction of the surrounding bone. The weakened area of bone is more likely to break. This is called a pathological fracture.
  
• Bone pain, especially in the middle and/or lower back, rib cage or hips. The pain can be mild or severe depending on the extent of the multiple myeloma, the speed with which it has developed, and whether fracture or nerve compression has occurred.
• Fatigue and/or shortness of breath: Myeloma can cause anemia,  which can lead to feeling short of breath with exertion or tiredness more than usual.
• Confusion: Multiple myeloma can lead to high calcium levels in the blood and/or kidney failure. This can lead to confusion. Confusion can also be related to hyperviscocity (overly thick) blood.
• Numbness or weakness: Multiple myeloma is sometimes associated with nerve compressions, which can lead to numbness in the limbs. Hyperviscocity can also lead to weakness or numbness of the face, arms, or legs
• Leg swelling: Multiple myeloma damages the kidneys, preventing them from working effectively. This means your body can't get rid of extra salts and fluids, which can produce swelling
• Appetite changes: High calcium levels in the blood and/or kidney failure can also cause a decrease in appetite, weight loss and nausea.
• Frequent infection: Because myeloma cells crowd out normal white blood cells, which fight infection, there is a risk of infection. Common myeloma infections include pneumonia, bladder or kidney infections, sinusitis and skin infections.
• Excessive thirst due to high blood calcium levels and kidney damage.

Complications

As a blood cancer, multiple myeloma interacts with many other body systems and can lead to a variety of issues. Complications of multiple myeloma include:

• Anemia: A shortage of red blood cells, caused when abnormal plasma cells crowd out healthy blood-producing bone marrow cells
• Leukopenia: A shortage of white blood cells, which can compromise your immune system
• Bone erosion or bone lesions: Myeloma cells produce substances called cytokines, which can trigger bone cells (osteoclasts) to destroy surrounding bone. When more than 30% of the bone has been destroyed, x-rays show a thinning of the bone (osteoporosis) or dark holes (lytic lesions). The weakened area of bone is more likely to break.
• High blood calcium levels: Related to bone erosion. Calcium stored in bones enters the bloodstream, which impacts other body systems.
• Hyperviscosity: In some cases, large amounts of m proteins can make your blood thicker, which impedes flow into smaller blood vessels

These complications are all associated with different signs and symptoms.

Causes

In 2015, an estimated 124,733 people in the United States were living with this disease. The exact cause of multiple myeloma is not known and no avoidable risk factors have been found. However, certain things appear to make you more likely to develop the disease.

Risk factors for multiple myeloma:

• Age: Over 65
• Gender: Men are slightly more likely to develop myeloma.
• Race: Black people are twice as likely to develop myeloma than white people.
• Radiation exposure
• Family history: If a parent, brother or sister has the disease, your risk is four times higher. However, this is rare.
• Working in oil-related industry: While some studies suggest this, it has not been proven.
• Obesity
• Other plasma cell disorders: If you have had one of the following you are at higher risk:
  • A precancerous condition called monoclonal gammopathy of undetermined significance (MGUS)
  • A single tumor of plasma cells (solitary plasmacytoma)
  • Smoldering myeloma, a precancerous condition that affects the plasma cells and can turn into multiple myeloma

Learn more:

Diagnosis and treatment

Why choose MD Anderson for your multiple myeloma treatment?

Treatment for multiple myeloma may continue for extended periods, with repeated remissions and recurrences. With so many new treatment options and combinations available, studies have shown improvements in clinical outcomes for patients who have a relationship with an oncologist specializing in the treatment of myeloma. For this reason, our teams of experts and specially-trained support professionals forge close medical relationships with you to be sure you receive personal, customized care. This individualized attention gives you the best chance of a full and healthy life.

Pioneering Advances

MD Anderson has been instrumental in some of the biggest advances in multiple myeloma treatment, including Revlimid® (lenalidomide), a derivative of thalidomide. It is one of the most important discoveries in myeloma therapy. We've also found that combining this drug with chemotherapy drugs often has a profound effect, even after other treatments have failed.

At MD Anderson, you benefit from one of the most active research programs in the United States, which includes a prestigious federally funded SPORE (Specialized Program of Research Excellence) program. This means we are able to offer a wide range of clinical trials (research studies) for every stage of multiple myeloma.