Multiple Myeloma

Multiple myeloma is a blood cancer related to lymphoma and leukemia. Though it can’t usually be cured, there are treatments that slow down its spread.

What Is Multiple Myeloma?

In multiple myeloma, a type of white blood cell called a plasma cell multiplies unusually. Normally, they make antibodies that fight infections. But in multiple myeloma, they release too much protein (called immunoglobulin) into your bones and blood. It builds up throughout your body and causes organ damage.

The plasma cells also crowd normal blood cells in your bones. They release chemicals that dissolve bone. The weak areas of bone this creates are called lytic lesions.

As multiple myeloma gets worse, those plasma cells begin to spill out of your bone marrow and spread through your body. This causes more organ damage.

Causes

No one knows what causes multiple myeloma. But you’re more likely to get it if:

  • You’re older than 65
  • You’re African-American
  • You have a family member with it

If you have one these other plasma cell diseases, you may be more likely to get multiple myeloma:

  • Monoclonal gammopathy of undetermined significance (MGUS)
  • Solitary plasmacytoma

Symptoms

Early on, multiple myeloma may cause no symptoms. As time passes, you could notice:

  • Bone pain
  • Weakness and fatigue
  • Weight loss

In rare cases, plasma cells can form purplish lumps that you can see underneath your skin. Your doctor will call them extramedullary plasmacytomas.

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Getting A Diagnosis

Your doctor may test you for multiple myeloma if a blood test shows you have:

  • Too much calcium in your blood (your doctor will call it hypercalcemia)
  • Anemia (too few red blood cells)
  • Kidney problems
  • High protein levels in your blood combined with a low albumin level (your doctor might say you have a "globulin gap")

If your doctor thinks you have multiple myeloma, he’ll test your blood, urine, and bones. Some tests he may order include:

  • Electrophoresis, which measures immunoglobulin
  • Blood urea nitrogen, also known as BUN, and creatinine. These check how well your kidneys are working.
  • A CBC, which stands for complete blood count. It measures and counts the cells in your blood.

After your test results come in, your doctor might want to do a bone marrow biopsy. He’ll insert a needle into a bone, usually in your hip, to get a sample of bone marrow to check the number of plasma cells in it.

He'll probably also want you to get X-rays. They can show spots of bone weakened by multiple myeloma. Sometimes you may also need a CT scan, MRI, or PET scan. 

Treatment

Medications

Several drugs and types of drugs are used to treat multiple myeloma.

Chemotherapy: You might get it alone or paired with another drug. The types of chemo most often used to treat multiple myeloma are:

  • Cyclophosphamide (Cytoxan)
  • Doxorubicin (Adriamycin)
  • Melphalan (Alkeran)
  • Liposomal doxorubicin (Doxil)
  • Panobinostat (Farydak)

Corticosteroids: If you're getting chemo, the doctor might prescribe dexamethasone or prednisone to reduce side effects.

Stem cell transplant: It won’t work for everyone, but if your doctor thinks you’re a good fit for it, they may start with a stem cell transplant. They will use a machine to remove some of your stem cells, then freeze and store them. Or they may use stem cells taken from a donor.  

Next, you get high-dose chemotherapy. This will destroy almost all the cells in your bone marrow -- both healthy cells and the plasma cells that cause the disease. Then the doctor will injects the stem cells into your veins. They travel to the bone marrow, where they multiply and make new, healthy blood cells.

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Stem cell transplantation doesn't cure multiple myeloma, but it often helps you live longer. It can also cause serious complications. For example, it can make you more likely to get infections.

Targeted Therapies

These medications target proteins, genes, or tissues and prevent cancer from growing.

Immunomodulatory drugs strengthen your immune cells to help them attack cancer cells. They also help starve the myeloma cells in your bone marrow by preventing new blood vessels from forming:

  • Lenalidomide (Revlimid)
  • Pomalidomide (Pomalyst)
  • Thalidomide (Thalomid)

Monoclonal antibodies help your immune system spot and destroy myeloma cells. You might hear your doctor call this immunotherapy:

  • Daratumumab (Darzalex)
  • Elotuzumab (Empliciti)

If you don’t have symptoms, your doctor will probably start you on one of these drugs to prevent myeloma from getting to a point where you need treatment.

Proteasome inhibitors stop the process that eats up extra proteins in cells. Myeloma cells make lots of proteins. When they build up, the cells die:

  • Bortezomib (Velcade)
  • Carfilzomib (Kyprolis)
  • Ixazomib (Ninlaro)

Your Treatment Plan

If you don’t have symptoms, your doctor may choose to watch you closely rather than start treatment right away.

If you do have symptoms, the doctor will work with you to come up with a treatment plan. It will aim to improve your quality of life by easing your symptoms and helping you get good nutrition. Your plan will have three main phases:

  • Induction therapy: Use medications to get quick control of the disease and its symptoms
  • Post-induction therapy: Add treatments like chemotherapy or a stem cell transplant (your doctor might also call it consolidation therapy)
  • Maintenance therapy: Keep your cancer at bay as long as possible

Which drugs your doctor chooses depends on your age and how aggressive your cancer is. Multiple myeloma cases are usually graded as high, intermediate, or standard risk. Most people start with a three-drug mix that combines a proteasome inhibitor, an immunomodulatory drug, and a corticosteroid. If you’re considered high risk, you might want to look into a clinical trial for an existing or new treatment. Research is ongoing, including clinical trials to identify more effective drugs and combinations.

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Treating Symptoms

Often multiple myeloma has no symptoms. But if yours causes painful bone damage, your doctor might suggest:

Bisphosphonates: These drugs treat bone damage. The doctor may have you try:

  • Pamidronate (Aredia)
  • Zoledronic acid (Zometa)

Be especially thorough with your brushing and flossing while you take these medications. It’s rare, but they can damage your jaw. Dental work makes this more likely.

Radiation therapy: The doctor will direct a beam from a machine to a bone or other affected body part. The beam kills plasma cells, which can ease your pain and strengthen weakened bones.

Taking Care of Yourself

To help you feel better while you get treatment:

  • Eat a healthy diet. A dietitian can help you choose the right foods, especially if you're having trouble with certain foods because of your treatment.
  • Exercise. Stay active to improve your mood and energy level, and protect your bones.
  • Get plenty of rest. Take naps or breaks during the day to recoup your energy.
  • Take advantage of good days to do the things you enjoy most.
  • Ask for help when you need it, and seek out support groups to help you and your family manage this disease.

What to Expect

Multiple myeloma varies widely among people. Some will live for years with few symptoms. With others, the condition gets worse quickly. Identifying the forms of multiple myeloma is often challenging for doctors.

Doctors have systems that predict survival rates. The simplest and most common uses the blood levels of two substances: albumin and beta-2-microglobulin. A higher albumin level and a lower beta-2-microglobulin level suggest a better chance for longer survival.

Other systems use multiple lab or DNA tests in plasma cells.

Knowing how aggressive your multiple myeloma is can help you and your doctor find the best plan for you.

Where to Find Support

To learn more about multiple myeloma, and to find support for you and your family, visit the Multiple Myeloma Research Foundation's website.

WebMD Medical Reference Reviewed by Neha Pathak, MD on July 20, 2017

Sources

SOURCES:

Abeloff, M. Abeloff's Clinical Oncology, 4th edition, Churchill Livingstone, 2008.

American Cancer Society: "Multiple Myeloma: Detailed Guide."

UpToDate: “Overview of the management of multiple myeloma,” “Patient Education: Multiple Myeloma treatment (Beyond the Basics).”

American Society of Clinical Oncology: “Multiple Myeloma: Treatment Options.”

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