Multiple Myeloma vs. Myelofibrosis

Medically Reviewed by Sabrina Felson, MD on June 25, 2022
5 min read

Multiple myeloma and myelofibrosis are both rare blood cancers. But they have distinct features that set them apart from one another. Though it’s unusual, you can develop these two cancers at the same time.

To explain the possible link between multiple myeloma and myelofibrosis, it helps to understand how each cancer acts in the body:

  • Multiple myeloma affects plasma cells. These are the cells that normally make special antibodies that help you fight infections. When healthy plasma cells become abnormal, they multiply and create faulty antibodies.
  • Myelofibrosis is a type of long-lasting leukemia. It happens when scar tissue builds up in the bone marrow – the soft, spongy tissue inside your bones. As the scar tissue grows, the bone marrow struggles to make enough healthy blood cells.

While both of these diseases can be serious, treatment can slow down the cancer and improve symptoms. For some people with myelofibrosis, a treatment called a stem cell transplant may offer a potential cure.

Myelofibrosis belongs to a family of related blood cancers known as myeloproliferative neoplasms (MPNs).

There are two types of myelofibrosis: primary and secondary.

Primary myelofibrosis happens on its own and is not a result of another disease.

Secondary myelofibrosis happens when another type of MPN changes into myelofibrosis. The most common of these are polycythemia vera (PV) and essential thrombocythemia (ET). Between 10%-20% of myelofibrosis cases start as ET or PV.

Most studies show it’s rare for a person to develop both multiple myeloma and an MPN, such as myelofibrosis, at the same time. They’re separate cancers with different causes and characteristics.

But one study has found that the incidence of myelofibrosis is higher in people with multiple myeloma and other blood cancers. The National Organization for Rare Diseases (NORD) says that myelofibrosis may happen as a “secondary characteristic” of multiple myeloma.

Doctors don’t know exactly what causes either myelofibrosis or multiple myeloma.

Myelofibrosis isn’t a disease that you inherit from your parents. But it has a link to changes in certain genes. About half of people with myelofibrosis have a mutation in their JAK2 gene. Around 35% of people with myelofibrosis have a mutation called calreticulin (CALR). And between 5%-10% have a change in their myeloproliferative leukemia (MPL) gene. But some people with myelofibrosis don’t have any gene defects.

You may be at a higher risk for myelofibrosis if you:

  • Are older than age 50
  • Have another blood disorder, such as PV or ET
  • Have been exposed to chemicals like toluene or benzene
  • Have been exposed to ionizing radiation

When it comes to multiple myeloma, researchers are still trying to identify genetic mutations. They know that most people with the disease don’t have all the pieces of a specific chromosome.

Your odds of developing multiple myeloma are higher if you:

  • Are older
  • Are male
  • Are Black
  • Have a family history of multiple myeloma
  • Have had monoclonal gammopathy of undetermined significance (MGUS). This is a condition where abnormal plasma cells in the blood make abnormal antibodies.
  • Are obese
  • Have an inflammatory disease, such as rheumatoid arthritis, type 2 diabetes, or heart disease
  • Have been exposed to radiation, Agent Orange, or other chemicals

Because myelofibrosis and multiple myeloma are both blood cancers, symptoms of the two diseases may overlap.

You might not notice any issues at all in the early stages of both cancers.

Common symptoms of myelofibrosis include:

  • Frequent infections
  • Easy bruising or bleeding
  • Fatigue or weakness
  • Paleness
  • Shortness of breath
  • A feeling of fullness
  • Weight loss or reduced appetite
  • Stomach pain
  • Fever or night sweats
  • Itchy skin
  • Bone or joint pain
  • Blood clots
  • Extramedullary hematopoiesis (abnormal growth of blood-forming cells outside of the bone marrow)
  • Portal hypertension (increased blood pressure in the vein that carries blood from the spleen to the liver)

Some typical symptoms of multiple myeloma are:

  • Bone pain
  • Weakness or numbness in the arms or legs
  • Nausea or vomiting
  • Fatigue or weakness
  • Unexplained weight loss
  • Reduced appetite or increased thirst
  • Easy bruising or bleeding
  • Fever
  • Confusion

Treatments for both myelofibrosis and multiple myeloma will depend on how advanced your cancer is, your symptoms, any underlying conditions, your overall health, and other factors.

If you happen to have both cancers, your doctor might focus treatment on the more aggressive one.

Treatments for myelofibrosis may include:

  • A JAK-inhibitor medicine such as fedratinib (Inrebic), pacritinib (Vonjo), or ruxolitinib (Jakafi)
  • Treatments for anemia (a low red blood cell count), such as chemotherapy, steroids, hormones, interferon, a blood transfusion, or immunomodulators (such as thalidomide or lenalidomide)
  • Treatments for an enlarged spleen, such as a JAK inhibitor, chemotherapy, radiation, surgery to remove the spleen, or interferon
  • A stem cell transplant to replace diseased bone marrow with healthy blood stems cells from a donor

Though a stem cell transplant can offer a potential cure for people with myelofibrosis, it’s a risky procedure. It’s usually only an option for young, healthy people.

Your doctor might recommend these treatments for multiple myeloma:

  • Chemotherapy to target abnormal plasma cells
  • Targeted medicines, which focus on specific targets within cancer cells
  • Steroids to lessen inflammation and kill cancer cells
  • Antibiotics to lower the risk of infection
  • Pain meds to relieve bone pain and discomfort
  • Immunotherapy medicines, which stimulate your body’s own immune system to fight cancer
  • Radiation therapy to kill cancer cells and help bone pain
  • A stem cell transplant that replaces unhealthy stem cells with healthy stem cells from your own body, or rarely, from a donor

As with most cancers, your outlook, or prognosis, will hinge on several things. These include your general health, the treatments you receive, and the extent of your disease. Survival rates can vary for both myelofibrosis and multiple myeloma.

Research has shown that people with primary myelofibrosis have a median survival of 6 years. But many patients live longer. One study has found that among survivors with myelofibrosis who had a stem cell transplant, the overall survival was 74% at 10 years.

Some people live 10 years or longer with multiple myeloma. According to the American Cancer Society, the 5-year survival rate for all stages of multiple myeloma is 56%. This means that, on average, people with the disease are about 56% as likely as those who don’t have it to be alive at least 5 years after their diagnosis.

If you develop myelofibrosis or multiple myeloma, find a doctor with experience in blood cancers to guide you through your treatment. New therapies are on the horizon that could improve survival and quality of life for people with these diseases.