Multiple myeloma (MM) is a rare blood cancer. A small number of people with MM also may have amyloidosis, another serious blood disease. One type, light-chain amyloidosis, is closely related to multiple myeloma.
The two diseases begin the same way – in plasma cells, white blood cells that help your immune system. There can be overlap of the two conditions. Amyloidosis can affect 12%-15% of people with MM. Not all of them have full amyloidosis, though. Some may have just a few amyloid deposits. They’re usually found only through a tissue biopsy. In other words, you won’t have symptoms.
Having these two diseases together – multiple myeloma and amyloidosis – can shorten your life expectancy.
What Are Multiple Myeloma and Amyloidosis?
About 35,000 adults in the United States are diagnosed with MM each year. In multiple myeloma, the cancerous plasma cells grow and multiply. After a while, there’s no room left for the healthy plasma cells.
Plasma cells come from the spongy tissue inside your bones, called bone marrow. Plasma cells produce antibodies, which help fight infections. As the cancerous plasma cells grow and outnumber healthy cells, they produce proteins that can be harmful, instead of antibodies. As the disease gets worse, it can cause:
An early form of the disease – a precancer called smoldering multiple myeloma – won’t give you any symptoms. Your doctor may decide to watch you closely to see if it gets any worse. But there are treatments and clinical trials available to hopefully lessen your risk of it becoming multiple myeloma.
The risk of getting multiple melanoma increases as you get older. Black people have a higher risk. And if people in your family have MM, your chances of getting it are higher, too.
Amyloidosis affects fewer than 20,000 people in the U.S. a year. It can affect many parts of the body at once (systemic), or only one part of the body (localized). Amyloidosis can damage tissues in your body. The disease can be serious and even life-threatening if it affects the organs, especially your heart. Amyloidosis can also affect your:
Anyone can get amyloidosis, but up to 70% of people with the disease are men.
Amyloidosis symptoms depend on what part of your body is affected. For example, if your heart or lungs are involved, you might feel fatigued and have chest palpitations (like your heart is fluttering), shortness of breath, and chest pain. If your digestive tract is affected, you may have little or no appetite, constipation, diarrhea, bloating, or gas.
The three most common forms of amyloidosis are:
- Light-chain amyloidosis, or AL, attacks many parts of the body – organs, nerves, skin, and even your tongue. Proteins called amyloid light chains group together, circulating in the blood until they land in tissues or organs and cause damage. This is the type that is closely related to multiple myeloma.
- AA amyloidosis affects the organs, most commonly the kidneys. If you have long-term inflammatory illnesses – like rheumatoid arthritis and inflammatory bowel disease (IBD) – or you get a lot of infections, you might get this diagnosis.
- Transthyretin amyloidosis, or ATTR-CM, is caused when the liver produces proteins that go to the heart. These proteins cause the left ventricle of your heart to become too stiff to pump properly. This type of amyloidosis can run in families. Or it can be “wild-type,” which means it happened for no known reason.
There are other, rarer forms of the disease, too.
How Are These Conditions Diagnosed?
The first step in diagnosing multiple myeloma is to have blood tests. A complete blood count (CBC) shows the levels of the blood cells in your blood. Other blood tests look at levels of:
- Creatinine: Higher levels can mean kidney damage. That’s common if you have myeloma.
- Albumin: Your levels may be lower if you have multiple myeloma.
- Calcium: If your multiple myeloma is advanced, you may have high calcium levels.
- Immunoglobulins/antibodies: Very high or low levels can mean multiple myeloma.
- Electrophoresis: This test also includes urine tests. It looks for certain proteins that are high if you have multiple myeloma. It also identifies antibodies.
- Free light chain: Light chains are made up of plasma cells. A certain type of rare multiple myeloma causes a higher level in your blood.
You’ll also need other urine tests, bone marrow biopsies, and imaging tests (X-rays and scans).
Once your doctor diagnoses multiple myeloma, it is staged – I-III – according to how far it has progressed and how aggressive it is. Stage I is less aggressive. Stage III is the most aggressive.
Your doctor may need several tests to diagnose amyloidosis. They depend on which area of your body is affected.
- Blood tests show how your body’s organs are working.
- Urine tests check your kidney health.
- Heart tests – electrocardiogram (EKG), echocardiogram, and MRI or nuclear scan – show how well your heart is working.
Your doctor may also get a biopsy, or small piece of tissue from your kidney, heart, bone, or fat from your belly.
Treating Multiple Myeloma and Amyloidosis
There is no cure for either disease. But treatment can help manage symptoms, extend your life, and improve the quality of your life. Treatments are often combined for the best response.
There are several medications your doctor may consider for your multiple myeloma:
- Chemotherapy: Drugs that kill or stop cancer cells from reproducing
- Immunotherapy: Drugs that work with your immune system to kill cancer cells
- Targeted therapy: Drugs that focus on specific cancer cells
Other treatments could include a bone marrow or stem cell transplant and radiation therapy. After receiving cancer-free bone marrow through a transplant, your body can start making healthy plasma cells on its own to replace the cancerous ones. Radiation therapy uses radiation to shrink melanoma cells.
Amyloidosis treatment can also include chemotherapy, targeted therapies, and bone marrow transplants. Treatment is focused on the part of the body the disease affects. Corticosteroids like prednisone can help reduce inflammation (swelling), and pain relievers may help you be more comfortable. You may need to take heart medications if the disease damages your heart. If your kidneys are damaged, you might need dialysis to help clear toxins out of your blood. Or you may need an organ transplant to replace a damaged organ that is no longer working the way it’s supposed to.
What Is the Outlook for People With Multiple Myeloma or Amyloidosis?
The earlier either disease is caught, the better the chances that treatment will extend your life. The average survival rate 5 years after a multiple myeloma diagnosis is almost 54%. This is an improvement over the survival rate in 1998, which was only about 35%.
The survival rate for amyloidosis is a bit more challenging to figure out. A lot depends on what part of the body is affected by the disease. The systemic form – which involves the whole body – has the worst outcomes.
People with amyloidosis combined with multiple myeloma do have a shorter life expectancy overall because of how amyloidosis attacks the body’s organs – the heart, in particular.
The outlook (prognosis) gets worse if you have smoldering multiple myeloma, especially when amyloidosis affects the kidneys or gastrointestinal tract.