Tests and Treatments for Multiple Myeloma

When you have multiple myeloma, cancer cells crowd out healthy blood cells in your body. Instead of making normal proteins called antibodies, they make particles called M proteins. (The M stands for monoclonal.) To diagnose you, your doctor will order blood and urine tests to check for M proteins. A lab then checks it for M proteins and another substance -- beta-2 microglobulin -- that are signs you have multiple myeloma.

The proteins that myeloma cells make don’t just show up in your blood. They can appear in your urine as well, which gives doctors another way to diagnose the disease. Plus, multiple myeloma can damage your kidneys, so your doctor will want to check your pee for any sign they aren’t working properly. Some of the tests require you to collect urine over a 24-hour period, not give just one sample.

In this test, your doctor takes a look at all the major bones in your body using X-rays. Multiple myeloma can cause bone problems, including pain, soft or thinning bones, and fractures. X-rays can show that kind of damage. A technician will show you how to position yourself and then take images from different angles to get views of all your bones.

Multiple myeloma starts in bone marrow, the spongy tissue inside some bones. To test it, the doctor uses medicine to numb the area near your pelvis, then they take a sample of the liquid inside your bone marrow using a needle that goes into your pelvic bone. They also remove a sliver of bone and marrow. Doctors will check the samples to see how your cells look and whether you have too many plasma cells, a sign of multiple myeloma.

This scan will show your doctor if myeloma cells have replaced normal bone marrow. Your doctor might also look for a tumor made up of plasma cells called a plasmacytoma. This type of imaging test is also good for spotting spine fractures from the bone damage the disease can cause. For an MRI, you’ll lie still inside a machine that looks like a large tube while high-energy magnets and radio waves make pictures of your insides.

A PET scan is sometimes combined with another test, computed tomography, or a CT scan. Before you lie inside the scanner, you’ll get a substance injected into your veins through an IV in your arm or hand. It has a sugar and a radioactive chemical. Cancer cells absorb more of this substance, so the image gives your doctor a good idea of where those cells are in your body.

Multiple myeloma can make too many proteins build up in some organs, which can damage them. It’s called amyloidosis. If your doctor suspects that’s happening to you, the best way to find out is to check the fat around your belly. The doctor puts a needle into your belly and removes a small bit of tissue. (You’ll get numbing medicine first to make you more comfortable.) Then, they’ll look at it under a microscope.

These highly detailed looks at your bone marrow or tumor cells can identify chromosomes, genes, proteins, and other things that are unique to your cancer. The names of some of these tests are cytogenetics and fluorescent in situ hybridization (FISH). You and your doctors can use the information from these tests to decide on your treatment plan.

Once you're diagnosed, you and your doctor may decide that the best treatment for your multiple myeloma is no treatment at all -- at least not right away. This approach is also called “active surveillance,” and it’s recommended if your disease is in the early stages and you don’t have any symptoms. You’ll have checkups often to make sure your status hasn’t changed. You might have blood and urine tests at these appointments.

This treatment uses drugs that go after your cancer’s specific genes, proteins, or the tissue that helps it survive. This approach -- also called novel therapy -- targets the cancer but limits harm to healthy cells. Drugs in this group include those that stop myeloma cells’ growth in your bone marrow and others that help your own immune system fight the cancer. You take some of these drugs as pills; a needle is used to put others into a vein in your arm.

This type of treatment uses drugs to destroy cancer cells. You may take them in pill form or through a needle in one of your veins. You’ll get a series of these treatments on a set schedule, called a regimen. The length will depend on the drugs you take and how severe your condition is. Sometimes, doctors give a few chemotherapy drugs at once.

Your doctor might order this treatment to shrink a tumor quickly if it’s causing pain or damaging a bone. High-intensity energy particles are beamed at your body from a machine, and the radiation from the particles kills the cancer cells. You’ll have a set number of treatments scheduled over a period of time.

Drugs such as prednisone and dexamethasone calm down your immune system, reducing inflammation and fighting the myeloma cells in your body. Your doctor might have you take a steroid as part of your treatment plan. You can take these drugs in pill form, or get them as shots into a vein in your arm.

This procedure replaces your damaged bone marrow with special blood-forming cells called hematopoietic stem cells. You can get them from a donor, or doctors can collect your own cells ahead of time and give them back to you. First, you’ll have chemotherapy to destroy the cancer cells in your body. Then the transplant puts new cells in to start making healthy bone marrow. The entire process takes several weeks. How much of that time you spend in the hospital depends on the specifics of your condition.

Note that a stem cell transplant is generally reserved for people whose multiple myeloma has potential for being cured. 

Your doctor might add one of these drugs to your treatment plan if your multiple myeloma is causing a lot of bone problems. They can slow bone disease, prevent fractures, and ease your bone pain. Two common drugs are pamidronate (Aredia) and zoledronic acid (Zometa). You get them in a shot that goes into a vein.

Operations can help deal with any bone fractures the disease causes -- they can reduce pain or help you move around better. Multiple myeloma often affects the spine. Nothing can undo the damage, but surgeons can help stabilize your back. You may have a procedure called vertebroplasty or another called kyphoplasty that can prevent spinal cord compression (which can lead to paralysis).