Multiple myeloma is cancer of the plasma cells. Plasma is a type of white blood cell that helps fight infections. Bone marrow produces plasma cells, and multiple myeloma affects the bones.
Multiple myeloma is a type of plasma cell neoplasm, and it also affects the immune system, kidneys, and red blood cell count.
The American Cancer Society (ACS) estimate that around 1 in 132 people will develop multiple myeloma at some time in their life.
Multiple myeloma tends to affect older people. Doctors diagnose fewer than 1% of cases in people below 35 years of age. It is most common in people aged 65 years and over and slightly more common in males than females.
Multiple myeloma is a type of cancer. Cancer starts when the structure of the DNA in a cell changes. This is called a genetic mutation.
A mutation can lead to rapid cell growth and can also stop unwanted cells from dying. As the mutated cells do not die off, they build up and form tumors.
Plasma cells are a type of white blood cell. They produce antibodies that help defend the body from infections.
Bone marrow produces white blood cells and is the soft, spongy tissue in the middle of most bones.
When multiple myeloma develops, the body produces too many plasma cells inside the bone marrow. As these cells multiply, tumors can develop. The cells also produce a protein known as monoclonal protein, or M protein.
A doctor will diagnose multiple myeloma when plasma cells make up 10% or more of the bone marrow or when a person has multiple tumors.
At first, the cells reproduce in the bone marrow of the spine. From there, they enter the bloodstream and travel to bone marrow in other parts of the body. They collect in the bone marrow and the hard, outer part of the bones.
As this progression happens, the plasma cells can cause multiple tumors. This development is then known as multiple myeloma.
Unlike many cancers, multiple myeloma appears to spread via the bloodstream. It can reach different parts of the body quickly, making it hard to treat.
Multiple myeloma is a type of plasma cell neoplasm. Other examples include monoclonal gammopathy of undetermined significance (MGUS) and plasmacytoma.
Plasma cell neoplasms can be benign or malignant. Benign forms are noncancerous, although some types can become cancerous later in life. Around 1% of people per year with MGUS have a risk of developing multiple myeloma.
Smoldering multiple myeloma is a condition that can lead to multiple myeloma. Find out more.
The symptoms of multiple myeloma depend on the stage of cancer and the general health of the individual. There may be no symptoms in the early stages.
If symptoms do occur, they can include:
What are the early signs of multiple myeloma? Find out here.
As myeloma develops, various complications can arise. Some of these can be life threatening.
One consequence is that calcium from the bones dissolves into the bloodstream. High calcium levels in the blood can lead to:
- excessive thirst and frequent urination
- loss of appetite
- nausea and vomiting
As plasma cells overproduce, they can crowd out healthy cells. Changes in red and white blood cell and platelet levels can cause:
- repeated infections
- easily bruised skin
- nosebleeds, bleeding gums, or other unusual bleeding
- a higher risk of infection, such as pneumonia
Kidney damage and spinal cord compression may also occur. These can lead to:
- tingling in the legs
Scientists do not know exactly what causes multiple myeloma, but the following factors may increase the risk:
Age: Most diagnoses occur in people aged 65 years or over.
Race or ethnicity: It is more likely to affect African Americans
Sex: It is slightly more common in males.
Genetic factors: Some people with multiple myeloma have a relative with the condition.
Obesity: This appears to increase the risk.
Other plasma cell conditions: Having MGUS can increase the risk.
A study published in 2012 concluded that exposure to chemicals that people use in farming, printing, and cleaning may increase the risk.
To diagnose multiple myeloma, doctors will take a personal and family history of the individual concerned.
They may also use a range of tests, including:
- a physical examination
- blood tests, urine tests, and X-rays
- imaging tests
- a bone marrow biopsy
Sometimes, a routine blood or urine test will show abnormal proteins, such as M proteins. These can indicate multiple myeloma.
Doctors use a staging system called the Revised International Staging System to confirm the stage of myeloma.
This system looks at four factors:
- levels of albumin in the blood
- levels of blood beta-2-microglobulin
- levels of LDH in the blood
- genetic features of the cancer
Depending on the results, a person will receive a diagnosis of stage 1, 2, or 3. Someone who receives a diagnosis at stage 1 will have a higher chance of living at least 5 more years.
However, only around 4.8% of people receive a diagnosis at this stage, because symptoms do not usually appear until later.
When a person receives a diagnosis of stage 3 multiple myeloma, what should they expect? Find out here.
There is no cure for myeloma, but treatment can help manage the progression of the disease.
Various treatments are explained below. These interventions aim to:
- manage cancer by removing malignant cells from the bone marrow
- prevent the cells from returning for as long as possible
- relieve symptoms, such as pain, anemia, and kidney damage
Chemotherapy can destroy myeloma cells. In chemotherapy, a doctor prescribes powerful drugs that can help kill cancer cells or stop them from dividing.
Chemotherapy can be either:
- systemic, which means it works throughout the body, or
- regional, targeting a specific area
A person can take these either by mouth or intravenously (IV) over several months.
Chemotherapy can kill cancer cells, but it can also kill healthy cells. This means it can have severe adverse effects. However, these side effects typically resolve after treatment finishes.
Learn more here about chemotherapy and its effects.
Stem cell transplantation
Stem cells are immature blood cells. Following high dose chemotherapy, the individual may receive a transfusion of stem cells that originate either from their own cells or those of a donor.
A person who has stem cell treatment may be able to tolerate a higher dose of chemotherapy, as the new stem cells help the body recover more effectively.
The use of this option depends on the disease progression, age, and the general state of health of the person with myeloma.
Corticosteroids: A doctor may prescribe drugs known as corticosteroids. These may encourage the immune system to stop the growth of new cancerous cells, but how they work is unclear.
Biologic therapy: These can delay or prevent tumor growth by affecting the way the immune system works. They include Thalidomide and interferon.
Targeted therapy: Some medications can identify and attack cells or functions that promote cancer growth. Unlike chemotherapy, they only affect certain cells, which means they should have fewer adverse effects. Monoclonal antibody therapy is one example.
There are currently two immunotherapy options for multiple myeloma that the Food and Drug Administration has approved:
- Daratumumab (Darzalex)
- Elotuzumab (Empliciti)
These are known as monoclonal antibodies. They target specific pathways and may help some people with advanced multiple myeloma.
Surgery and radiation therapy
Sometimes a doctor will recommend a combination of surgery and radiation therapy to remove a tumor.
There are also clinical trials for multiple myeloma. Anyone who may be interested should speak to their doctor about joining one of these. Participating in trials can give a person access to new treatment options that are not yet available to everyone.
A doctor may prescribe different treatments for other symptoms and complications, such as:
- pain relief medication for back or bone pain
- dialysis for kidney problems
- an annual influenza jab to prevent infections
- therapy and possible transfusion for anemia
The doctor may also recommend staying hydrated and avoiding certain medications that can worsen kidney symptoms.
Sometimes, a person will not receive any treatment, but they will instead attend routine visits to allow the doctor to monitor for changes. This approach is called watchful waiting.
Lifestyle measures cannot cure multiple myeloma. However, they may boost overall health and reduce the impact of myeloma on people’s quality of life.
Dietary tips that may help strengthen the body during treatment include:
- maintaining a healthy weight
- avoiding crash diets
- eating 5–6 small meals a day or a small meal every 3 hours
- consuming bland foods, such as crackers, yogurt, and potatoes, so reducing the risk of nausea
- including protein-rich foods, such as eggs, fish, or nuts, which play a role in cell repair
- eating whole-grain foods, such as whole wheat bread and rice
- following food hygiene rules, as the person may have a higher risk of infection
- staying hydrated, especially by drinking water
- limiting or avoiding sweets, sugars, and alcohol
- monitor bowel habits for changes
- consuming plenty of fresh fruits and vegetables
These choices can help reduce the impact of myeloma on everyday life.
Is there a link between diet and cancer? Learn more here.
Other lifestyle tips
Other lifestyle choices that may help include:
- getting some physical exercise and also enough rest
- finding a local support group to help with emotional and other help
- quitting smoking, if appropriate
Some people recommend taking supplements and other measures to manage cancer.
Anyone with cancer should speak to their doctor before trying an alternative or complementary therapy, as some remedies can interact with existing treatment or make symptoms worse.
Multiple myeloma is not curable, but it is treatable. A person who receives a diagnosis has the following chance, on average, of living at least another 5 years:
- Early stage: 73.9%
- Later stage: 51.1%
Around 4.8% of people receive a diagnosis in the early stages.
Health authorities calculate these percentages by using past statistics. However, individual factors will affect how long a person lives with any type of cancer.
These factors include:
- the type of cancer
- the person’s age
- their overall health, especially their kidneys function
In addition, thanks to scientific and medical progress, the chances of surviving most types of cancer have increased over the last few years and continue to do so.
Two of my husband’s close relatives have had a diagnosis of multiple myeloma. I have two children, aged 8 and 10 years old. Should I worry about them? Should they have screening?