Multiple myeloma is a cancer of the plasma cells. Plasma is a type of white blood cell found in the bone marrow. The cancer affects the bones, immune system, kidneys, and red blood cell count.

Multiple myeloma is also known as myeloma or plasma cell myeloma.

The American Cancer Society (ACS) estimates the risk of developing multiple myeloma over a lifetime as 1 in 143 or 0.7 percent.

Fast facts on multiple myeloma

  • Multiple myeloma is a cancer of the blood plasma.
  • Symptoms include confusion, constipation, vomiting, and abdominal pain.
  • Age is a risk factor for myeloma, with 96 percent of people with myeloma aged over 45 years.
  • The cancer is treatable but not curable. It can be controlled using chemotherapy treatment and maintenance therapy.
  • Self-management techniques for myeloma include dietary and lifestyle changes.
  • The 5-year survival rate for multiple myeloma is 49 percent.

What is multiple myeloma?


Multiple myeloma is a cancer of the blood plasma.

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. The mutation can lead to rapid cell growth and can also stop unwanted cells from dying.

This leads to a buildup of mutated cells that form tumors.

Plasma cells are a type of white blood cell. White blood cells are produced in bone marrow, the soft, spongy tissue that is found in the middle of most bones. These white blood cells produce antibodies called immunoglobulin, which helps to fight off infections.

Multiple myeloma leads to the production of too many plasma cells inside the bone marrow. Normally, less than 5 percent of bone marrow consists of plasma cells, but in multiple myeloma, plasma cells can make up more than 10 percent of the marrow.

In this type of cancer, a group of abnormal white blood cells is produced, and they multiply in the body. These are called myeloma cells. They cause immunoglobin levels to become too high.

The abnormal myeloma cells start 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 they collect in the different bones, they can cause multiple tumors. This is multiple myeloma.

Unlike many cancers, multiple myeloma is thought to spread via the bloodstream. It can reach different parts of the body quickly, making it very hard to cure.

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Symptoms

The signs and symptoms of multiple myeloma depend on the stage of the cancer and the general health of the patient. There may be no symptoms in the early stages.

If symptoms do occur, they can include bone pain, especially in the back, pelvis, ribs, and skull. High calcium levels in the blood can also indicate myeloma, as calcium from the bones dissolves into the bloodstream.

High calcium levels can cause:

  • excessive thirst and frequent urination
  • confusion
  • constipation
  • loss of appetite
  • nausea and vomiting
  • abdominal pain

Changes in red and white blood cell and platelet levels can cause:

  • fatigue, tiredness, and lethargy
  • breathlessness
  • repeated infections
  • easily bruised skin
  • nosebleeds, bleeding gums, or other unusual bleeding

Kidney damage and spinal cord compression may also occur, potentially leading to numbness, weakness, and tingling in the legs.

Causes and risk factors

Scientists have not yet confirmed exactly what causes multiple myeloma, but the following factors may put people at risk:

  • Age increases the risk, with 96 percent of cases occurring in people over 45 years of age, and 63 percent in those over 65 years of age.
  • Genetic inheritance increases the risk.
  • Obesity increases the risk of developing many cancers, including multiple myeloma.
  • A diet with a low intake of fish and green vegetables may have an impact.
  • HIV and AIDS puts people at greater risk
  • Occupational exposure may be a factor, affecting people involved in agriculture, leather, cosmetology, and petroleum.
  • Exposure to certain chemicals and products may be linked to multiple myeloma, such as heavy metals, some hair dyes, plastics, dust, asbestos, herbicides, insecticides, and petroleum products.
  • Radiation exposure is thought to be a factor, and there is a significantly higher incidence of multiple myeloma among survivors of the atomic bomb explosions in Hiroshima and Nagasaki.
  • Some autoimmune disorders have been linked to myeloma, such as rheumatoid arthritis.
  • Monoclonal gammopathy (MGUS) has been linked to the condition. One percent of people with MGUS in the US develop multiple myeloma each year. People with MGUS have higher levels of M proteins in the blood.

Diagnosis


A biopsy can help to diagnose multiple myeloma.

To diagnose multiple myeloma, doctors use blood tests, urine tests, and X-rays.

They may request MRI or CT scans to check for bone damage. A biopsy of a sample of bone marrow will test for myeloma cells.

Sometimes a routine blood or urine test will show abnormal proteins, known as monoclonal proteins or M proteins. These can indicate multiple myeloma.

A staging system called the Durie-Salmon system is used to confirm the stage of the myeloma.

The system looks at four factors:

  • red blood cell (RBC) count
  • calcium levels in the blood
  • M proteins in the blood
  • the state of the bones

At stage 1, blood calcium levels are normal, RBC levels are either normal or slightly low, there are low levels of M proteins, and the bones show little or no damage. Most patients have no symptoms.

At stage 2, the levels of calcium and RBC levels are close to normal, there are low levels of M proteins, and there may be damage to one or two bones. There may also be kidney damage.

At stage 3, RBC levels are lower, symptoms of anemia may be present. Blood calcium levels have risen, M protein levels are high, and there is damage to two or three bones. Kidney damage is likely.

Treatment

People with multiple myeloma will normally be referred to a specialist in blood cancers known as a hematological oncologist.

Most patients in Stage 1 will not receive immediate treatment, but bodily changes will be monitored.

Patients in Stages 2 and 3 usually receive chemotherapy and treatment to help control symptoms.

The aims of treatment are to bring the cancer under control by removing the cancer cells from the bone marrow, and then ensure that they do not return for as long as possible.

Treatment also aims to relieve symptoms such as pain, anemia, and kidney damage.

Controlling myeloma

Myeloma cannot be cured, but its spread can be controlled.

Chemotherapy is used to destroy the myeloma cells. Examples of drugs used include vincristine, or Oncovin, and doxorubicin, or Doxil. These can be taken either orally or intravenously (IV) over a period of months.

Side effects of chemotherapy include:

  • nausea
  • vomiting
  • diarrhea
  • fatigue
  • skin rashes
  • infertility
  • hair loss

These side effects normally resolve once treatment has finished. Hair tends to grow back within 3 to 6 months of the end of treatment.

Stem cell transplantation is another option. Stem cells are immature blood cells. Following high-dose chemotherapy, the patient receives a transfusion of stem cells created either from their own cells or those of a donor.

Stem cell transplantation as a treatment option depends on the disease progression, age, and the general state of health of the person with myeloma.

Maintenance therapy

An individual with myeloma needs to top up their treatment. This is to keep the cancer from returning or spreading.

Following the initial treatment, corticosteroids are often prescribed. This is thought to encourage the immune system to stop the growth of new cancerous cells. The way it works is unclear.

Thalidomide, or Thalomid, is an approved treatment for multiple myeloma. It is usually taken orally once a day. Thalidomide appears to stop the cancerous cells from returning. It achieves this by targeting the blood vessels required for the growth of cancer cells.

Interferon alpha injections are another form of maintenance therapy. They stimulate the immune system to attack any cancer cells that may remain in the bone marrow. Most patients need three injections per week, and they can learn how to inject themselves without needing to visit a doctor.

All of these drugs have potential side effects.

Patients may need to receive treatment for other symptoms and complications of multiple myeloma. These include back pain, kidney problems, which may require dialysis, infections due to low levels of white blood cells, bone loss, and anemia.

Self-management


The impact of multiple myeloma can be managed through healthy dietary choices.

Outside of treatment, it is important to preserve health and reduce the impact of myeloma on quality of life.

This can involve changes to the diet or lifestyle. Here are some dietary tips to help strengthen the body during myeloma treatment:

  • Be sure to maintain a healthy weight. Crash diets are not recommended during myeloma.
  • Eat 5 to 6 small meals once every 3 hours.
  • Consume bland foods, such as cheese, bread, crackers, yogurt, and potatoes. Nausea and vomiting may occur as a result of myeloma treatment, and bland foods can reduce the risk.
  • Include protein-rich foods in the diet, such as eggs, fish, or nuts.
  • Eat whole-grain foods, such as whole wheat bread and rice.
  • Be vigilant about food hygiene, as myeloma increases the likelihood of infection.
  • Stay hydrated.
  • Limit or avoid sweets, sugars, and alcohol.
  • Monitor your bowel habits.
  • Include plenty of fruits and vegetables in the diet.

These can help reduce the impact of myeloma on everyday life.

Lifestyle changes can include slowly increasing exercise levels and resting often. Finding a local support group can also be instrumental in reducing the emotional effects of myeloma. Any smokers with myeloma should also consider quitting.

Outlook

The 5-year survival rate for people with multiple myeloma is 49 percent. The condition is treatable but not curable.

Younger patients, people with normal kidney function, and those in better overall health, without other chronic diseases, can expect a better outcome.

Source: Multiple myeloma: Symptoms, causes, and treatment

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