Multiple Myeloma


Most people have never heard of multiple myeloma when initially diagnosed. If you feel overwhelmed, you are not alone. Learning as much as you can about the disease and its treatment will empower you to make the decisions that are ahead. A multi-disciplinary team of doctors and specialists will be there to support and assist you along the way.

What is Multiple Myeloma?

Multiple myeloma is a type of hematologic (blood) cancer. Also referred to as a plasma cell neoplasm, it begins when the blood’s plasma cells multiply uncontrollably.

Plasma cells are produced in the bone marrow. They make antibodies to help fight germs and viruses, and stop infection and disease. As a type of white blood cell, they are an important part of the immune system, a network of cells that work together to defend your body against infections. Plasma cells create different types of antibodies, which are proteins created as a reaction to foreign substances, such as bacteria, in the body.

When abnormal plasma cells grow out of control, they can weaken the immune system by preventing healthy plasma cells from producing antibodies, which can affect the body’s ability to fight infection. These abnormal, cancerous plasma cells are called myeloma cells, and, like normal plasma cells, myeloma cells also make antibodies. But these myeloma cells produce too much of the same antibody called the M-protein, which does not fight infection. They accumulate in the blood and urine and can lead to damage of the kidneys or other organs. Myeloma cells also overcrowd the bone marrow and suppress the growth of healthy cells that produce blood. This unusual cell growth can result in anemia, bone damage and excessive bleeding from cuts.

Myeloma cells multiply uncontrollably and accumulate in bone marrow, solid parts of bone and, occasionally, in other organs (see Figure 1). This accumulation of myeloma cells usually occurs in multiple areas of the bones in the body, giving the disease its name, “multiple myeloma”.

When the cells collect in bone marrow, they slow down the growth of healthy white blood cells, red blood cells and platelets. These cells collect in solid bone, causing holes called lytic lesions. The majority of people with multiple myeloma have these lesions when their disease is diagnosed.

People with multiple myeloma may or may not have symptoms, which can make it difficult to diagnose. As a result, the disease may be at an advanced stage when it is diagnosed.

If your doctor suspects you have multiple myeloma, you may have blood and urine tests as well as a bone marrow biopsy and imaging tests, which may include computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and X-rays.

Molecular testing may be performed to check for chromosome abnormalities. Additionally, your doctor may order a biopsy of fat from around your stomach to check for amyloidosis, which is a buildup of an abnormal protein called amyloid.

The only two known precursors to multiple myeloma are monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma. MGUS occurs when abnormal plasma cells produce many copies of an identical antibody. Most cases of multiple myeloma are preceded by MGUS, but it is unknown whether MGUS is always present before diagnosis.

Smoldering myeloma, also called asymptomatic multiple myeloma, is an early stage of myeloma. Preventive treatments to delay smoldering myeloma from progressing to multiple myeloma are being studied in clinical trials.

Although the exact cause of multiple myeloma is unknown, scientists continue to learn more about the development of the disease. As you educate yourself about multiple myeloma, you will see that significant treatment advances in the past 10 years have led to more people successfully managing this disease and leading healthy, active lives. More treatments are in the pipeline, which offers more hope for patients.




The Common Signs of Multiple Myeloma


The most common signs of multiple myeloma, which are attributed to the same factors used to stage multiple myeloma (see Staging), can be described with the CRAB acronym:

Calcium level – the disease may cause elevated calcium levels in the blood

Renal (kidney) function – kidney failure may result from damage to the kidneys caused by the multiple myeloma protein

Anemia – low red blood cell counts may be caused by cancer cells slowing the growth of healthy bone marrow cells

Bone lesions – multiple myeloma cells can cause bone damage (lytic lesions), thinning of the bones (osteoporosis) or a compression fracture of the spine