What is multiple myeloma?

Multiple myeloma is a bone marrow cancer in which plasma cells have become cancerous. Plasma cells, a type of white blood cell, are an essential part of the immune system. They make antibodies, a type of protein, that help fight infections.

When plasma cells become cancerous, they form monoclonal antibodies or M-protein. High levels of M-protein can cause kidney damage and lead to kidney failure.

“Multiple myeloma typically begins in the bone marrow,” explains multiple myeloma specialist Sarah Holstein, MD, PhD. “However, it can sometimes grow outside the bone marrow or bones and involve other organs or tissues.”

Multiple myeloma can also cause problems such as:

• Anemia (low red blood cell count) 
• High blood calcium levels
• Increased infections
• Bone damage

Bone damage is caused by weakened areas in the bones (called lytic lesions). This can cause bone pain and even lead to fractures.

What are the risk factors for multiple myeloma?

While aging is a major risk factor for developing multiple myeloma, we still have an incomplete understanding of the risk factors for this disease.

Other potential risk factors for multiple myeloma include:

• Obesity
• Diet 
• Prior exposure to radiation 
• Environmental exposures (such as pesticides, for example) 
• Changes in the gut microbiome (microbes, like bacteria, that live in the human gut)
• Genetic changes 
• Chronic infections

Does myeloma run in families?

There is a small, increased risk of developing myeloma if a first-degree relative (such as a parent or sibling) has myeloma. However, it’s important to remember that the overall risk of myeloma is low. Currently, no genetic test can determine if you’re at higher risk of the disease.

What are the symptoms of multiple myeloma?

No one symptom is specific to myeloma. Some people experience worsening fatigue or unexplained weight loss. Others might experience bone pain or an unexpected fracture.

How is myeloma diagnosed?

According to the American Cancer Society, approximately 36,000 people will be diagnosed with myeloma this year in the U.S., with nearly 200 new cases in Nebraska. During routine blood work, signs of myeloma include anemia, elevated creatinine levels (a sign of kidney damage), or high protein levels may be detected. These findings may lead your doctor to order additional tests to look specifically for multiple myeloma.

The next step is to have a bone marrow biopsy to sample the bone marrow directly. This test shows the number of plasma cells and if they’re abnormal. A multiple myeloma diagnosis is given when more than 10% of bone marrow cells are plasma cells.

Finally, imaging of the bones is performed to screen for weakened areas in the bones. A whole body CT scan, MRI or PET/CT scan is ordered.

“If a diagnosis of multiple myeloma is made, it’s important to see a provider who specializes in the disease,” says Dr. Holstein. “Studies have shown improved survival outcomes for patients with a myeloma specialist at an NCI-designated cancer center as part of their care team.”

How is multiple myeloma treated?

High-dose chemotherapy and autologous stem cell transplantation remain the backbone of therapy for most patients aged 75 and younger.

For patients who are older, frailer or who don’t want a transplant, the current standard of care is a three-drug regimen, continued for as long as it keeps working.

“Whether or not a stem cell transplant is performed, at some point, multiple myeloma will recur, and a new treatment will need to be started,” explains Dr. Holsten. “Changes in treatment are needed over time, as the disease becomes resistant to various drugs.”

Because of this, new therapies and treatment options are needed to help improve and extend the lives of those living with myeloma.

How is pain from multiple myeloma managed?

Myeloma pain typically comes from bone damage that is part of the disease. This may improve over time as the myeloma is treated, but there can be chronic pain due to bone damage.

In addition to chemotherapy to kill the cancer cells, treatments to reduce myeloma pain include: 

• Radiation therapy to select bone lesions 
• Procedures to alleviate pain caused by compressed vertebrae
• Pain medications

What is the prognosis for someone with multiple myeloma? Can it be cured?

Currently, myeloma is not considered curable. The average survival for patients with standard-risk disease is now better than 10 years. However, survival rates continue to improve with the arrival of new drugs and therapies.

Ongoing research is focused on developing new treatments that harness the power of the immune system to fight myeloma. Recently approved therapies include (CAR) T-cell therapies and bispecific antibodies for late-line treatments.

Continued patient participation in clinical trials is critical. Without clinical trials, new drugs and treatments can’t be developed. If you want to participate, talk to your doctor or visit NebraskaMed.com/Cancer/Trials.

To schedule an appointment with a Nebraska Medicine multiple myeloma specialist, call 402.559.5600.