Multiple myeloma is an uncommon blood cancer that affects the bone marrow, the body's blood-forming system, and can lead to kidney problems.
What is Multiple Myeloma?
In this disease, the plasma cells (a type of white blood cell) become abnormal and multiply rapidly. This causes them to interfere with the production of normal blood cells.
The plasma cells make an abnormal protein that is sent into the blood and urine. In the blood, these proteins are called monoclonal proteins (M proteins) or paraproteins. In the urine, they are called Bence Jones proteins.
If these proteins build up in large amounts, the kidneys may have trouble processing all of the protein. This may cause the kidneys to stop working as well as they should. Multiple myeloma cells also can eat away at areas of bone, putting these bones at higher risk of fracture.
Multiple Myeloma Causes
In 2015, an estimated 124,733 people in the United States were living with multiple myeloma. The exact cause of multiple myeloma is not known and no avoidable risk factors have been found. Although its exact cause is unknown, multiple myeloma can be controlled in most patients, sometimes for many years. However, certain things appear to make you more likely to develop multiple myeloma:
- Age: Over 65
- Gender: Men are slightly more likely to develop multiple myeloma.
- Race: African-Americans are twice as likely as white Americans to develop multiple myeloma.
- Radiation exposure
- Family history: If a parent, brother or sister has the disease, your risk is four times higher. However, this is rare.
- Working in oil-related industry: While some studies suggest this, it has not been proven.
- Obesity
- Other plasma cell diseases: If you have had one of the following you are at higher risk:
- A precancerous condition called monoclonal gammopathy of undetermined significance (MGUS)
- A single tumor of plasma cells (solitary plasmacytoma)
What are some multiple myeloma symptoms?
Multiple myeloma often doesn’t have symptoms at first. This can make it difficult to diagnose in the early stages. Symptoms of multiple myeloma may include:
- Fractures: Myeloma cells produce substances called cytokines, which can trigger bone cells (osteoclasts) to destroy surrounding bone. When more than 30% of the bone has been destroyed, X-rays show a thinning of the bone (osteoporosis) or dark holes (lytic lesions). The weakened area of bone is more likely to break. This is called a pathological fracture.
- Bone pain, especially in the middle and/or lower back, rib cage or hips. The pain can be mild or severe depending on the extent of the multiple myeloma, the speed with which it has developed, and whether fracture or nerve compression has occurred. Typically, movement makes the pain much worse.
- Fatigue and/or shortness of breath: Myeloma can cause anemia for some patients which can lead to feeling short of breath with exertion or tiredness more than usual.
- Confusion: For some patients, bone involvement of myeloma can lead to high calcium levels in the blood and/or kidney failure. This can lead to confusion.
- Appetite changes: High calcium levels in the blood and/or kidney failure can also cause a decrease in appetite, weight loss and nausea.
- Infection: Because myeloma cells crowd out normal white blood cells, which fight infection, there is a risk of infection. Common myeloma infections include pneumonia, bladder or kidney infections, sinusitis and skin infections.
How is multiple myeloma diagnosed?
To give you every advantage in treating multiple myeloma, MD Anderson’s specialized experts us the most advanced equipment with the highest level of skill.
As a center of excellence, we use genetic testing information to personalize your multiple myeloma treatment. This often means higher rates of success in treatment, as well as less impact on the body.
Multiple Myeloma Diagnosis
If you have symptoms that may signal multiple myeloma, your doctor will examine you and ask you questions about your health and your medical history. One or more of the following tests may be used to find out if you have multiple myeloma. These tests also may be used to find out if treatment is working.
Blood and urine tests determine calcium levels and changes in abnormal proteins that multiple myeloma produces. In the blood, these proteins are called paraproteins. A test called serum protein electrophoresis (SPEP) measures paraproteins. In the urine, these proteins are called Bence-Jones proteins. They are measured by collecting a 24-hour urine sample and running a urine protein electrophoresis (UPEP).
A blood test called an immunofixation (IFE) test, may help find small traces of abnormal proteins. Immunoglobulins and light chains are checked in the blood; myeloma can make increased levels of these proteins. These tests are also followed in the blood to evaluate how the disease is responding to treatment.
Bone marrow aspiration and biopsy: For the majority of patients, myeloma is found in the bone marrow. Plasma cells that turn into cancer cells define myeloma and plasma cells normally reside in the bone marrow. This test not only informs whether someone has myeloma, but also provides information on how aggressive the cells are which helps with prognosis and appropriate treatment planning.
Biopsy: Multiple myeloma can cause tumors called plasmacytomas in the bone or soft tissue around the bone. These tumors may be biopsied, or surgically removed and examined under a microscope for the presence of cancer cells.
Imaging tests, which may include:
- X-rays
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- Bone density scan
- CT or CAT (computed axial tomography) scans
What are the stages of multiple myeloma?
If you are diagnosed with multiple myeloma, your doctor will determine the stage of the disease. Staging is a way of determining how much disease is in the body and where it has spread. This information helps the doctor plan the best treatment. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.
Multiple Myeloma Stages
(source: Cancer Network)
The Revised International Staging System (R-ISS) is used to determine the stage of multiple myeloma. It is based on two blood tests, the serum albumin and the serum Beta 2 microglobulin (β2M).
Stage 1 Multiple Myeloma: serum beta-2 microglobulin <3.5 mg/L, serum albumin level of 3.5 g/dL or greater, normal LDH level and no high risk chromosomal abnormalities (i.e. deletion 17p, translocation (4;14) or translocation (14;16))
Stage 2 Multiple Myeloma: serum beta-2 microglobulin >3.5 mg/L but less than 5.5 mg/L, and/or serum albumin level < 3.5 g/dL, normal LDH level and no high risk chromosomal abnormalities (i.e. deletion 17p, translocation (4;14) or translocation (14;16))
Stage 3 Multiple Myeloma: serum beta-2 microglobulin > 5.5 mg/L and either high risk chromosomal abnormalities (i.e. deletion 17p, translocation (4;14) or translocation (14;16)) or high LDH level
What are the multiple myeloma treatment methods?
At MD Anderson, we offer multiple myeloma patients the most advanced treatments along with a range of clinical trials (research studies) of newer drugs and therapies. Our myeloma experts work closely together and with you to develop the most effective treatment plan, while focusing on your quality of life.
While treatments usually do not cure multiple myeloma, we can improve the quality of life and health of many patients by decreasing the disease and its symptoms for extended periods.
Advanced Treatment Options
The standard approach to newly diagnosed multiple myeloma is frontline chemotherapy for a few months, followed by high dose chemotherapy and a stem cell transplant (also known as stem cell rescue), then maintenance therapy, which entails lower doses of chemotherapy. MD Anderson is among a select few centers that are pioneering newer options which will hopefully improve outcomes. Many patients have had remarkable success.
These options include immunotherapy to help your body fight the cancer and new methods for stem cell transplantation. In addition, we are actively pursuing ways to reduce the symptoms and side effects of multiple myeloma and its treatments. For instance, we were instrumental in finding that multiple myeloma patients taking bisphosphates are less likely to have bone-related events, such as breaks.
Multiple Myeloma Treatments
If you are diagnosed with multiple myeloma, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.
Your treatment for multiple myeloma will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Multiple myeloma chemotherapy
Chemotherapy is the usual starting point in treating multiple myeloma. MD Anderson offers the most up-to-date and advanced chemotherapy options.
Immunotherapy
MD Anderson is among just a few cancer centers in the nation that are able to offer targeted therapies for some types of multiple myeloma. These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the cancer with what it needs to grow.
Possibilities may include:
- Monoclonal antibodies, including Darzalex (daratumumab) and Empliciti (elotuzumab)
- Monoclonal antibodies, including Rituxan® (Rituximab) Darzalex (daratumumab) and Empliciti (elotuzumab)
- Chimeric antigen rector T cells (CAR T cells) which are genetically modified T cells which fight the myeloma directly
- Bispecific t cell engagers which help activate and get your own immune cells next to myeloma cells in your body to kill them
- Cytokine therapies
- Vaccine therapy
Multiple myeloma radiation therapy
Radiation therapy often plays a valuable role in providing quick pain relief and decreasing the risk of fractured bones. It can also attack soft tissue collections of myeloma cells (plasmacytomas) that may threaten neurologic function by compressing the spinal cord or various nerves. In rarer instances, plasma cell tumors will present in one location (solitary plasmacytoma). In these situations radiation therapy alone is often used as the primary treatment.
A typical radiation treatment plan for a patient with multiple myeloma includes five sessions a week for approximately two weeks. Despite the lower doses of radiation therapy that are utilized to treat patients with multiple myeloma, it is still essential that radiation therapy is administered in a targeted way to minimize radiation exposure to surrounding normal tissues. This is accomplished through the utilization of computed tomography (CT) scan based radiation planning, immobilization devices to minimize patient movement during treatment and modern radiation planning techniques that permit focused radiation delivery, such as intensity modulated radiation therapy (IMRT), volumetric arc radiation therapy (VMAT) and proton radiotherapy.
Our Radiation Oncology Center treats more than 100 multiple myeloma and plasmacytoma patients each year, with a team of four skilled radiation oncologists who specialize in the management of patients with hematologic malignancies. Our ultimate goal is to administer effective, safe, modern radiation therapy while limiting toxicity.
Multiple myeloma stem cell transplants
A stem cell transplant replaces defective or damaged cells in patients whose normal blood cells have been affected by cancer. If a stem cell transplant is needed, MD Anderson has one of the most active and advanced programs in the nation.
Multiple myeloma plasma exchange
High levels of abnormal proteins can lead to thickening of the blood. Plasma can be removed and replaced with normal plasma from a healthy donor. This can quickly relieve symptoms of increased blood thickness until chemotherapy/immunotherapy has a chance to destroy the multiple myeloma cells that produce the abnormal protein.
Watchful Waiting
The watchful waiting approach involves closely monitoring multiple myeloma without active treatment. It is recommended for patients with asymptomatic (smouldering) myeloma or monoclonal gammopathy of undetermined significance (MGUS).
Why choose MD Anderson for your multiple myeloma treatment?
Many times, treatment for multiple myeloma may continue for extended periods, with repeated remissions and recurrences. For this reason, our teams of experts, including specially trained support professionals, forge close medical relationships with you to be sure you receive personal, customized care. This individualized attention gives you the best chance of a full and healthy life.
Pioneering Advances
MD Anderson has been instrumental in some of the biggest advances in multiple myeloma treatment, including Revlimid® (lenalidomide), a derivative of thalidomide. It is one of the most important discoveries in multiple myeloma therapy in recent years. We've also found that combining this drug with chemotherapy drugs often has a profound effect on multiple myeloma, even after other treatments have failed.
At MD Anderson, you benefit from one of the most active research programs in the United States, which includes a prestigious federally funded SPORE (Specialized Program of Research Excellence) program. This means we are able to offer a wide range of clinical trials (research studies) for every stage of multiple myeloma.
Cancer, after all, is a battle, and a positive attitude and hope are crucial weapons. So far, I win!
Multiple Myeloma Moon Shot
MD Anderson’s High-Risk Multiple Myeloma Moon Shot® aims to rapidly and dramatically improve the disease’s survival rates and reduce suffering through earlier intervention, research and new treatments.
Learn more about the Multiple Myeloma Moon ShotWhat do you do when your body doesn’t respond to physical training in the same way it did just a few years ago? How do you react if you feel pain in your rib cage, yet X-rays show no fractures?
These are some of the questions I was asking myself in 2013. Early that year, I was training for a two-day, 150-mile cycling event, but it didn’t seem like I was getting any stronger.
Throughout the summer and fall, I’d also been experiencing rib pain, and I suffered a sharp back pain while helping a friend move furniture.
My multiple myeloma diagnosis
The rib pain was initially diagnosed as costochondritis, a cartilage disorder that can cause significant discomfort around the sternum. I’d had a weak back for years, so muscle strains and back pain were nothing new. I chalked them up to getting older.
Still, this pain was a little different, and by the end of November 2013, I’d had enough. I was tired and in nearly constant pain. Blood tests showed moderate anemia and high levels of protein, but were otherwise inconclusive. My doctor ordered more extensive blood tests.
While waiting for the results, I started looking online for potential causes of my symptoms. One was multiple myeloma, a rare cancer that typically affects men in their 60s. Only about 1% of patients are younger than 40 when diagnosed. Since I was only 38 at the time, I figured my odds of having multiple myeloma were similar to my odds of winning the lottery.
Exceptional diagnosis calls for exceptional care
Unfortunately, the second round of blood work showed I’d defied the odds: I had multiple myeloma. I was stunned. I grasped that my doctor was referring me to someone, but I missed most of the details.
Once I could think straight again, I realized that winning this type of lottery meant I needed to be treated at the nation’s premier cancer center, MD Anderson.
Luckily, because I live in a suburb just north of Houston, my doctor referred me to Douglas Nelson, M.D., a physician at MD Anderson in The Woodlands.
Finding joy despite a cancer diagnosis
My first visit was a whirlwind of activity. My wife and I met with Dr. Nelson and his staff. Then I had a bone marrow biopsy and all the other diagnostic tests necessary for a formal diagnosis.
With the holidays coming up, Dr. Nelson told us to go ahead and keep our travel plans. I could begin my multiple myeloma treatment when we returned in January. Of course, enjoying a trip after receiving an incurable cancer diagnosis is easier said than done. But we tried not let the news ruin our celebration.
Why I chose MD Anderson
One of the reasons I chose MD Anderson is that I knew I had more treatment options there than I would have at other hospitals.
At MD Anderson, I received a relatively new multiple myeloma chemotherapy regimen before it became the standard of care. It was a 21-day cycle which consisted of one Revlimid (lenalidomide) capsule for 14 days, four Velcade injections over the first 12 days and two dexamethasone tablets taken in conjunction with each injection. Then, in April 2014, I received an autologous stem cell transplant.
After that, I was given a choice: I could restart my induction therapy protocol, begin a typical maintenance therapy protocol or join a Phase II clinical trial under Robert Orlowski, M.D. The trial was for a potential new maintenance therapy involving a medication then known as “MLN-9708,” or ixazomib.
I opted for the clinical trial. And while I do have a few lingering side effects — mainly mild neuropathy, muscle fatigue and digestive upsets — they are totally manageable and not significantly different than what would be expected with traditional maintenance therapy. Best of all, I have seen no disease progression since starting the clinical trial.
Today, I am living a nearly normal life, even with an incurable cancer. And that is what’s most important to me, my wife and our children.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
