Multiple Myeloma Diagnosis & Treatment
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 diagnose multiple myeloma. These tests also may be used to find out if treatment is working. 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 tests
A blood test called serum protein electrophoresis (SPEP) can be used to detect paraproteins (m proteins) in the blood. These are the abnormal proteins produced by cancerous plasma cells. Other tests can be used to assess blood calcium levels.
Urine tests
Your doctor may collect a 24-hour urine sample and run a urine protein electrophoresis (UPEP) test to detect the presence of Bence Jones proteins, the abnormal protein produced by cancerous plasma cells.
Bone marrow aspiration and biopsy
For the majority of patients, myeloma is found in the bone marrow. Using a long needle, your doctor will aspirate (remove) a small amount of your bone marrow to examine in a laboratory. This is called a bone marrow biopsy. Looking at your bone marrow under a microscope can help your doctor determine if cancerous cells are present. This also provides information on how aggressive the cells are which helps with prognosis and appropriate treatment planning.
Tumor 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
These imaging tests may include:
- X-rays
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- Bone density scan
- CT or CAT (computed axial tomography) scans
These tests may not be performed in all cases. However, they can help your doctor detect complications associated with multiple myeloma, like bone lesions, and also determine if cancer has spread.
Treatment
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 multiple myeloma or help relieve symptoms.
Watchful waiting
For patients with asymptomatic (smoldering) myeloma or monoclonal gammopathy of undetermined significance (MGUS), a watchful waiting approach may be appropriate. The watchful waiting approach involves closely monitoring multiple myeloma without active treatment.
Chemotherapy
Chemotherapy is the usual starting point in treating multiple myeloma. It uses special drugs that kill fast-growing cells, like multiple myeloma cells. MD Anderson offers the most up-to-date and advanced chemotherapy options.
Targeted therapy
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. Targeted therapy is a broad term used to describe drugs that specifically target weaknesses of the cancer cells. This can mean targeting the blood vessels that feed tumors or attacking specific genetic and proteins of cancer. Ultimately, by targeting the weaknesses of cancer, these treatments help stop its growth and spread.
Immunotherapy
Immunotherapy is one of several innovative targeted therapies performed by MDAnderson. It uses your own immune cells to fight off cancer cells. Usually, the immune system does not attack cancer cells because they produce special proteins that help them blend in with other cells. Immunotherapy drugs interfere with the production of these proteins, triggering an immune response to fight off your cancer. There are a few different methods used for immunotherapy, including:
- Monoclonal antibodies, including Darzalex (daratumumab) and Empliciti (elotuzumab)
- Chimeric antigen receptor (CAR) T cells, which are genetically modified T cells that 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
Radiation therapy
Radiation therapy often plays a valuable role in providing quick pain relief and decreasing the risk of fractured bones. It involves using a high-energy beam to quickly kill cancer cells in a specific area. Radiation therapy can help prevent nerve compressions by attacking soft tissue collections of myeloma cells (plasmacytomas). It is also useful for targeting plasma cell tumors 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. We use 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. 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.
Stem cell transplants
A stem cell transplant (or bone marrow transplant) replaces defective or damaged bone marrow cells with your own healthy blood-forming cells. First, your doctor will remove some of your healthy, blood-forming stem cells. Then, you will receive high-dose chemotherapy to kill off the diseased bone marrow cells. Finally, your healthy blood-forming stem cells will be transplanted in place of the diseased tissue. If a stem cell transplant is needed, MD Anderson has one of the most active and advanced programs in the nation.
Plasma exchange
High levels of abnormal proteins can lead to thickening of the blood. The liquid component of your blood, called the plasma, can be removed and replaced with normal plasma from a healthy donor. This can quickly relieve symptoms of increased blood thickness (hyperviscosity) until chemotherapy/immunotherapy has a chance to destroy the multiple myeloma cells that produce the abnormal protein.
Learn more:
Since they were first introduced more than 60 years ago, stem cell transplants have cured or extended the lives of millions diagnosed with aggressive lymphomas, leukemias, myelomas and other blood cancers.
One type of transplant, called an allogeneic transplant, uses stem cells from a donor. But in many cases, a transplant may use stem cells from a patient’s own body. This is called an autologous stem cell transplant.
We talked with Partow Kebriaei, M.D., to learn more about what happens when a patient becomes their own donor.
What are hematopoietic stem cells?
The immature, undeveloped cells that live in the bone marrow where blood is made are called hematopoietic stem cells. Hematopoietic means blood-forming. These “baby” cells have not yet decided which type of blood cell they want to be when they grow up. Eventually, they’ll mature into one of three types:
- white blood cells to fight infection
- red blood cells to carry oxygen throughout the body
- platelets to control bleeding
Who needs a stem cell transplant, and why?
Patients with blood cancers receive high doses of chemotherapy to wipe out cancer cells in the bone marrow. The powerful treatment kills not only cancer cells, but also healthy, blood-forming stem cells. These hematopoietic stem cells need replacing after the chemotherapy ends so the body can continue making blood.
What is an autologous stem cell transplant?
Some patients rely on healthy donors for stem cells. Others “bank” their own stem cells, which will be transplanted back into their bone marrow after the high-dose chemotherapy treatment is complete. This type of transplant is called autologous. Auto means self.
Who is eligible for an autologous stem cell transplant?
Autologous stem cell transplants are an option for patients whose cancer is in remission or has stabilized. This type of transplant is used most frequently to treat multiple myeloma and lymphoma.
Leukemia patients usually receive an allogeneic stem cell transplant. That’s because research has shown that stem cells from donors help prevent leukemia from returning.
What are the steps in an autologous stem cell transplant?
- Collecting the stem cells: Before treatment begins, a needle is inserted into the patient’s arm vein. Blood is withdrawn and redirected into a special machine that removes about 4 million stem cells – the amount needed for a transplant. The stem cells are frozen until needed, and the rest of the blood is returned to the patient’s body.
- Conditioning: The patient receives high doses of chemotherapy to kill cancer cells and prepare, or “condition,” the body for transplant. This typically takes one to seven days.
- Transplanting the stem cells: After conditioning is completed, the stem cells are thawed and reintroduced into the recipient’s vein through an IV. The stem cells automatically migrate to the bone marrow. About two weeks later, they begin producing normal, cancer-free blood cells.
What happens after an autologous stem cell transplant?
Many transplant recipients agree that the several weeks following transplant are the most challenging. Their blood counts are still very low during this time. Infection risk is high due to lack of infection-fighting white blood cells. Patients may be anemic due to lack of red blood cells. They’re also at risk for bleeding due to lack of platelets.
Doctors prescribe antibiotics to prevent infections, and patients will likely need transfusions of platelets and red blood cells. During this time, they’ll still be experiencing side effects of the chemotherapy they received during conditioning. Side effects may include nausea, diarrhea, hair loss, mouth sores and fatigue.
Most autologous transplant patients see a steady return to normal blood counts within two to four weeks. They can usually return to their normal activities in three to six months.
What’s the difference between a stem cell transplant and a bone marrow transplant?
In the early days, stem cells were collected directly from the bone marrow. Patients were taken to the operating room, anesthetized, and doctors inserted needles to remove bone marrow from the hip bone. Stem cells were extracted from the marrow and frozen until transplant day. This is where the term “bone marrow transplant” originated.
Today, we use medications that stimulate the stem cells to move out of the bone marrow and into the bloodstream, where they can be collected more easily. Stem cell transplant is very similar to bone marrow transplant, except the stem cells are harvested from the patient’s bloodstream rather than from the bone marrow.
What’s the main advantage of an autologous stem cell transplant?
A successful autologous stem cell transplant helps many people with lymphoma or multiple myeloma become cancer-free or delays the cancer’s return. Patients who use their own cells avoid graft vs. host disease, which occurs when the body views cells from a donor as foreign and attacks them.
Is one autologous stem cell transplant enough?
Most patients need only a single autologous transplant. Others, particularly those with multiple myeloma, may receive a planned second transplant several months after the first one. This is called a tandem transplant.
What’s your advice for patients considering an autologous stem cell transplant?
Recovery is a slow process, so patience is required. Most patients go from feeling lousy the first month after transplant to feeling back to normal six months later.
But everybody’s different. Some patients recover in three months, and some need a year to regain their strength and stamina. Take one day at a time, and you’ll get through it. Your MD Anderson team is here to support you every step of the way.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.