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What is Multiple Myeloma?
Multiple myeloma is a type of blood cancer that affects the bone marrow, the body's blood-forming system. 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
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
- 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)
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 can 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.
Infection: Because myeloma cells crowd out normal white blood cells, which fight infection, there is a risk of infection. Symptoms of myeloma depend on where the infection is. Pneumonia, bladder or kidney infections, sinusitis and skin infections are common.
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.
We’re one of the few cancer centers with the ability to use genetic testing to examine your bone marrow to determine exactly how to treat multiple myeloma. 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 and if it has spread. 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.
Bone marrow aspiration and biopsy
Biopsy: Multiple myeloma can cause tumors called plasmacytomas in the bone or soft tissue around the bone. These tumors may be biopsied.
Imaging tests, which may include:
- Bone density scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
- CT or CAT (computed axial tomography) scans
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: National Cancer Institute)
The International Staging System 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: Albumin ≥ 3.5 g/dL and β2M < 3.5 mg/L
Stage 2 Multiple Myeloma: Albumin < 3.5 g/dL and β2M < 3.5 mg/L; or β2M ≥ 3.5 mg/L and < 5.5 mg/L
Stage 3 Multiple Myeloma: β2M ≥ 5.5 mg/L
At MD Anderson, we help patients with multiple myeloma by offering a variety of treatments, as well as a range of clinical trials (research studies) of newer drugs and therapies. Our myeloma experts work closely with you to tailor the treatments that will best fight the disease, 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
For years, the standard approach to multiple myeloma has been high-dose chemotherapy to wipe out the bone marrow and the blood supply, often followed by a stem cell transplant. But MD Anderson is among a select few centers that are pioneering newer options that have less impact on your body. Many patients are having 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 answers to reducing the side effects of multiple myeloma and its treatment. For instance, we were instrumental in finding that bisphosphates often can decrease bone-related events in multiple myeloma.
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.
Drug therapy is the usual starting point in treating multiple myeloma. MD Anderson offers the most up-to-date and advanced chemotherapy options. Liposomal drug delivery is an innovative method that can help chemotherapy be more effective.
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 Rituxan® (Rituximab)
- Biological therapies that develop antibodies to destroy cancer cells
- Proteasome inhibitors, such as bortezomib (Velcade®)
- Immune modulators, such as thalidomide and lenalidomide, that modify the environment of the tumor cell and allow it to die
- Small molecule treatment, such as panobinostat
- Cytokine therapies
- Vaccine therapy
- Bisphosphonates help reduce high calcium levels and decrease the risk of bone fracture
This usually is used to treat a specific area where there is bone destruction and pain. Radiation can destroy cancer cells more quickly than chemotherapy and has fewer side effects. For this reason, it often is used to get quicker pain relief and control severe bone loss.
Stem Cell Transplants
If a stem cell transplant is needed, MD Anderson has one of the most active and advanced programs in the nation.
If abnormal proteins become very high, leading to thickening of the blood, the 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 are responsible for producing the abnormal protein.
This approach involves closely monitoring multiple myeloma without active treatment.
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.
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 Shot
Gary Rudman has a motto: “Never quit. Never stop. Not today. Not ever.” And he’s lived by it throughout his multiple myeloma journey.
It showed when he rejected unacceptable treatment options at diagnosis. It continued with his commitment to exercise during recovery. And it spurred him on as he hiked to the summit of Mt. Kilimanjaro in February 2017, along with five other cancer survivors.
“The last day of the ascent was the hardest thing I have ever done, including chemotherapy and a stem cell transplant,” Gary says. “It was cold and dark, and we were all frozen. But we kept climbing and got there.”
The journey to MD Anderson
Gary’s hiking days might well have been over if he’d accepted the first treatment option he was offered. When he was diagnosed with a pelvic tumor called an isolated solitary plasmacytoma of the soft tissue in 2014, Gary’s first doctor recommended a risky surgery that he’d performed only once before.
“The chances of becoming paralyzed were huge,” Gary says. “I also could have lost bowel and bladder functions. So that was out of the question.”
Gary kept searching until he found a more acceptable treatment plan at MD Anderson — and a team of doctors who created it just for him.
“When I met Dr. Robert Orlowski, he asked me how aggressive I wanted to be,” Gary says. “And I said, ‘As aggressive as I need to be.’”
Keeping a promise to himself
At MD Anderson, Gary underwent chemotherapy and an autologous stem cell transplant. To keep up his strength during treatments, Gary walked laps around his unit and set up a bicycle trainer in his hospital room. Gary logged more than 2,500 miles on his bike before the year was over, including cycling after his stem cell transplant.
“I think physical fitness can help you beat cancer, so I refused to stay in bed,” he says. “The one promise that I made to myself was that I was not going to get into bed unless I was really sick.”
Gary kept that promise. He only took to his bed once — on the second or third day after his stem cell transplant. “The effects of the chemo kicked in and just slammed me,” he recalls.
Fighting cancer with exercise
Today, exercise helps Gary deal with lingering side effects, such as chronic back pain. He regularly logs 30-60 miles on his bike over the weekend. He still goes hiking, too.
“The tumor has no metabolic activity now, but I still have a softball-sized lump of scar tissue in my sacrum, so the longer I sit, the more it hurts,” he says. “I go to the gym at lunch because that helps. If I don’t, I’m in significant pain when I get home.”
‘Cancer is just a pothole’
One reason Gary climbed to the highest point in Africa 18 months after his stem cell transplant was to prove to other cancer patients that it could be done.
“We needed to show other patients that cancer is not a stoppage,” Gary says. “Cancer is just a pothole, and you can soon pave it over.”
Once he reached the top, Gary unfurled a banner he’d made bearing the names and photos of 78 other cancer patients. “Taking them to the top of the world with me was something I was determined to do,” Gary says. “It was hard as heck. But I never stopped.”
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