Myeloma


Fact: Myeloma is the second most common blood cancer in the world.

Myeloma

  • Is a type of cancer that begins in the bone marrow. It is a cancer of plasma cells, which are a type of white blood cells (also called plasma B cells).
  • The disease belongs to a spectrum of disorders referred to as “plasma cell dyscrasias.”
  • Has several forms:
    • Multiple myeloma - most common form: More than 90 percent of people with myeloma have this type. Multiple myeloma affects several different areas of the body.
    • Plasmacytoma - only one site of myeloma cells evident in the body, such as a tumor in the bone, skin, muscle, or lung.
    • Localized myeloma - found in one site with exposure to neighboring sites.
    • Extramedullary myeloma - involvement of tissue other than the marrow, such as the skin, muscles or lungs.

Doctors divide myeloma into groups that describe how rapidly or slowly the disease is progressing:

  • Asymptomatic or smoldering myeloma progresses slowly and has no symptoms even though the patient has the disease.
  • Symptomatic myeloma has related symptoms such as anemia, kidney damage and bone disease.



How Does Myeloma Develop?
Myeloma develops when a plasma cell is changed (mutated). 

  • Plasma cells are made from B lymphocytes (B cells), a type of white blood cell that is found in the bone marrow. Healthy plasma cells are part of the immune system and make proteins called “antibodies,” which help fight infection.

The mutated plasma cell (myeloma cell) multiplies, and, if untreated, these cells continue to grow in the marrow. They crowd out the healthy plasma cells and the normal stem cells in the bone marrow that form the white blood cells, red blood cells and platelets. If not treated, the cancerous cells can:

  • Crowd out functioning white cells, and the immune system can't guard against infection effectively
  • Secrete high levels of protein in the blood and urine, which can lead to kidney damage
  • Build up in bone, causing it to weaken, which can lead to bone pain and fractures.


Risk Factors
Doctors don't know why some cells become myeloma cells and others don't. For most people who have myeloma, there are no obvious reasons why they developed the disease.

There are some factors that may increase the risk of developing myeloma, including:

  • Age - Most people who develop myeloma are over age 50 years. Fewer cases of myeloma occur in people younger than 40.
  • Sex - More men than women develop myeloma.
  • Race - Blacks are nearly twice as likely as whites to develop myeloma.
  • Medical History - People with a history of MGUS (monoclonal gammopathy of unknown significance).
  • Environment - Some studies are investigating a link between the development of myeloma and one or more of the following factors: radiation or exposure to certain kinds of chemicals such as pesticides, fertilizers and Agent Orange.
  • Obesity - New research suggests that obese people have a higher incidence of myeloma.
  • Presence of chronic immunodeficiency
  • Presence of known inflammatory diseases or conditions (eg, cardiovascular disease or type II diabetes).


Statistics
New Cases

  • An estimated 30,280 new cases of myeloma (17,490 males and 12,790 females) are expected to be diagnosed in the US in 2017.

Prevalence

  • An estimated 110,345 people in the US are living with, or in remission from, myeloma.

Survival

  • Five-year relative survival has increased from 12 percent in 1960-1963 among whites (only data available) to 50.2 percent from 2006 to 2012 (for all races and ethnicities).
  • The 3-year survival rate as of January 1, 2013, is 65.0 percent (for all races and ethnicities).

Deaths

  • Approximately 12,590 deaths from myeloma are anticipated in 2017.

Multiple myeloma symptoms

Some signs of multiple myeloma symptoms vary for each individual, some common ones include:

  • Bone pain (often in the back or ribs)
  • Unexplained bone fractures (usually in the spine)
  • Fatigue, feeling of weakness
  • Recurrent infections, fevers
  • Shortness of breath
  • Weight loss
  • Nausea
  • Constipation
  • Increased thirst, urination


Related conditions associated with multiple myeloma

In addition to experiencing the symptoms of multiple myeloma as it progresses, one or more of the following conditions may develop:

  • Low blood counts: In multiple myeloma, malignant cells replace the normal blood-forming cells in the marrow. This can result in anemia (low red blood cell count), which can cause shortness of breath, fatigue or a feeling of weakness; leukopenia (low white blood cell count), which can increase the risk of infections; or thrombocytopenia (low blood platelet count), which can cause easy bruising or bleeding.
  • Hypercalcemia (high levels of calcium in the blood): As the osteoclasts rapidly dissolve bone tissue, calcium is released into the blood. Hypercalcemia can cause excessive thirst, frequent urination, nausea, dehydration and constipation, as well as mental confusion, dizziness or even coma.
  • Kidney problems: The build-up of abnormal antibody proteins and high blood calcium levels from the dissolved bone tissue may lead to kidney problems.
  • Spinal cord compression: Multiple myeloma can cause weakened and/or collapsing bone structures, such as the vertebrae, which can lead to spinal cord compression. Pain, numbness or tingling may be a sign of pressure on the spinal cord, which could lead to paralysis if there is no immediate medical intervention.


Diagnosis
In some cases, your doctor may detect multiple myeloma accidentally when you undergo a blood test for some other condition. In other cases, your doctor may suspect multiple myeloma based on your signs and symptoms.

Tests and procedures used to diagnose multiple myeloma include:

  • Blood tests. Laboratory analysis of your blood may reveal the M proteins produced by myeloma cells. Another abnormal protein produced by myeloma cells — called beta-2-microglobulin — may be detected in your blood and give your doctor clues about the aggressiveness of your myeloma.
    Additionally, blood tests to examine your kidney function, blood cell counts, calcium levels and uric acid levels can give your doctor clues about your diagnosis.
  • Urine tests. Analysis of your urine may show M proteins, which are referred to as Bence Jones proteins when they're detected in urine.
  • Examination of your bone marrow. Your doctor may remove a sample of bone marrow for laboratory testing. The sample is collected with a long needle inserted into a bone (bone marrow aspiration and biopsy).
    In the lab, the sample is examined for myeloma cells. Specialized tests, such as fluorescence in situ hybridization (FISH) can analyze myeloma cells to understand their genetic abnormalities. Tests are also done to measure the rate at which the myeloma cells are dividing.
  • Imaging tests. Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include an X-ray, MRI, CT or positron emission tomography (PET).


Assigning a stage and a risk category
If tests indicate you have multiple myeloma, your doctor will use the information gathered from the diagnostic tests to classify your disease as stage I, stage II or stage III. Stage I indicates a less aggressive disease, and stage III indicates an aggressive disease that may affect bone, kidneys and other organs.

Your multiple myeloma may also be assigned a risk category, which indicates the aggressiveness of your disease.
Your multiple myeloma stage and risk category help your doctor understand your prognosis and your treatment options.


Treatment
If you're experiencing symptoms, treatment can help relieve pain, control complications of the disease, stabilize your condition and slow the progress of multiple myeloma.

Immediate treatment may not be necessary
If you have multiple myeloma but aren't experiencing any symptoms (also known as smoldering multiple myeloma), you may not need treatment. However, your doctor will regularly monitor your condition for signs that the disease is progressing. This may involve periodic blood and urine tests.


If you develop signs and symptoms or your multiple myeloma shows signs of progression, you and your doctor may decide to begin treatment.

Treatments for myeloma
Standard treatment options include:

  • Targeted therapy. Targeted drug treatment focuses on specific abnormalities within cancer cells that allow them to survive. Bortezomib (Velcade), carfilzomib (Kyprolis) and ixazomib (Ninlaro) are targeted drugs that block the action of a substance in myeloma cells that breaks down proteins. This action causes myeloma cells to die. Targeted-therapy drugs may be administered through a vein in your arm or in pill form.
    Other targeted-therapy treatments include monoclonal antibody drugs that bind to the specific proteins present on myeloma cells, causing them to die.
  • Biological therapy. Biological therapy drugs use your body's immune system to fight myeloma cells. The drugs thalidomide (Thalomid), lenalidomide (Revlimid) and pomalidomide (Pomalyst) enhance the immune system cells that identify and attack cancer cells. These medications are commonly taken in pill form.
  • Chemotherapy. Chemotherapy drugs kill fast-growing cells, including myeloma cells. Chemotherapy drugs can be given through a vein in your arm or taken in pill form. High doses of chemotherapy drugs are used before a bone marrow transplant.
  • Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, regulate the immune system to control inflammation in the body. They are also active against myeloma cells. Corticosteroids can be taken in pill form or administered through a vein in your arm.
  • Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, is a procedure to replace your diseased bone marrow with healthy bone marrow.
    Before a bone marrow transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow.
  • Radiation therapy. This treatment uses beams of energy, such as X-rays and protons, to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells form a tumor (plasmacytoma) that's causing pain or destroying a bone.


​How treatments are used

Which combination of treatments you're likely to receive will depend on whether you're considered a good candidate for bone marrow transplant. This depends on the risk of your disease progressing, your age and your overall health.

  • If you're considered a candidate for bone marrow transplant, your initial therapy will likely include a combination of treatments, such as targeted therapy, biological therapy, corticosteroids and, sometimes, chemotherapy.
    Your stem cells will likely be collected after you've undergone a few months of treatment. You may undergo the bone marrow transplant soon after your cells are collected or the transplant may be delayed until after a relapse, if it occurs. In some cases, doctors recommend two bone marrow transplants for people with multiple myeloma.
    After your bone marrow transplant, you'll likely receive targeted therapy or biological therapy as a maintenance treatment to prevent a recurrence of myeloma.
  • If you're not considered a candidate for bone marrow transplant, your initial therapy will likely include chemotherapy combined with corticosteroids, targeted therapy or biological therapy.
  • If your myeloma recurs or doesn't respond to treatment, your doctor may recommend repeating another course of the treatment that initially helped you. Another option is trying one or more of the other treatments typically used as first line therapy, either alone or in combination.
    Research on a number of new treatment options is ongoing, and you may be eligible for a clinical trial in order to gain access to those experimental treatments. Talk to your doctor about what clinical trials may be available to you.


Treating complications
Because multiple myeloma can cause a number of complications, you may also need treatment for those specific conditions. For example:

  • Bone pain. Pain medications, radiation therapy and surgery may help control bone pain.
  • Kidney complications. People with severe kidney damage may need dialysis.
  • Infections. Your doctor may recommend certain vaccines to prevent infections, such as the flu and pneumonia.
  • Bone loss. Your doctor may recommend medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), to help prevent bone loss.
  • Anemia. If you have persistent anemia, your doctor may recommend medications to increase your red blood cell count.

Want to learn more?

The following are organizations and/or websites dedicated to providing information and education surrounding Myeloma. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.


Cancer Treatment Centers of America 
Leukemia & Lymphoma Society
International Myeloma Foundation
Mayo Clinic

WebMD


Information on this page taken directly from:
Cancer Treatment Centers of America 
Leukemia & Lymphoma Society
International Myeloma Foundation
Mayo Clinic