Multiple myeloma is a type of cancer that begins in plasma cells — cells in the bone marrow, that, under normal circumstances, are involved in our immune defense system and produce antibodies. In multiple myeloma, too many plasma cells (myeloma cells) build up in the bone marrow. The presence of these tumor cells in the marrow can lead to bone abnormalities, kidney dysfunction, and anemia.
Normally, the bone marrow contains stem cells that have the capacity to develop into three types of mature blood cells: red blood cells (that carry oxygen and other materials to all tissues of the body), white blood cells (that fight infection and disease) and platelets (that help prevent bleeding by causing blood clots to form). As the population of myeloma cells in the bone marrow expands, fewer red blood cells, white blood cells, and platelets are produced.
Symptoms of multiple myeloma
Sometimes, multiple myeloma does not cause any symptoms. Symptoms, which may be caused by other conditions, can include:
- Bone pain, often in the back or ribs due to tumor growth or fractures
- Unexplained fever and sweating
- Frequent infections (especially upper respiratory infections)
- Easy bruising or bleeding
- Trouble breathing
- General weakness and fatigue
- Unintentional weight loss
In many patients, myeloma leads to bone damage, which in turn may cause hypercalcemia, elevated calcium levels in the blood. Elevated calcium can affect the kidneys, muscles, and digestive tract.
Hypercalcemia may cause the following symptoms:
- Loss of appetite
- Nausea or vomiting
- Feeling thirsty
- Frequent urination
- Feeling very tired
- Muscle weakness
- Mental confusion or trouble thinking
Although myeloma can affect anyone in the adult population, you may be at higher risk if you are:
- African American
- A sibling to someone with multiple myeloma
- Previously exposed to certain chemicals such as benzene, industrial strength pesticides, or high doses of radiation as from a nuclear facility
Dana-Farber’s Irene Ghobrial, MD, is leading a research study called PROMISE to identify, screen, and monitor individuals at high risk of developing multiple myeloma. This includes individuals ages 45 to 75 years old who are African American and/or individuals with a first-degree relative with a plasma cell disorder, such as multiple myeloma.
Treatment for multiple myeloma
In evaluating a patient with suspected multiple myeloma, doctors use various tests that examine one’s blood, bone marrow, and urine. These include a physical exam and history, laboratory studies from blood and urine, and a bone marrow aspiration and biopsy.
Treatment may not be needed for patients without symptoms who have precursor conditions (which include monoclonal gammopathy of undetermined significance and smoldering multiple myeloma).
For those individuals who have overt multiple myeloma, which is characterized by the presence of organ impairment and/or symptoms related to the condition, treatment is typically carried out in phases with:
- Induction therapy (sometimes followed by stem cell transplantation)
- Consolidation chemotherapy
- Maintenance therapy
- Radiation and or surgery may be required in certain circumstances