Multiple myeloma

Multiple myeloma

Overview

Multiple myeloma is a cancer of 1 type of white blood cell. White blood cells fight infections in the body. They are made in the center of your bones, in a part called the bone marrow. When people have multiple myeloma, the bone marrow makes too many of these white blood cells and not enough of the normal blood cells a person’s body needs. This can cause symptoms.

Symptoms

Multiple myeloma can cause many different symptoms. These include:

• Bone pain or bones that break easily
• Nausea, vomiting, confusion, or feeling more thirsty than usual
• Feeling more weak, tired, or short of breath than usual
• Blurry vision
• Numbness, tingling, or weakness in the chest, lower back, or legs
• Getting sick more easily
• Losing weight without trying to

All of these symptoms can also be caused by conditions that are not multiple myeloma. But if you have these symptoms, let your doctor or nurse know.

Sometimes, symptoms of multiple myeloma can be a medical emergency. For example, it is an emergency if multiple myeloma cells or pieces of broken bone push down on a person’s spinal cord. The spinal cord is the group of nerves that runs down a person’s back. See a doctor immediately if you have:

• Severe back pain
• Weakness, numbness, or tingling in the legs
• No control over your bladder or bowel (that is a new problem)

Some of the symptoms happen because parts of the body that don’t normally make red blood cells start trying to make them. This is why some people notice swelling or abnormal growth of certain organs or bones.

People with multiple myeloma can get sick from infections more easily than normal. Because of this, it’s important to wash your hands often and stay away from people who are sick. Tell your doctor or nurse right away if you get a fever.

Causes

It’s not clear what causes myeloma.

Doctors know that myeloma begins with one abnormal plasma cell in your bone marrow — the soft, blood-producing tissue that fills in the center of most of your bones. The abnormal cell multiplies rapidly.

Because cancer cells don’t mature and then die as normal cells do, they accumulate, eventually overwhelming the production of healthy cells. In the bone marrow, myeloma cells crowd out healthy white blood cells and red blood cells, leading to fatigue and an inability to fight infections.

The myeloma cells continue trying to produce antibodies, as healthy plasma cells do, but the myeloma cells produce abnormal antibodies that the body can’t use. Instead, the abnormal antibodies (monoclonal proteins, or M proteins) build up in the body and cause problems such as damage to the kidneys. Cancer cells can also cause damage to the bones that increases the risk of broken bones.

A connection with MGUS

Multiple myeloma almost always starts out as a relatively benign condition called monoclonal gammopathy of undetermined significance (MGUS).

In the United States, about 3 percent of people older than age 50 have MGUS. Each year, about 1 percent of people with MGUS develop multiple myeloma or a related cancer.

MGUS, like multiple myeloma, is marked by the presence of M proteins — produced by abnormal plasma cells — in your blood. However, in MGUS, the levels of M proteins are lower and no damage to the body occurs.

Risk factors

Factors that may increase your risk of multiple myeloma include:

• Increasing age. Your risk of multiple myeloma increases as you age, with most people diagnosed in their mid-60s.
• Male sex. Men are more likely to develop the disease than are women.
• Black race. Black people are about twice as likely to develop multiple myeloma as are white people.
• Family history of multiple myeloma. If a brother, sister or parent has multiple myeloma, you have an increased risk of the disease.
• Personal history of a monoclonal gammopathy of undetermined significance (MGUS). Every year 1 percent of the people with MGUS in the United States develop multiple myeloma.

Diagnosis

• Blood or urine tests
• Bone marrow biopsy – A doctor will take a very small sample of the bone marrow. Another doctor will look at the sample under a microscope to see if cancer cells are present.
• Imaging tests, such as CT scans, PET scans, MRI scans, or X-rays – Imaging tests create pictures of the inside of the body.

Treatment

People with multiple myeloma often have 1 or more of the following treatments:

• “Watch and wait” – Some people have a condition called “smoldering myeloma” before they get multiple myeloma. These people do not have any symptoms and might not receive treatment right away. But they do get checked by a doctor regularly. When they start to have symptoms, they will have active treatment.
• Chemotherapy – Chemotherapy is the term doctors use to describe a group of medicines that kill cancer cells.
• Steroid medicines– These medicines can kill cancer cells and slow cancer growth. These are not the same as the steroids some athletes take illegally.
• Medicines called “immune modulating medicines” – These medicines stop the cancer from growing.
• Antibodies – Antibodies are proteins in your blood. Your immune system makes them to help your body fight infections. But there are other types of antibodies that are created in a lab and used as medicine. They kill cancer cells by targeting specific parts of the cells.
• Bone marrow transplant – The bone marrow makes blood cells, including white blood cells. During a bone marrow transplant, a doctor removes some bone marrow from the body. Then, the person gets medicines called “chemotherapy.” These medicines are usually used to kill cancer cells, but they also kill bone marrow cells. After chemotherapy, the doctor puts the bone marrow back into the person’s body.

People with multiple myeloma also get treatment for any symptoms they have. For example, doctors might treat bone symptoms with pain medicines, medicines to stop bone loss, or radiation therapy. Radiation can kill cancer cells.