Multiple Myeloma

What is multiple myeloma?

Multiple myeloma and other plasma cell neoplasms are cancers where the body makes too many plasma cells. When plasma cells grow out of control, they usually produce tumors in the bone marrow. If it is only one tumor, it is called a plasmacytoma. Usually the tumors are spread throughout the bone marrow and called multiple myeloma. While about 90% of myelomas occur in multiple sites (multiple myeloma), it can sometimes occur in only one site (solitary myeloma or plasmacytoma), a few localized sites or involve other tissues like skin, muscle or lung (extramedullary myeloma). An estimated 15,980 cases of multiple myeloma will be diagnosed in the United States this year.

The physicians at the Rocky Mountain Blood & Marrow Transplant Program are at the forefront of developing and testing new treatments for multiple myeloma. They all specialize in the care of patients with blood cancers and see only those kinds of patients. Ask about clinical trials in this area.

What causes multiple myeloma?

Multiple myeloma results from an acquired (not inherited) injury to the DNA of a single cell. Age is the most significant risk factor for multiple myeloma, since the average age at diagnosis is 68 years old. Men are more likely to contract the disease, and it is twice as common among African American men. Multiple myeloma seems to be common in some families, but this is rare. Other risk factors include exposure to radioactivity, working in certain petroleum-related industries, obesity and having solitary plasmacytoma or monoclonal gammopathy of undetermined significance (MGUS is a common problem—found in 3-4% of older people—that has some risk of turning into myeloma).

How is multiple myeloma diagnosed?

Unfortunately many people who have multiple myeloma may not experience symptoms until the condition has reached an advanced stage. Some common symptoms include bone pain, anemia, shortness of breath, dizziness, weakness, mental confusion, numbness, kidney failure and increased infections.

Results of any single test are not enough to make a diagnosis of multiple myeloma, which is based on a combination of factors, including the patient’s symptoms. Doctors use a variety of tests to detect and diagnose multiple myeloma, including:

• Physical examination and history


• Biopsy of bone, lymph nodes or tissue


• Bone marrow aspiration and biopsy with special tests to check the chromosomes and DNA changes


• Radiology studies (X-rays, MRI scan, CT scan)


• Complete blood count


• Number of red blood cells, white blood cells, and platelets


• Amount of hemoglobin (protein that carries oxygen) in the red blood cells


• Portion of the sample made up of red blood cells


• Blood chemistry studies


• Blood immunoglobulin studies


• Urine test


• Electrophoresis (special blood test)


• Serum free light chain test

Once multiple myeloma has been diagnosed, tests are done to see how advanced it is (stage). The spread of most cancers is usually described as stages. The number of myeloma cells in the body is determined by the level of hemoglobin in the blood, levels of calcium and creatinine in the blood, amount of bone damage, and amount of antibody M protein in the blood and/or urine. That was the basis for the Durie-Salmon staging system. More recently, a newer staging system looks not so much at how much myeloma is present, but more at how it might actually behave or progress in the patient. This is known as the “ISS” classification.

• Stage I multiple myeloma – least aggressive


• Stage II multiple myeloma – in between


• Stage III multiple myeloma – most aggressive


• Refractory multiple myeloma – the number of myeloma cells continues to increase even though treatment is given


• Recurrent multiple myeloma – cancer returns after treatment


• Symptomatic myeloma – myeloma which requires treatment


• Smoldering myeloma also known as asymptomatic myeloma – does not require treatment but is expected to need treatment (become symptomatic) at some time in the future

What are the treatment options?

Different types of treatment are available for patients with multiple myeloma and other plasma cell neoplasms. Unfortunately, multiple myeloma is still felt with rare exception to be an incurable cancer. Clinical trials are underway to improve current treatments and develop new treatments. The prognosis (chances of recovery) and treatment options depend on the age of the patient, the stage of the disease, the chromosome changes, and the patient’s general health and symptoms.

Standard treatments for multiple myeloma:

• Chemotherapy


• Other drug therapy (corticosteroid, thalidomide, bisphosphonate such as pamidronate or zolendronate)


• High-dose chemotherapy with bone marrow or stem cell transplantation


• Allogeneic transplants (using donor cells, more aggressive and dangerous, but can be highly effective, usually offered to younger patients)


• Radiation therapy


• Watchful waiting


• Plasmapheresis for a few patients with severe kidney problems

There are excellent web sites for patients with multiple myeloma, including:
www.myeloma.org, www.multiplemyeloma.org, and www.leukemia-lymphoma.org.