The cause of multiple myeloma is unknown. Risk factors include obesity, radiation exposure, family history, and certain chemicals. Multiple myeloma may develop from monoclonal gammopathy of undetermined significance that progresses to smoldering multiple myeloma.
The abnormal plasma cells produce abnormal antibodies, which can cause kidney problems and overly thick blood. The plasma cells can also form a mass in the bone marrow or soft tissue. When one tumor is present, it is called a plasmacytoma; more than one is called multiple myeloma.
Multiple myeloma is diagnosed based on blood or urine tests finding abnormal antibodies, bone marrow biopsy finding cancerous plasma cells, and medical imaging finding bone lesions. Another common finding is high blood calcium levels.
Multiple Myeloma Symptoms
In the early stages of multiple myeloma, you might not have any symptoms, or they might be very mild. Everyone who has the disease will feel different effects. In general, symptoms of multiple myeloma include:
- Pain in your bones, especially in your back, ribs, and skull
- Feeling very thirsty
- Getting infections and fevers often
- Changes in how often you need to pee
- Nausea and vomiting
- Loss of appetite
- Weight loss
- Numbness, especially in your legs
Multiple myeloma can affect your body in different ways.
Bones: The disease can make your bones weak and easy to break.
Blood: Because your bone marrow makes blood, multiple myeloma can affect how many healthy blood cells you have.
- Too few red blood cells (called anemia) can make you feel weak, short of breath, or dizzy.
- Too few white blood cells (called leukopenia) can make it easy to get infections like pneumonia. It can take longer to recover from them, too.
- Having too few platelets (called thrombocytopenia) makes it harder for wounds to heal. Even minor cuts can bleed too much.
Multiple Myeloma Stages
When your doctor diagnoses multiple myeloma, she’ll try to give you an idea of how much cancer has grown or spread in your body. This is called the stage of your disease.
Doctors can tell what stage the multiple myeloma is in by looking at X-rays of your bones and testing your blood, pee, and bone marrow.
Your stage might be:
- Smoldering myeloma: This is very early in the disease when there are no symptoms or problems. The blood and kidneys are normal, and there is no bone damage. People who have smoldering myeloma often do not need treatment right away.
- Stage I: There aren’t that many myeloma cells in the body. Doctors can’t see any bone damage on X-rays, or cancer has damaged only one area of bone. The amount of calcium in the blood is normal. Other blood tests may be only slightly off-balance.
- Stage II: This is the middle ground between stage I and stage III. There are more myeloma cells in the body than in stage I.
- Stage III: There are many myeloma cells, and cancer has destroyed three or more areas of bone. Blood calcium is high, and other blood tests are abnormal.
Multiple Myeloma Causes
No one knows what causes multiple myeloma. But you’re more likely to get it if:
- You’re older than 65
- You’re African-American
- You have a family member with it
- You’re overweight or obese
If you have one of these other plasma cell diseases, you may be more likely to get multiple myeloma:
- Monoclonal gammopathy of undetermined significance (MGUS)
- Solitary plasmacytoma
Multiple Myeloma 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.
Multiple Myeloma Complications
Complications of multiple myeloma include:
- Frequent infections. Myeloma cells inhibit your body’s ability to fight infections.
- Bone problems. Multiple myeloma can also affect your bones, leading to bone pain, thinning bones, and broken bones.
- Reduced kidney function. Multiple myeloma may cause problems with kidney function, including kidney failure. Higher calcium levels in the blood related to eroding bones can interfere with your kidneys’ ability to filter your blood’s waste. The proteins produced by the myeloma cells can cause similar problems.
- Low red blood cell count (anemia). As myeloma cells crowd out normal blood cells, multiple myeloma can also cause anemia and other blood problems.
Multiple Myeloma Diagnosis
To diagnose multiple myeloma, your doctor will do a combination of tests.
- Complete blood count
- Chemistry profile
- Beta2 microglobulin
- Antibody/immunoglobulin levels and types
- Serum protein electrophoresis
- Immunofixation electrophoresis
- Serum-free light chain assay
- Urine protein level
- Urine protein electrophoresis
- Imaging studies
- Bone marrow biopsy or aspiration
- Karyotyping and fluorescence in situ hybridization (FISH)
Multiple Myeloma Treatment
Treatments for multiple myeloma include:
Immunomodulatory drugs: These drugs are the workhorses of multiple myeloma treatment. They work on your immune system. Some turn on certain immune cells and others stop the signals that tell cancer cells to grow so they kill myeloma cells.
Proteasome inhibitors: Proteasomes are protein complexes that help cells — including cancer cells — get rid of old proteins so they can be replaced by newer versions. Proteasome inhibitors prevent cancer cells from doing this. As old proteins pile up, the cancer cells die.
Steroids: These drugs are used at all stages of the disease. High doses can kill multiple myeloma cells. They’re also used to ease symptoms like pain and pressure by stopping white blood cells from racing to affected areas. And they can help with the side effects of chemotherapy, like nausea and vomiting.
HDAC inhibitors: These drugs stop multiple myeloma cells from making too much of the histone deacetylase (HDAC) protein, which helps malignant cells quickly grow and divide.
Monoclonal antibodies: These immunotherapy drugs help your immune system fight cancer. They bring antibodies into your body to target specific proteins on multiple myeloma cells.
Chemotherapy: These drugs treat cancer by killing cells that are in the process of dividing. They also kill healthy cells around them, which causes unpleasant side effects.
Stem cell transplants: There are two types of stem cell transplant for multiple myeloma:
- Autologous stem cell transplant, which uses your stem cells
- Allogeneic stem cell transplant, which uses cells from a donor. The latter is less common because of the risk of rejection.
You usually get the transplant along with chemotherapy.
Radiation: This treatment uses high-energy particles, or rays, to damage cancer cells and prevent them from growing. You get it from a machine that sends high-energy rays into your body.
Adjunctive care: These treatments help manage the side effects of medications and complications of multiple myeloma.
Supportive care: These treatments can make life with multiple myeloma easier. They include physical therapy, nutritional counseling, massage, exercise, and more.
Hospice care: When your condition no longer responds to medication, this option will provide pain and symptom management to keep you as comfortable as possible.
Taking Care of Yourself
To help you feel better while you get treatment:
- Eat a healthy diet. A dietitian can help you choose the right foods, especially if you’re having trouble with certain foods because of your treatment.
- Exercise. Stay active to improve your mood and energy level, and protect your bones.
- Get plenty of rest. Take naps or breaks during the day to recoup your energy.
- Take advantage of good days to do the things you enjoy most.
- Ask for help when you need it, and seek out support groups to help you and your family manage this disease.
What to Expect
Multiple myeloma varies widely among people. Some will live for years with few symptoms. With others, the condition gets worse quickly. Identifying the forms of multiple myeloma is often challenging for doctors.
Frequently asked questions about Multiple Myeloma
What is multiple myeloma?
Multiple myeloma is a kind of cancer that starts in plasma cells. This is a type of white blood cell. These cells make proteins called antibodies (immunoglobulins). They help your body fight infection. When plasma cells grow out of control, they build up either in the bone marrow or in organs.
The tumors that are formed can destroy normal bone tissue. This can cause bone pain and sometimes breaks (fractures). The tumors can also cause large amounts of calcium to leave the bones and enter the blood. This can cause problems. These include confusion, pain, and kidney failure.
Is multiple myeloma painful?
Maybe at some point during the course of the disease you may feel some pain, particularly in your bones, but do not hesitate to visit your medical team as they will help you attain the best possible control over this symptom.
What is biological therapy?
Biological therapy or immunotherapy is a treatment designed to stimulate the body’s immune system to act against cancer cells. It is generally administered by intravenous infusion.
Who gets multiple myeloma?
Most people who get multiple myeloma are 65 or older. It’s rarely seen in people younger than age 35. More men get it than women get it. So do more African-American people than white people. Multiple myeloma is uncommon cancer. Experts aren’t sure why one person gets it and another one does not.
What are the symptoms of multiple myeloma?
A person’s symptoms depend on how advanced the cancer is. Some people with early multiple myeloma have no symptoms. Instead, it may be found during routine blood or urine tests. People may feel pain in their bones, often in their back or ribs. Some people may get broken bones since cancer causes the bones to weaken. Other people feel tired and weak.
They may have more infections than normal, and they may lose weight or have other problems. Some people feel thirsty all the time and have to urinate often. These symptoms do not mean that a person has multiple myeloma. Other things could be causing these symptoms. If you have these symptoms, see your healthcare provider.
How is multiple myeloma diagnosed?
Your healthcare provider will ask questions about your symptoms and health and family history. He or she will also ask about your history of exposures. Your healthcare provider will do a physical exam to check for signs of cancer. He or she may order these tests to help make the diagnosis:
- Blood tests
- Urine tests
- CT scan
- Positron emission tomography (PET scan)
- Biopsy, if the tumor is in soft tissue
- Bone marrow aspiration and biopsy
Should everyone get a second opinion for multiple myeloma?
Many people with cancer get a second opinion from another healthcare provider. There are many reasons to get one. Here are some of those reasons:
- Not feeling comfortable with the treatment decision
- Being diagnosed with a rare type of cancer
- Having several options for how to treat the cancer
- Not being able to see a cancer expert
Many people have a hard time deciding which treatment to have. It may help to have a second healthcare provider look at the diagnosis and treatment options before starting treatment. Note that, in most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion. Many insurance companies will pay for a second opinion.
How can I get a second opinion for multiple myeloma?
There are many ways to get a second opinion.
- Ask a primary care healthcare provider. He or she may be able to suggest a specialist. This may be a hematologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.
- Call the National Cancer Institute’s Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
- Seek other options. Check with a local medical society or a support group to get the names of providers who can give you a second opinion. You can also ask a nearby hospital or medical school. Or ask other people who’ve had cancer for their suggestions.
How is multiple myeloma treated?
Some people with early (often called “smoldering”) multiple myeloma may not need treatment right away. In this case, your healthcare provider will closely watch you. If you have certain symptoms or your disease is progressing, you will start treatment.
Treatment for multiple myeloma is mainly systemic. These kinds of treatments kill or control cancer cells all through your body. Healthcare providers almost always use chemotherapy, targeted therapy, or other medicines to treat people with multiple myeloma. They may also use stem cell transplants. Although these treatments won’t cure myeloma, they can often help people live for many years.
Local treatments fight cancer cells in one area. Radiation is an example. Healthcare providers use it to control bone pain or prevent breaks.