Multiple myeloma is a plasma cell cancer that occurs when the plasma cells in your bone marrow produce abnormal antibodies. While multiple myeloma isn’t a curable condition, it’s very treatable with approaches like stem cell transplants and monoclonal antibody therapy.
How does multiple myeloma develop?
Imagine white blood cells as security guards in your bloodstream that are constantly on patrol for disease and infection.
When they’re alerted to potential harm, they spring into action by changing into plasma cells that ultimately produce proteins known as antibodies (also called immunoglobulins). These antibodies bind to the harmful substances, remove them from your body and leave your bloodstream once their job is done.
Myeloma occurs when plasma cells multiply and produce atypical antibodies that no longer help your body fight off infection. This can lead to organ damage, kidney disease or holes in your bones.
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Conditions
Myeloma can develop in different ways:
- Multiple myeloma: The most common form of myeloma, multiple myeloma, occurs when cancer is present in more than one bone marrow site.
- Solitary plasmacytoma: This occurs when cancer is present in only one bone marrow site. Plasma cell tumors are known as plasmacytomas.
- Extramedullary myeloma: This form of myeloma occurs when cancer is present in tissues other than marrow.
So whether the myeloma is present in 1 or multiple bone marrow sites or even in tissues other than bone marrow, you can trust that our team can care for different kinds of myeloma, like:
Monoclonal gammopathy of renal significance (MGRS)
Monoclonal gammopathy of undetermined significance (MGUS)
Multiple myeloma
Newly diagnosed multiple myeloma requiring therapy
Relapsed myeloma
Relapsed refractory myeloma
Smoldering multiple myeloma
Solitary plasmacytoma
Multiple myeloma symptoms
Since multiple myeloma often involves bone lesions, the most common early symptom is bone pain. Tenderness and pain usually develops in the lower back or ribs, but can affect any part of the body. These bone lesions release calcium into the blood, leading to higher calcium levels than normal.
Another symptom to be on alert for is kidney dysfunction. Abnormal plasma cells in multiple myeloma produce proteins in an uncontrolled manner, causing people to experience symptoms resembling kidney failure, like:
- Fatigue
- Decreased urination
- Swelling of the feet and legs
These abnormal plasma cells accumulate and crowd out the normal marrow. When the bone marrow can’t function properly, this leads to low red blood cell levels (anemia), and low levels of white blood cells and platelets. As a result, people may experience:
- Easy bruising
- Fatigue
- Infections due to low white blood cell counts
- Nose or gum bleeding due to low platelets (small cells that help blood to clot)
- Weakness and shortness of breath on exertion due to anemia
Testing
Properly diagnosing multiple myeloma requires examining your blood, bone marrow and urine for plasma cells and proteins:
- Bone marrow aspiration or biopsy: We'll test for increased bone marrow myeloma cells (malignant plasma cells).
- Blood and urine tests: These tests can detect if you have increased counts of "monoclonal" proteins ("M" component) in the blood and urine.
- X-ray: We'll examine your bones for any bone lesions.
We can also measure the following levels to better understand your condition:
- Blood: We'll look for lower-than-normal red blood cell, white blood cell and platelet cell counts to understand how much bone marrow is affected. Blood tests can also evaluate your kidney function.
- Calcium: Bone destruction can elevate your calcium and lead to low levels of the protein albumin.
- Beta-2 microglobulin: This protein is an indirect measure of the size and growth rate of myeloma.
Staging of multiple myeloma
Once we've confirmed that you're living with myeloma, it's important to understand if the disease is spreading and, if so, how far. This process, called staging, helps us design the most effective care plan for you.
We follow the Revised International Staging System (R-ISS) to stage myeloma. Our experts can evaluate your genetic risk with a process known as interphase fluorescence in situ hybridization (FISH), where we select the purest plasma cells to examine.
Treatments
Myeloma isn’t a curable condition for most people, but it is treatable. We’ll explore the latest medications and therapies to prevent any organ damage (which leads to fewer symptoms) and empower you with more time to live on your own terms.
Because multiple myeloma can take different forms from person to person, we’ll pay special attention to your:
- Overall organ health, especially the kidneys
- Bone health, including bone marrow function
- Blood counts
Monoclonal antibody therapy is a game-changing treatment that continues to extend survival for people living with multiple myeloma. A monoclonal antibody is a lab-made protein designed to bind to harmful, unwanted substances in your body, like antigens on the surface of cancer cells.
Should your myeloma relapse, we can treat your condition with new monoclonal antibodies (like daratumumab or elotuzumab) and agents (like selinexor).
Stem cell transplant
People up to age 75 are oftentimes considered for an autologous stem cell transplant when myeloma’s presence is minimal following initial therapy. An autologous stem cell transplant is when we source cells from your own body to treat your condition. This approach can keep myeloma in remission for years, and we can repeat the treatment if the myeloma returns.
We collect these stem cells by using a machine that filters the white blood cells from the rest of your blood, and returns the other cells and plasma to your bloodstream. This process is called leukapheresis.
The white blood cells are returned to your body following a round of high-dose chemotherapy.
Protecting your immune system
People living with multiple myeloma require continuous care. We can offer support by providing timely vaccinations after stem cell transplants to helping protect your immune system while traveling.
We can even help protect your immune system in the winter months when pneumonia is most common by offering rotating antibiotics or immunoglobulin injections.
Tracking your body’s response to treatment
It’s important to know that myeloma will require lifelong care because relapsing is common. Relapse occurs because a very small amount of the disease remains in your body even after we cannot find signature proteins in the blood or urine. This is called minimal residual disease.
We can better understand your risk of relapse by testing your minimal residual disease.
Clinical trials + research
Our research aims to turn data points into action plans that can positively impact your health. This translational research continues to advance our understanding of modern plasma cell diseases and how to best treat them.
A major focus of our research is identifying the genes and proteins that enable malignant plasma cells to cause disease and to survive despite modern treatments.
We encourage speaking with your care team about participating in clinical trials. Being at the forefront of these studies allows you to not only pursue what’s next in your health, but possibly what’s next in the future of healthcare.
FAQs
What is smoldering myeloma?
Smoldering myeloma is when the abnormal protein has been detected and there are more than 10% abnormal plasma cells in the bone marrow. Most people with smoldering myeloma don’t experience any symptoms early on because the condition doesn’t lead to organ damage.
What is monoclonal gammopathy of undetermined significance (MGUS)?
Monoclonal gammopathy of undetermined significance (MGUS) is when the abnormal protein is found, but the percentage of abnormal plasma cells is less than 10%.
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