What is multiple myeloma?
Multiple myeloma and other plasma cell neoplasms (cancers) are diseases in which the body makes too many plasma cells.
Plasma cells develop from B lymphocytes (B cells), a type of white blood cell that is made in the bone marrow. Normally, when bacteria or viruses enter the body, some of the B cells will change into plasma cells. The plasma cells make a different antibody to fight each type of bacteria or virus that enters the body, to stop infection and disease.
Plasma cell neoplasms are diseases in which there are too many plasma cells, or myeloma cells, that are unable to do their usual work in the bone marrow. When this happens, there is less room for healthy red blood cells, white blood cells and platelets. This condition may cause anemia or easy bleeding, or make it easier to get an infection. The abnormal plasma cells often form tumors in bones or soft tissues of the body. The plasma cells also make an antibody protein, called M protein9, which is not needed by the body and does not help fight infection. These antibody proteins build up in the bone marrow and can cause the blood to thicken or can damage the kidneys.
In multiple myeloma, abnormal plasma cells (myeloma cells) build up in the bone marrow, forming tumors in many bones of the body. These tumors may prevent the bone marrow from making enough healthy blood cells. Normally, the bone marrow produces stem cells (immature cells) that 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.
- Platelets that help prevent bleeding by causing blood clots to form.
As the number of myeloma cells increases, fewer red blood cells, white blood cells and platelets are made. The myeloma cells also damage and weaken the hard parts of the bones.
A tumor can damage the bone and cause hypercalcemia (a condition in which there is too much calcium in the blood). This damage can affect many organs in the body, including the kidneys, nerves, heart, muscles and digestive tract, and cause serious health problems.
In rare cases, multiple myeloma can cause organs to fail, which may be caused by a condition called amyloidosis. Antibody proteins build up and may bind together and collect in organs — such as the kidney and heart —causing the organs to become stiff and unable to function.
What are the risk factors for multiple myeloma?
Age can affect the risk of developing plasma cell neoplasms. Plasma cell neoplasms are found most often in people who are middle aged or older.
Other risk factors include the following:
- Being black.
- Being male.
- Having a brother or sister who has multiple myeloma.
- Exposure to petroleum and other chemicals.
- Exposure to high amounts of radiation.
What are the symptoms of multiple myeloma?
Sometimes multiple myeloma does not cause any symptoms. The following symptoms may be caused by multiple myeloma or other conditions. A doctor should be consulted if any of the following problems occur:
- Bone pain, often in the back or ribs.
- Bones that break easily.
- Fever for no known reason or frequent infections.
- Easy bruising or bleeding.
- Trouble breathing.
- Weakness of the arms or legs.
- Feeling very tired.
How is multiple myeloma diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for myeloma bone disease may include the following:
- X-ray – a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.
- Blood and urine tests.
- Bone marrow aspiration and/or biopsy – a procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size and maturity of blood cells and/or abnormal cells.
- Magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body.
How are prognosis and staging determined?
Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis depends on the following:
- The type of plasma cell neoplasm.
- The stage of the disease.
- Whether a certain immunoglobulin (antibody) is present.
- Whether the kidney is damaged.
- Whether the cancer responds to initial treatment or recurs (comes back).
After multiple myeloma and other plasma cell neoplasms have been diagnosed, tests are done to find out the amount of cancer in the body. This process is called staging. It is important to know the stage in order to plan treatment.
There are three stages for multiple myeloma. The number of myeloma cells in the body is determined by the following:
- Level of hemoglobin in the blood.
- Levels of calcium and creatinine in the blood.
- Amount of bone damage.
- Amount of antibody M protein in the blood and/or urine, and how well the kidneys are working.
The following stages are used for multiple myeloma:
- Stage I – In stage I multiple myeloma, there is a low number of myeloma cells in the body.
- Stage II – In stage II multiple myeloma, there is a moderate number of myeloma cells in the body.
- Stage III – In stage III multiple myeloma, there is a large number of myeloma cells in the body.
Treatment for multiple myeloma
Specific treatment will be determined by your physician based on:
- Your age, overall health and medical history.
- Extent of the disease.
- Your tolerance for specific medications, procedures or therapies.
- Expectations for the course of the disease.
- Your opinion or preference.
Patients without symptoms may not need treatment. When symptoms appear, treatment for any stage of multiple myeloma may include the following:
- Bone marrow or stem cell transplantation.
- High-dose corticosteroid therapy.
- Thalidomide therapy.
- Combination chemotherapy.
- Biologic therapy with monoclonal antibodies.
- Radiation therapy for tumors of the spine.
- Alpha interferon – a biological response modifier (a substance that stimulates or improves the ability of the body’s immune system to fight disease) that interferes with the division of cancer cells, therefore slowing tumor growth. Interferons are substances normally produced by the body but that also can by produced in the laboratory.
Clinical trials available
The VCU Massey Cancer Center has a number of Phase I and Phase II clinical trials for multiple myeloma. Please click to learn about the benefits of enrolling in a clinical trial.
To locate a trial at Massey, please visit “Find a clinical trial” on this Web site.
Attribution: Sections of this article have been reprinted from the article “Multiple Myeloma and Other Plasma Cell Neoplasms” prepared by the National Cancer Institute. For more information from the NCI, please write to this address:
NCI Public Inquiries Office
6116 Executive Boulevard, MSC8322
Bethesda, Maryland 20892-8322