What Is Multiple Myeloma? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Multiple myeloma is a cancer that affects plasma cells, a type of white blood cell found primarily in bone marrow (the soft, inner tissue of bones).

Multiple myeloma has no cure, but treatments are available to help get the cancer into remission.

Multiple myeloma symptoms vary from person to person. Some people may have no symptoms at all, especially when the cancer is at an early stage. When symptoms occur, they can be vague or similar to those of other health conditions or aging.

• Bone pain, most often in the spine, pelvis, or ribs
• Thrombocytopenia, or low levels of platelets in the blood, which can cause increased bruising and bleeding
• Bone fractures
• Fatigue
• Weakness
• Frequent infections
• Weakness or numbness in the legs
• Excessive thirst
• Constipation
• Nausea
• Loss of appetite

• Age Multiple myeloma is most often diagnosed in adults over age 65.
• Sex Men are at a slightly higher risk than women.
• Race Black Americans are almost twice as likely to get multiple myeloma as white Americans.
• Family History Having a close relative with multiple myeloma increases a person’s odds of developing it. But most people with multiple myeloma have no family history of the disease.
• Obesity People who are overweight or have obesity are at higher risk.

Precursors to Multiple Myeloma

• Monoclonal Gammopathy of Undetermined Significance (MGUS) This is a precancerous condition in which abnormal proteins, called M proteins, are found in the blood, with no other symptoms or signs of myeloma present. MGUS is typically monitored, but not treated unless it progresses to myeloma.
• Smoldering Multiple Myeloma (SMM) This precancerous stage shows a higher level of M proteins than MGUS, but still without the symptoms of active myeloma. The risk of SMM progressing to active myeloma is higher than with MGUS, so closer monitoring is needed. In some high-risk cases, treatment is considered to delay progression.

• Complete blood count
• Urine analysis
• Bone marrow biopsy
• Fluorescence in situ hybridization, a procedure to locate the positions of specific DNA sequences on chromosomes
• Low-dose computed tomography (CT) scan
• Positron emission tomography (PET) scan
• Magnetic resonance imaging (MRI)
• X-rays

• Hypercalcemia (high calcium levels in the blood)
• Kidney damage
• Anemia (low red blood cell counts)
• Bone lesions
• Bone marrow where at least 60 percent of the cells are cancerous plasma cells (no other criteria are needed to make a diagnosis in this case)
• A large ratio between kappa and lambda free light chains (small protein components of antibodies), in which one is over 100 times higher than the other
• More than one focal lesion (an abnormal area that signals the development of a small hole in the bone) on an MRI

Staging indicates how much cancer is in the body, where it is, and whether it has spread. Doctors stage multiple myeloma to help determine the best treatment plan and estimate the prognosis.

• The amount of albumin, a protein made by the liver, in the blood
• The amount of beta-2 microglobulin, a protein that is a tumor marker, in the blood
• The amount of lactate dehydrogenase (LDH), an enzyme; high levels can indicate more severe disease
• Chromosomal abnormalities

Based on the findings, the disease can be categorized into one of three stages:

Current treatments aim to relieve symptoms, prolong the length of remissions, and extend survival. Oncologists have many ways to treat multiple myeloma and will typically use more than one treatment at a time.

Induction Therapy

Three-drug regimens (triplet therapy) generally include:

• Proteasome inhibitors stop enzyme complexes (proteasomes) in your cells from breaking down certain proteins that are important for controlling cell division. These drugs affect tumor cells more than normal cells.

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• Immunomodulatory drugs work by activating certain cells in the immune system, preventing myeloma cell growth, and directly killing myeloma cells.
• Steroids can kill multiple myeloma cells when given in high doses. They can also decrease inflammation, relieve pain, and reduce side effects from other treatments.

Stem Cell Transplantation

• Stem cells are collected from your blood and stored for later use. Most transplants for multiple myeloma are autologous stem cell transplants, in which a person’s own stem cells are removed and later transplanted back into the bloodstream. Stem cells from a donor (allogeneic transplants) are used primarily in research.
• You will undergo high-dose chemotherapy (with a drug called melphalan) to kill any remaining cancer cells.
• Your saved stem cells will be infused back into your bloodstream.
• You will go on maintenance therapy, typically with an oral immodulatory drug called lenalidomide.

Other Treatments

These treatments may also be used to treat multiple myeloma

• CAR T-cell therapy involves genetically engineering a person’s own T cells (a type of white blood cell) to recognize and attack cancer cells.

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• Chemotherapy is used during the stem cell transplant process. It is rarely used on its own to treat multiple myeloma.

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• Radiation therapy uses high-energy rays to kill cancer cells. It’s often used in the case of a solitary bone plasmacytoma, in which the disease has only presented as a single bone lesion and hasn’t spread to the bloodstream, or to target areas of bone damaged by multiple myeloma.

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• Surgery is sometimes used to relieve spinal cord compression or stabilize bones that have deteriorated due to the effects of multiple myeloma.

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• Novel therapies are some of the newest drugs used to treat multiple myeloma that do not fit the classification of any existing drug. These new drugs work in different ways than drugs in the other classes (meaning they have novel mechanisms of action).

The type of multiple myeloma also makes a difference. People with smoldering multiple myeloma may remain symptom free for many years before the disease begins to take a toll. Conversely, people who have a form of myeloma with a high-risk genetic feature may have a poor prognosis.

• Low Blood Counts As myeloma cells multiply in bone marrow, they leave less space for red blood cells, white blood cells, and platelets. Low red blood cell counts, a condition known as anemia, can result in fatigue and weakness. A drop in white blood cells can decrease the body’s ability to fight disease. A lack of platelets can lead to significant bleeding and bruising, even from minor scrapes or cuts.
• Bone and Calcium Issues Myeloma cells can accelerate the breakdown of old bone and slow the building of new bone. This can lead to osteoporosis, raising the risk of fractures. Bones may become so fragile that even normal actions, such as coughing and walking, may be enough to lead to a broken bone.
• Suppressed Immune System Myeloma cells interfere with both the quality and quantity of infection-fighting white blood cells, raising the risk of infection.
• Kidney Damage An antibody produced by myeloma cells can harm the kidneys and lead to kidney failure.

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• Neuropathy Proteins secreted by myeloma cells may damage motor and sensorimotor nerve cells by stripping their myelin sheaths and by causing the degeneration of axons — the long, threadlike parts of nerve cells, along which impulses are conducted from the cell body to other cells. Neuropathy may also be a consequence of spinal damage caused by the cancer.

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• Eye Problems M proteins can thicken the blood and slow down blood flow in the small blood vessels of the retina, leading to a number of eye problems.

Multiple myeloma accounts for less than 2 percent of cancers nationwide, but it is the most common blood cancer among Black Americans.

Black Americans are also underrepresented in clinical trials for new and potentially promising treatments for multiple myeloma. This could be due to clinical trial availability by location, cost, or the inherent racism built into the system — for example, a Black person not being told about a clinical trial they qualify for, because the physician assumes they won’t be interested.

If you’ve been diagnosed with multiple myeloma, you may want to seek support to help you understand and cope with the disease. The following organizations provide information, as well as emotional, financial, and medical support for people with multiple myeloma:

International Myeloma Foundation

The International Myeloma Foundation provides resources, including over 160 support groups for people with the disease. They offer information on treatments, including clinical trials, and other support.

Blood Cancer United

Blood Cancer United (formerly the Leukemia & Lymphoma Society) offers support groups, financial assistance, nutrition advice, and more for people with blood cancers, including multiple myeloma, and their caregivers.

• Multiple myeloma is a cancer of the plasma cells, a type of white blood cell found in the bone marrow.
• Symptoms, which aren’t always present, include bone pain and fractures, fatigue, and weakness.
• Risk factors for multiple myeloma include being over 65, being male, and having obesity. Black Americans are almost twice as likely as white Americans to be diagnosed with multiple myeloma and face obstacles to getting care.
• Treatment for multiple myeloma includes stem cell transplantation, chemotherapy, and a number of other medications.

Additional reporting by Christina Frank and Kaitlin Sullivan.