What is Myeloma?

Myeloma is a cancer of plasma cells – a type of white blood cells – that begins in the bone marrow. Myeloma can be classified as one of the following:

• Multiple myeloma: This is the most common form, making up more than 90 percent of myeloma diagnoses. It affects more than one area of the body, and cancer cells create abnormal proteins that can damage the kidneys.
• Plasmacytoma: This type occurs when only one site of myeloma cells is evident in the body, such as a tumor in the bone or soft tissues.
• Localized myeloma: In this form, myeloma is evident in a few neighboring sites throughout the body, but it has not spread extensively.
• Extramedullary myeloma: This type encompasses myeloma present in tissue other than the marrow, such as the skin, muscles or lungs.
• Plasma cell leukemia (PCL): This rare and aggressive variation of myeloma causes malignant cells to accumulate in bone marrow and circulate in high numbers in the bloodstream. 

Myeloma is considered asymptomatic if it is progressing slowly and a patient shows no symptoms. Symptomatic myeloma presents with related symptoms like anemia, kidney damage and bone disease.

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of myeloma. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Common symptoms of myeloma include:

• Bone pain and/or skeletal fractures
• Fatigue and weakness due to anemia (low red blood cell counts)
• Frequent infections
• High levels of blood calcium
• Numbness, tingling, burning or pain in the hands or feet
• Renal insufficiency (poor function of the kidneys)

Diagnosis

We use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor myeloma. Common diagnostic procedures can include:

Blood and urine tests: Myeloma may first be suspected after a routine blood test shows an elevated level of total protein. A physician will look for intact monoclonal immunoglobulins (M proteins) or immunoglobulin light chains (Bence Jones proteins) in additional blood and urine tests.

Bone marrow aspiration/biopsy: This procedure involves removal of a small amount of bone marrow in liquid form or in tissue form for examination. The physician inserts a special needle into a bone and drains a small sample of bone marrow fluid or captures a tiny sample of bone marrow tissue. This marrow is tested for malignant plasma cells.

Imaging studies: These scans can sometimes identify bone thinning, holes or fractures that characterize myeloma. Magnetic resonance imaging (MRI), especially of the spine, can detect bone changes earlier than conventional X-rays, and positron emission tomography (PET) scanning is also useful in some cases.

Causes

Researchers don’t know why some cells become myeloma cells and others don’t.

Risk Factors

Risk factors that can contribute to myeloma include:

Age: Most people who develop myeloma are over the age of 50.

Environment:  Some studies have suggested a link between the development of myeloma and radiation exposure or exposure to certain kinds of chemicals such as pesticides, fertilizers and Agent Orange.

Lowered immunity: People who take medicine to lower immunity after an organ transplant are at higher risk for myeloma.

MGUS: People with a history of monoclonal gammopathy of unknown significance – the presence of the abnormal M protein in the blood – are more likely to develop myeloma.

Race:  African-Americans have a higher incidence of myeloma.

Sex: Men are more likely than women to develop myeloma.

Prevention

There is no known way to prevent myeloma.

Prognosis

Myeloma patients often live 10 years or more after diagnosis. Outcomes are influenced by the stage of the disease, chromosome changes, effectiveness of clinical interventions, patient’s age and the presence of other medical conditions.

Treatment and Recovery

Myeloma treatment depends on a person’s age and overall health, the type and whether it has spread to other parts of the body. Common treatments include:

Clinical Trials

These may involve therapy with new drugs or drug combinations or new approaches to stem cell transplantation.

Chemotherapy

Special drugs designed to kill myeloma cells can be given as a pill or injected into the bloodstream.

Radiation Therapy

High-energy radiation targets myeloma cells and may be helpful in certain cases, especially for plasmacytomas.

Stem Cell Transplantation with High-Dose Chemotherapy

This procedure replaces diseased bone marrow with healthy bone marrow. Before the transplant, a patient receives high doses of chemotherapy or radiation to destroy diseased bone marrow. Then, the patient receives an infusion of blood-forming stem cells to help rebuild the bone marrow – either from a donor or one’s own stem cells.

Supportive Care

Patients may receive supportive care to ease myeloma symptoms or to treat side effects. These treatments and therapies may focus on treating anemia, stabilizing damaged bones, preventing infections and maintaining kidney function.

Complications

Complications of myeloma stem from the disease itself as well as side effects of treatment, and may include:

Acute myeloid leukemia: In rare cases, this cancer of the bone marrow and the blood may develop after chemotherapy treatment.

Anemia: This is a condition that develops when the blood lacks enough healthy red blood cells or hemoglobin.

Fatigue: This can stem from disease-related anemia, treatment and medication side effects, physical immobility, sleep disturbances, nutritional deficits, depression, stress and anxiety.

Hyperviscosity syndrome: The concentration of monoclonal proteins in the blood of some myeloma patients is so high that it makes the blood viscous, interfering with the blood flow and delivery of oxygen to tissues.

Infections: Myeloma prevents white blood cells from making antibodies to fight infection. Chemotherapy, which is toxic to normal blood cells as well as myeloma cells, also eliminates normal cells from the bone marrow.

Kidney impairment: High levels of Bence Jones protein in the urine can interfere with healthy kidney function, as can excess calcium in the blood and uric acid in the urine, all common in myeloma.

Myelosuppression: Chemotherapy may interrupt or inhibit the bone marrow’s constant production of red blood cells, white blood cells and platelets.

Pain: This may occur because of the growth of myeloma cells in the bone, fractures of the bone or collapsing vertebrae pressing on nerves.

Peripheral neuropathy: Temporary or ongoing numbness, tingling, burning, coldness or weakness in the arms or legs can occur due to nerve damage from the disease itself or from chemotherapy.

Thrombosis and embolism: Myeloma patients risk developing deep venous thrombosis (DVT) – when a blot clot develops in a vein deep in the body – from chemotherapy and other treatment drugs. If the clot breaks away, it can travel to the lungs or pulmonary arteries and become a life-threatening pulmonary embolism.