Multiple myeloma is a cancer that attacks a type of white blood cell (plasma cell), making it hard for your body to fight infection. While there isn’t a cure for multiple myeloma, effective treatment can slow the disease and relieve symptoms.
What is multiple myeloma?
When you have multiple myeloma, cancerous plasma cells build up in the bone marrow (spongy tissue in bones). Instead of making healthy antibodies, they produce abnormal antibodies called monoclonal protein, or M protein. They also take up space meant for healthy blood cells.
These abnormal antibodies can’t fight infection and may cause kidney damage. It can also lead to:
- Anemia (lack of red blood cells)
- Bone damage
- Bruising and bleeding
Causes and risk factors
Researchers don’t know exactly what causes multiple myeloma. The condition occurs more often in African Americans and men. Other risk factors include:
- Age: More common over 65
- Family history: A sibling or parent with the disease
- Other plasma cell disorders: Monoclonal gammopathy of undetermined significance (MGUS), smoldering myeloma, and solitary plasmacytoma
You may not have any symptoms in the early stages of the disease. The most common symptom is bone pain, especially in hips, rib cage, and back.
Other symptoms may include:
- Excessive thirst
- Loss of appetite or nausea
- Frequent infections or fevers
- Weakness and fatigue
- Weight loss
Multiple myeloma has many types, all based on the kind of protein myeloma cells produce. The three general categories of multiple myeloma are:
- Monoclonal gammopathy of undetermined significance (MGUS): MGUS is a precancerous condition characterized by a small number of abnormal cells in the bone marrow. It does not form tumors or cause symptoms.
- Asymptomatic myeloma: This type is also called smoldering or indolent myeloma. People with asymptomatic myeloma have more abnormal cells than those with MGUS and will likely need treatment.
- Symptomatic (active) myeloma: With this type, the cancer causes symptoms, such as anemia, bone damage, hypercalcemia (high calcium levels), or kidney problems.
To diagnose multiple myeloma, your doctor performs a medical exam and asks about your health and family health history. You may also have tests to look for signs of cancer and determine the stage (or extent) of it.
- Blood tests: These tests can show cancer spread and if you have any signs of infection.Blood tests measure levels of white and red blood cells, the amount of inflammation in the body, and liver and kidney function. These tests can also detect the presence of abnormal proteins produced by myeloma cells.
- Bone marrow biopsy or aspiration: During aspiration, doctors use a thin, hollow needle to remove a small amount of bone marrow (spongy tissue in bones). A biopsy involves removing a small amount of bone removed along with bone marrow. These tests can determine the extent (stage) of cancer.
- Imaging: These tests produce detailed images of the body to help determine the cancer type and its severity. Imaging tests such as an X-ray, CT scan, MRI or PET can detect bone issues that often occur with multiple myeloma.
- Tumor biopsy: Some people develop tumors with multiple myeloma. Doctors can remove part or all of the tumor to examine it for signs of cancer.
- Urinalysis: A urine test can find abnormal M proteins that occur with the disease.
Watch and wait
Multiple myeloma may grow slowly without symptoms, so doctors often recommend a “watch and wait” approach, also known as watchful waiting or active monitoring. Evidence shows treating early stages of multiple myeloma before symptoms appear doesn’t offer benefits.
While you'll have regular doctor visits and tests, you may not need treatment unless you develop symptoms or changes in your blood counts.
If you need treatment, options depend on the extent (stage) of the cancer and other factors, including your age and overall health.
Treatment options may include:
- Chemotherapy: These drugs destroy cancer cells. You receive chemotherapy drugs through an injection in the vein or in pill form.
- Targeted therapy: Targeted drugs and other substances can often stop the growth of cancer cells or kill them while minimizing harm to surrounding healthy tissue.
- Immunotherapy: These drugs help your immune system fight off cancer. Immunotherapy treatments include antibodies, drugs that help your body develop antibodies, and targeted therapies that block cancer cells from multiplying.
- Radiation: Radiation uses focused beams of high energy to target and kill cancer. Doctors carefully plan treatments to pinpoint the cancer and reduce harm to nearby healthy tissue. Radiation may also provide pain relief and be useful in targeting cancer cells that destroy bone.
- Steroids: Corticosteroids decrease swelling and inflammation.
- Stem cell transplant (bone marrow transplant): A stem cell transplant may be an option if other treatments haven’t worked. The doctor extracts damaged stem cells (blood-forming cells in the bone marrow) and replaces them with healthy cells from either the patient or a donor.
- Chimeric antigen receptor T-cell (CAR T-cell) therapy: A type of immunotherapy, CAR T-cell therapy uses genetically modified T cells to fight cancer. It’s a promising new treatment for people who don’t respond to other therapies. CAR T-cell therapy is FDA-approved for multiple myeloma treatment.
- Clinical trials: Clinical trials available at some medical centers may give eligible patients access to promising treatments not widely available.
Other helpful organizations
The below organizations offer additional information and resources for multiple myeloma patients and their loved ones.