Multiple Myeloma Overview
Multiple myeloma is a cancer of plasma cells, which are part of the body’s immune system. Plasma cells, make proteins called antibodies that help the immune system attack and kill germs. Myeloma begins when a plasma cell becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. These abnormal plasma cells are called myeloma cells.
Myeloma cells make antibodies called M proteins and other proteins. These proteins can collect in the blood, urine, and organs. In time, myeloma cells collect in the bone marrow. They may damage the solid part of the bone. When myeloma cells collect in several of your bones, the disease is called “multiple myeloma.” This disease may also harm other tissues and organs, such as the kidneys.
Some patients have an indolent form of myeloma called “smoldering myeloma”; many of these patients may be observed without immediate need for treatment. Other patients with myeloma are made ill by their disease and require immediate treatment.
Visit the National Cancer Institute where this information and more can be found about Multiple Myeloma or ask your cancer care team questions about your individual situation.
Doctors sometimes find multiple myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an x-ray for a broken bone. Usually though, patients go to the doctor because they are having other symptoms.
To find out whether such problems are from multiple myeloma or some other condition, your doctor may ask about your personal and family medical history and do a physical exam. Your doctor also may order some of the following tests:
- Blood tests: The lab does several blood tests:
- Multiple myeloma causes high levels of proteins in the blood. The lab checks the levels of many different proteins, including M protein and other immunoglobulins (antibodies), albumin, and beta-2-microglobulin.
- Myeloma may also cause anemia and low levels of white blood cells and platelets. The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets.
- The lab also checks for high levels of calcium.
- To see how well the kidneys are working, the lab tests for creatinine.
- Urine tests: The lab checks for Bence Jones protein, a type of M protein, in urine. The lab measures the amount of Bence Jones protein in urine collected over a 24-hour period. If the lab finds a high level of Bence Jones protein in your urine sample, doctors will monitor your kidneys. Bence Jones protein can clog the kidneys and damage them.
- X-rays: You may have x-rays to check for broken or thinning bones.An x-ray of your whole body can be done to see how many bones could be damaged by the myeloma.
- Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether myeloma cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hip bone or another large bone. A pathologist uses a microscope to check the tissue for myeloma cells.
There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:
- Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
- Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.
If the biopsy shows that you have multiple myeloma, your doctor needs to learn the extent (stage) of the disease to plan the best treatment.
Staging May Involve Having More Tests:
- Blood tests: For staging, the doctor considers the results of blood tests, including albumin and beta-2-microglobulin.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your bones.
- MRI: A powerful magnet linked to a computer is used to make detailed pictures of your bones.
Doctors May Describe Multiple Myeloma As:
- Stage I
- Stage II
- Stage III
The stage takes into account whether the cancer is causing problems with your bones or kidneys. Smoldering multiple myeloma is an early disease without any symptoms. For example, there is no bone damage. Early disease with symptoms (such as bone damage) is Stage I. Stage II or III is more advanced, and more myeloma cells are found in the body.
People with multiple myeloma have many treatment options. The options are watchful waiting, induction therapy, immunotherapy, and stem cell transplant. Sometimes a combination of methods is used.
Radiation therapy is used sometimes to treat painful bone disease. It may be used alone or along with other therapies. See the Supportive Care section to learn about ways to relieve pain.
The choice of treatment depends mainly on how advanced the disease is and whether you have symptoms. If you have multiple myeloma without symptoms (smoldering myeloma), you may not need cancer treatment right away. The doctor monitors your health closely (watchful waiting) so that treatment can start when you begin to have symptoms.
If you have symptoms, you will likely get induction therapy. Sometimes a stem cell transplant is part of the treatment plan.
When treatment for myeloma is needed, it can often control the disease and its symptoms. People may receive therapy to help keep the cancer in remission, but myeloma can seldom be cured. Because standard treatment may not control myeloma, you may want to talk to your doctor about taking part in a clinical trial. Clinical trials are research studies of new treatment methods.
People with smoldering myeloma or Stage I myeloma may be able to put off having cancer treatment. By delaying treatment, you can avoid the side effects of treatment until you have symptoms.
If you and your doctor agree that watchful waiting is a good idea, you will have regular checkups (such as every 3 months). You will receive treatment if symptoms occur.
Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. In some cases, it may reduce the chance to control myeloma before it gets worse.
You may decide against watchful waiting if you don’t want to live with untreated myeloma. If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option in most cases.
Treatment for multiple myeloma used to consist of only chemotherapy, but chemotherapy is only part of the treatment equation now. In fact, targeted therapies have become the mainstay of myeloma treatment. Over the past 15 years, more than 10 targeted therapies have been approved by the FDA for use in myeloma patients.
Many different types of drugs are used to treat myeloma. People often receive a combination of drugs, and many different combinations are used to treat myeloma.
Each type of drug kills cancer cells in a different way:
Chemotherapy kills fast-growing myeloma cells, but the drug can also harm normal cells that divide rapidly. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).
Targeted therapies use drugs that block the growth of myeloma cells.The targeted therapy blocks the action of an abnormal protein that stimulates the growth of myeloma cells.Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Several types of targeted therapy may be used to treat multiple myeloma and other plasma cell neoplasms. There are different types of targeted therapy:
- Proteasome inhibitor therapy: This treatment blocks the action of proteasomes in cancer cells. A proteasome is a protein that removes other proteins no longer needed by the cell. When the proteins are not removed from the cell, they build up and may cause the cancer cell to die.
- Monoclonal antibody therapy: Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading.
- Histone deacetylase (HDAC) inhibitor therapy: This treatment blocks enzymes needed for cell division and may stop the growth of cancer cells
- BCL2 inhibitor therapy: This treatment blocks a protein called BCL2. Blocking this protein may help kill cancer cells and may make them more sensitive to anticancer drugs.
Some steroids have antitumor effects. It is thought that steroids can trigger the death of myeloma cells. A steroid may be used alone or with other drugs to treat myeloma.
You may receive the drugs by mouth or through a vein (IV). The treatment usually takes place in an outpatient part of the hospital, at your doctor’s office, or at home. Some people may need to stay in the hospital for treatment.
Immunotherapy drugs stimulate the body’s own immune system to battle cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biologic therapy.
- Immunomodulator therapy: Thalidomide, lenalidomide, and pomalidomide are immunomodulators used to treat multiple myeloma and other plasma cell neoplasms.
- CAR T-cell therapy: This treatment changes the patient's T cells (a type of immune system cell) so they will attack certain proteins on the surface of cancer cells. T cells are taken from the patient and special receptors are added to their surface in the laboratory. The changed cells are called chimeric antigen receptor (CAR) T cells. The CAR T cells are grown in the laboratory and given to the patient by infusion. The CAR T cells multiply in the patient's blood and attack cancer cells. CAR T-cell therapy is being studied in the treatment of multiple myeloma that has recurred (come back).
Stem Cell Transplant
Many people with multiple myeloma may get a stem cell transplant. A stem cell transplant allows you to be treated with high doses of drugs. The high doses destroy both myeloma cells and normal blood cells in the bone marrow. After you receive high-dose treatment, you receive healthy stem cells through a vein. (It’s like getting a blood transfusion.) New blood cells develop from the transplanted stem cells. The new blood cells replace the ones that were destroyed by treatment.
Stem cell transplants take place in the hospital. Some people with myeloma have two or more transplants.
Stem cells may come from you or from someone who donates their stem cells to you:
- From you: An autologous stem cell transplant uses your own stem cells. Before you get the high-dose chemotherapy, your stem cells are removed. The cells may be treated to kill any myeloma cells present. Your stem cells are frozen and stored. After you receive high-dose chemotherapy, the stored stem cells are thawed and returned to you.
- From a family member or other donor: An allogeneic stem cell transplant uses healthy stem cells from a donor. Your brother, sister, or parent may be the donor. Sometimes the stem cells come from a donor who isn’t related. Doctors use blood tests to be sure the donor’s cells match your cells. Allogeneic stem cell transplants are under study for the treatment of multiple myeloma.
- From your identical twin: If you have an identical twin, a syngeneic stem cell transplant uses stem cells from your healthy twin.
There are two ways to get stem cells for people with myeloma. They usually come from the blood (peripheral blood stem cell transplant). Or they can come from the bone marrow (bone marrow transplant).
After a stem cell transplant, you may stay in the hospital for several weeks or months. You’ll be at risk for infections because of the large doses of chemotherapy you received. In time, the transplanted stem cells will begin to produce healthy blood cells.
Multiple Myeloma Research & Clinical Trials
At Rocky Mountain Cancer Centers, our commitment to our patients is to provide the most advanced treatments for all types of cancers of the blood, including multiple myeloma. Please find the Rocky Mountain Cancer Centers location that is most convenient for you and call to request an appointment.
RMCC’s dedicated oncologists and researchers– and patients– have been instrumental in gaining approval for emerging therapies that have transformed treatment and prognosis for patients with multiple myeloma.
Currently, we are researching emerging therapies and therapy combinations for multiple myelomas.