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Myeloma: Symptoms, Diagnosis and Treatment

  • A blood cancer that affects plasma cells
  • Bone pain and bone fractures are common symptoms
  • Treatments include chemotherapy, immunotherapy, targeted therapy and other options
  • Involves hematology, cancer center, and medical oncology

Overview

Blood has many important functions in your body, including producing the cells that power your immune system. In fact, nearly half (about 45 percent) of your blood consists of red blood cells, white blood cells and platelets. Think of your white blood cells as soldiers who fight for your health, if needed. During an infection, the body transforms a particular type of white blood cell known as a B cell into a plasma cell, which creates antibodies to fight it. When these plasma cells start growing in an uncontrolled way, it may lead to myeloma, or multiple myeloma, which is cancer of the plasma cells.

Myeloma is the rarest type of blood cancer, with 30,000 new cases diagnosed each year. In total, myeloma accounts for about 1 to 2 percent of all cancers diagnosed, and about 10 percent of all blood cancers. Myeloma is more common in men than in women, tends to arise in older adults (the average age of diagnosis is 65) and is nearly twice as common in African Americans as in the Caucasian population.

“Myeloma is generally considered an acquired, not a hereditary condition,” says Natalia Neparideza, MD, a Yale Medicine hematologist. “Luckily, over the course of the last two decades, several new, very effective treatments have been developed for myeloma. Thanks to these new treatments, survival in multiple myeloma has greatly improved, often allowing people diagnosed with myeloma to live for many years.”

What is myeloma?

In a healthy person, plasma cells make up less than five percent of your blood. Plasma cells produce antibodies to fight many of the different types of infection your body encounters. Abnormal plasma cells, called myeloma cells, usually form in the bone marrow, leading to low blood counts, thinning of bones and risk of fractures. Plasma cells produce an abnormal antibody called M protein which is harmful, not helpful, in fighting infection. In addition to interfering with regular antibody production, M protein in excessive amounts can lead to thickening of the blood and damage to kidneys.

How many kinds of myeloma are there?

Myeloma or multiple myeloma, as it's sometimes called, is so-named because it is generally widespread throughout multiple locations in the body. Mostly these are within the bones, but occasionally soft tissues are involved. There is an earlier condition, called plasmacytoma, which refers to myeloma cells affecting only one part of the body, and that is often easier to treat. 

Who is at risk for myeloma?

Though not much is known about the reasons and the risk factors for developing myeloma, there are certain patterns. The disease affects men more than women, is more common after middle age, and more often found in African Americans. Varieties of risk factors have been suggested, including exposure to radiation and certain chemicals, chronic inflammation, metabolic syndromes, environmental causes, and possible genetic risk factors. It is now believed that every case of myeloma develops gradually, from a precursor silent condition called MGUS (monoclonal gammopathy of undetermined significance).

What are the symptoms of myeloma?

The most common symptoms of myeloma are bone pain and bone fractures. Other symptoms include fatigue and/or weakness (caused by anemia), bruising or bleeding easily, frequent infections and fevers, and kidney damage. In some cases, calcium and M protein build-up caused by myeloma can lead to increased thirst and urination, constipation, headaches, and shortness of breath.

How is myeloma diagnosed?

A variety of tests are used to diagnose myeloma, including blood and urine tests to detect the presence of M protein and other irregularities in the blood. Bone marrow biopsy and imaging tests including X-ray, MRI, PET, and CT scans, can be used to confirm the presence and extent of the spread of myeloma. In some cases, myeloma is diagnosed incidentally, based on routine blood tests showing low blood counts, or electrolyte or protein abnormalities in the bloodstream.

What are the treatments for myeloma?

The effectiveness of treatment for myeloma will depend on the extent to which myeloma has spread throughout the body, and your overall health and age. Myeloma treatments include the following:

  • Chemotherapy, which introduces anticancer drugs to the body to kill cancer cells.
  • Targeted therapies, using drugs that will target and kill rapidly reproducing myeloma cells without harming normal ones.
  • Blood stem cell transplantation, in which healthy stem cells—generally a person’s own stem cells—are introduced into the bone marrow to replace killed cancer cells after a high dose of chemotherapy.
  • Immunotherapies, which are drugs that activate the body’s own immune system to attack cancer cells.
  • Radiation therapy, using high-energy rays to kill cancer cells and stop new cancer cells from being produced. Radiation therapy is commonly used in myeloma to relieve bone pain or for people who have plasmacytoma. 
  • Surgery is not typically recommended for multiple myeloma, but may be helpful in combination with radiation therapy for treating plasmacytoma.

What does Yale Medicine offer patients with myeloma?

Yale Medicine offers a strong team of myeloma specialists, who dedicate their time in clinic and in research to studying myeloma. The myeloma team at Yale Medicine takes a multidisciplinary approach in treating patients.

“Treatment decisions are made at myeloma multidisciplinary tumor board conferences, where several myeloma physicians and other specialists, including radiologists, kidney specialists, cardiologists, hematopathologists and radiation oncologists arrive at consensus treatment recommendations,” Dr. Neparidze says.

This myeloma team at Yale Medicine offers numerous clinical trial options that provide opportunities for patients to have access to new treatments. Additionally, physicians collaborate closely with research scientists within the Yale Cancer Center and worldwide to study blood and bone marrow in myeloma, and to develop more targeted, personalized treatment strategies for the patients with this diagnosis, she says.