Multiple Myeloma: Overview

Symptoms of Multiple Myeloma

Multiple myeloma can be tricky to diagnose, according to the leading specialists SurvivorNet consulted. Many of its symptoms, like tiredness, nausea, and constipation, can be signs of any number of conditions, from the flu to a stomach bug.

So how do you know whether you should be concerned? If you already have MGUS or smoldering multiple myeloma, see your doctor. Also make an appointment if your symptoms stick with you and don’t improve.

Other symptoms to watch out for are:

• Weakness, dizziness, and shortness of breath, which are signs of a low red blood cell count, called anemia
• Bone pain, which could be a sign of a fracture
• Peeing too much or too little, muscle cramps, nausea and vomiting, which are symptoms of kidney failure
• Confusion, which is caused by too much calcium in the blood
• Frequent infections, because you have too few white blood cells to fight them

Could my symptoms be multiple myeloma? Dr. Shah describes how your doctor will check you for this cancer.

Getting a Diagnosis

Sometimes doctors find multiple myeloma while doing a blood test to look for another condition, or when trying to find out what’s causing a patient’s unexplained symptoms.

According to SurvivorNet’s experts, blood tests may indicate a patient has smoldering multiple myeloma or MGUS, because these conditions don’t usually cause symptoms. Smoldering multiple myeloma and MGUS aren’t cancer, but they can sometimes turn into cancer.

If you have smoldering multiple myeloma or MGUS, what is your risk of multiple myeloma? Dr. Hillengass explains the likelihood.

The odds that either condition will become cancer are very small, but to be safe, your doctor will probably check you more closely with blood and urine tests, and sometimes a bone marrow biopsy, which involves removing and testing a small sample of the spongy material inside your bones.

These tests can help monitor you for changes that signal you’ve switched over to multiple myeloma, and that you need to start treatment for this cancer. You may also need a bone marrow biopsy to help your doctor make the initial diagnosis.

Doctors use blood and urine tests and imaging tests such as X-ray or MRI to help diagnose multiple myeloma and to guide treatment options. Ultimately, a bone marrow biopsy will confirm the diagnosis.

Monitoring your bone strength and health over time will help your doctors understand how, or if, your disease is progressing.

How imaging tests could lead your doctor to the right diagnosis

Which Treatment is Right for You?

Not everyone with multiple myeloma needs treatment right away. If you have smoldering multiple myeloma, your doctor might simply monitor you regularly, to see if your disease progresses.

If you develop symptoms or your doctor thinks you need treatment, there are many options.  Which of these treatments you receive, and how they are sequenced, depends on several factors, and on whether your treatment team thinks you are a good candidate for a bone marrow transplant.

Treatment options include:

• Bone Marrow (Stem Cell) Transplant: This is also known as a stem cell transplant. It is a procedure to replace diseased bone marrow with healthy bone marrow without myeloma cells. Based on multiple factors, your doctor may decide that a stem cell transplant is best for you. The transplant process can be involved and requires multiple steps, including chemotherapy. Be sure to discuss this with your treating team to understand what is involved and what options are available.
• Targeted Therapy: Targeted therapy is now available for patients with multiple myeloma, and targets abnormalities in myeloma cells that allow the cancer to survive. Examples of targeted agents your doctor may use include bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Sarclisa). These drugs are either given in a pill or through an IV, and cause myeloma cells to die by preventing the breakdown of certain proteins in myeloma cells. You doctor may also use other targeted agents in the class of medications known as monoclonal antibodies.
• Biologic Therapy: Biologic therapy is another class of medication your treatment team may use to treat your myeloma. These medications use your bodys immune system to help fight and kill myeloma cells. This class of medication is most often given in pill form and include medications such as thalidomide (Thalidomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst).
• Chemotherapy: Sometimes your treatment team may recommend chemotherapy to treat your myeloma. Chemotherapy uses strong medicine to target cancer cells throughout your body. If your doctor recommends a bone marrow transplant high doses of chemotherapy are used for this purpose.
• Steroids: Occasionally, doctors may use corticosteroids such as dexamethasone or prednisone as part of your treatment. Steroids are different from chemotherapy, targeted therapy, and biologic therapy. They work to reduce inflammation throughout your body. Steroids are given as a pill, and are also active against myeloma cells.
• Radiation: Radiation uses high-dose X-rays to stop cancer cells from dividing. It is sometimes used to target myeloma in specific areas that may be causing you issues or pain. It is also used if there are tumors or deposits of myeloma cells that need to be treated, such as a plasmacytoma — a tumor made of abnormal plasma cells — of the bone.

Treating Relapsed/Refractory Multiple Myeloma

Sometimes the cancer can return, or relapse after treatment. If this happens, your doctor can put you on one of the treatments you’ve already tried again, try a new treatment, or recommend that you enroll in a clinical trial.

Recently, the FDA granted accelerated approval to iberdomide (ZENBEXUS), a first-in-class CELMoD (a newer type of targeted immune-boosting therapy) treatment, for adults with multiple myeloma who have already received at least one prior treatment. This new oral therapy is designed to help overcome resistance to earlier drugs like lenalidomide and pomalidomide, offering patients a promising next-generation option.

How will induction therapy make me feel? Dr. Shah gives you an overview of what to expect.

When multiple myeloma is considered under control, the maintenance phase of treatment, the goal is to keep the disease stable and maintain the patient’s quality of life.

Which type of maintenance therapy you get, and what prognosis you can expect, will depend on whether your doctor determines that your multiple myeloma is standard risk or high risk.

One of SurvivorNet’s experts describes the maintenance process for this disease as similar to lawn care. Once you care for your lawn and it’s no longer overgrown (that’s the initial treatment), it will need some tending, but with that attention (such as low doses of maintenance drugs), it can remain healthy.

Why the many phases of multiple myeloma are like caring for your lawn, says hematologic cancer specialist, Dr. Sid Ganguly