Multiple Myeloma: Overview

Multiple Myeloma Overview

Multiple myeloma is a rare type of blood cancer. When you have this cancer, white blood cells called plasma cells (the cells that make antibodies to fight infections) in your bone marrow grow out of proportion to healthy cells. Those abnormal cells leave less room for the healthy blood cells your body needs to fight infections. They can also spread to other parts of your body and cause problems with organs like your kidneys.

Hematologist and SurvivorNet advisor, Dr. Nina Shah, helps you understand this rare cancer

SurvivorNet’s medical experts say that often, people are diagnosed with this cancer after going to their doctor seeking an answer for persistent tiredness or other unusual symptoms. Getting an answer to those symptoms might generate a whole new list of questions, like:

• What caused your cancer?
• How will your doctor treat you?
• What is your prognosis likely to be?

Read on to learn more about this cancer, and how your doctor will manage it.

What Increases Your Risk for Multiple Myeloma?

Certain factors increase your likelihood of getting multiple myeloma. Remember that this is a rare cancer overall, and just because you have any of these factors doesn’t mean you will get this cancer. Most likely, you won’t. Conversely, it’s possible to have no risk factors and still get multiple myeloma.

Here are a few factors that might increase your risk:

• Age. Most people with this cancer are diagnosed in their 60s, although it is possible to get multiple myeloma earlier in life.
• Family history. Having a sibling, parent, or other close relative with this cancer could increase your risk.
• Gender. Men are at slightly higher risk for this cancer than women.
• Race. African Americans tend to have higher rates of this disease, although it is still relatively rare. Asian Americans are least likely to get this cancer.
• Monoclonal gammopathy of undetermined significance (MGUS). This condition with the hard-to-pronounce name simply means that you have too much of an abnormal protein–called monoclonal protein–in your bone marrow and blood. MGUS is rare, and the risk that it will turn into multiple myeloma is only 1% each year.

Myeloma expert, Dr. Jens Hillengass, explains why multiple myeloma is more common in African American people

What are the 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.

Could I have multiple myeloma? Dr. Ravi Vij tells SurvivorNet what tests doctors use to find out for sure.

According to SurvivorNet’s experts, blood tests are also the way your doctor might learn that you have 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–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, depend on several factors, and on whether your treatment team thinks you are a good candidate for a bone marrow transplant.

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. Be sure to discuss this with your treating team to understand what is involved and what options are available.

If you’re not a good candidate for chemotherapy, your treatment options include targeted therapies, biologics, and steroids.

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.

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.

Any of these treatments can cause side effects, which may include nerve pain and fatigue. Your doctor can adjust your medication if you do have side effects. In general, you should start to feel better once your treatment starts to work.

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

Then you’ll reach the maintenance phase of treatment. Now that your doctor has gotten your cancer under control, from here the goal is to keep your disease stable and to maintain your 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.

Hematologist-oncologist Dr. Adam Cohen lays out your options during the maintenance phase of treatment

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

Sometimes this disease will return, even when you’re on maintenance therapies. You’ll still have treatments available if this happens.

Though it can be daunting to choose treatments for relapsed multiple myeloma, the medical experts at SurvivorNet are here to help you make sense of them. Remember that you do have options, and that the goal—which becomes more achievable with each new treatment that’s introduced—is to preserve your quality of life and extend your lifespan.