Your immune system is designed to protect you from disease, but sometimes it can become sick and harm you with little warning. That’s the case with multiple myeloma, an uncommon form of cancer that affects about 30,000 people each year in the United States.
Multiple myeloma is cancer of the immune system. It occurs in plasma cells, a type of white blood cell that is found in bone marrow—the spongy tissue inside our bones that makes blood.
Plasma cells are meant to help our bodies fight infection. However, when they become cancerous, they grow too much and produce an abnormal protein (known as “M protein” or “light chains”). The cells take over normal bone marrow, and the protein travels in the blood. The overgrowth of cells and excess protein can cause trouble, including damage to the kidneys and bones, infections and low blood counts, which can lead to other health problems.
UNC Health oncologist Sascha Tuchman, MD, MHS, shares what you need to know about the condition and treatment.
Who Is At Risk of Multiple Myeloma?
Anyone can get multiple myeloma. It doesn’t typically run in families and is not associated with common risk factors for other cancers, such as smoking.
“Most people who get multiple myeloma get it out of nowhere,” Dr. Tuchman says. “Most patients with multiple myeloma do not have any family members who have it, and the chance of an immediate family member also developing it is very low.”
However, research has shown the following factors can put you at a higher risk.
- Age: The risk goes up as you get older. The average age of diagnosis is about 70, Dr. Tuchman says. Multiple myeloma is rare in people younger than 40.
- Gender: Men are more likely to develop multiple myeloma than women.
- Race: Multiple myeloma is more common in African Americans than people of other ethnicities.
- Farmers: Researchers are studying whether farmers with long-term exposure to pesticides might be at a slightly elevated risk for multiple myeloma.
- Chemical exposure: People who have been exposed to radiation, asbestos or benzene may be at higher risk for multiple myeloma.
Symptoms of Multiple Myeloma
Symptoms of multiple myeloma usually don’t appear until the condition is advanced. They can include:
- Bone pain and bone fractures: Multiple myeloma chews away at bone over time, causing pain and fractures. Bone pain can occur anywhere but is most often in the back, hips and skull.
- High levels of calcium in the blood (called hypercalcemia): This can cause constipation, dehydration, abdominal pain, loss of appetite, kidney problems and kidney failure.
- Anemia (lack of healthy red blood cells): Multiple myeloma slows production of red blood cells, which are the cells that deliver oxygen from the lungs to the rest of the body. This can cause fatigue, shortness of breath, dizziness, appetite loss and weakness.
- Unexplained weight loss: Myeloma, like any cancer, can speed up metabolism and cause people to eat less because they feel bad.
If you notice any of these symptoms, reach out to your doctor as soon as possible. Most often people experiencing these symptoms will not turn out to have multiple myeloma, but the symptoms are nonetheless important to get checked out, Dr. Tuchman says.
Multiple myeloma is diagnosed through a bone marrow biopsy. Blood and urine tests can strongly suggest a diagnosis of multiple myeloma, but bone marrow biopsies are the gold standard for confirming the diagnosis and its severity.
Treatment for Multiple Myeloma
Medications for multiple myeloma can help treat symptoms and prolong life. However, there is no cure.
Still, “People often live comfortably for many years after diagnosis,” Dr. Tuchman says. “Twenty years ago, someone diagnosed with myeloma would often only live on average about two years after diagnosis. Now, it’s closer to 10 years thanks to advancements in treatment.”
Multiple myeloma is primarily treated with combinations of medications that attack myeloma in different ways and can come in pills or shots. Medications can include steroids, immunomodulatory drugs (drugs that stimulate a patient’s immune response), proteasome inhibitors and monoclonal antibodies.
Some of the newest approaches include immunotherapy, which equips your own immune system to fight the cancer. The two most developed techniques are chimeric antigen receptor (CAR) T-cell therapy and bispecific antibody drugs. Both turn on the body’s own T-cells (a type of white blood cell) to kill myeloma.
“The medicines we use to treat multiple myeloma nowadays usually cause more mild side effects than what people typically associate with treatment, such as hair loss and nausea,” Dr. Tuchman says. “That’s because multiple myeloma therapies are much more targeted, meaning they damage the multiple myeloma cells and largely spare normal cells.”
Immunotherapy is an exciting area of research because it has been shown to “control the disease for a meaningful length of time, even in patients who have advanced disease that’s resisting other medications,” he says.
Another option for treatment in some people is a stem cell transplant, in which the patient’s own healthy bone marrow stem cells are extracted and then put back into their blood after intensive chemotherapy treatment. If successful, the chemotherapy kills the cancer cells and the transplant replaces them with healthy, blood-forming cells.
Any of these treatments can result in remission, meaning the signs and symptoms of disease are under control, although none of these approaches, including transplant, typically cure multiple myeloma.
“Almost all patients who have multiple myeloma and get treated for it go into remission and can remain there for years,” Dr. Tuchman says.
Multiple Myeloma Can’t Be Prevented
Unfortunately, there’s not a way to prevent multiple myeloma. Some blood tests can screen for the M protein, which will tell you if you have precursor conditions to multiple myeloma, including smoldering myeloma, also called asymptomatic myeloma, or monoclonal gammopathy of undetermined significance (MGUS). Neither show symptoms other than M protein levels in the blood.
People with precursor conditions are monitored regularly to make sure the condition doesn’t evolve into multiple myeloma, also known as active myeloma. Only about 1 percent of people each year with MGUS eventually develop multiple myeloma. Smoldering myeloma is higher risk, meaning people who have it have a higher chance of developing multiple myeloma.
“While there is not a way to prevent multiple myeloma, treatment is steadily improving,” Dr. Tuchman says. “Life expectancy is only getting better because new tools and more targeted medications are coming out regularly, either through clinical studies or FDA approval. We will continue to research until we hopefully have a cure.”
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