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:
There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:
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.
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:
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.
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:
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.
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.