Multiple Myeloma: Symptoms, Causes & Treatment

Multiple myeloma is a cancer that affects plasma cells, which are cells that help produce antibodies. When these cells are affected, the immune system can become weaker, causing symptoms such as frequent infections or excessive tiredness.

This type of cancer is uncommon and occurs more often in older adults. It does not have one known cause, but it appears to result from genetic changes that affect how bone marrow cells function.

Treatment for multiple myeloma is guided by an oncologist or hematologist-oncologist. It depends on the stage of the disease, symptoms, and overall health, and may include regular monitoring, chemotherapy, immunotherapy, targeted therapy, or CAR T-cell therapy, for example.

Multiple myeloma symptoms

The main symptoms of multiple myeloma are:

• Excessive tiredness

• Frequent infections

• Weakness or drowsiness

• Purple marks on the skin

• Difficulty breathing

• Nausea, vomiting, or constipation

• Loss of appetite or unexplained weight loss

Other symptoms may include frequent urination, confusion, and bone pain, especially in the hips and ribs.

According to the American Cancer Society, some people with multiple myeloma have no signs or symptoms, although the disease can cause problems such as bone pain, weakness, infections, and low blood counts as it progresses.

When signs appear that may suggest multiple myeloma, it is important to see a primary care provider or geriatrician for an initial evaluation and referral to a hematologist-oncologist, who can confirm the diagnosis and guide the most appropriate treatment.

Confirming a diagnosis

Multiple myeloma may first be suspected by a primary care doctor or geriatrician based on symptoms, a physical exam, and laboratory tests.

After the diagnosis is confirmed, the person is referred to a hematologist-oncologist to start treatment based on the stage of the cancer and their overall health.

Main tests

The main tests for multiple myeloma are:

• Complete blood count (CBC) and urine tests

• Blood calcium levels, electrolytes, albumin, and blood urea nitrogen (BUN)

• Protein electrophoresis, to identify the presence of M protein

• Blood immunoglobulin levels

• Bone marrow biopsy and bone marrow aspirate

In some cases, imaging tests may also be recommended, such as X-rays, CT scans, PET scans, and MRI scans, to check for bone changes.

Possible causes

The exact cause of multiple myeloma is not fully understood, but it is known to result from genetic changes.

These changes cause plasma cells to multiply clonally, meaning they produce many identical abnormal cells within the bone marrow, which can disrupt normal bone marrow function.

Multiple myeloma cells also produce abnormal antibodies called M proteins. These proteins can accumulate in the body and may lead to kidney problems.

Risk factors

The main factors that increase the risk of multiple myeloma are:

• Family history of multiple myeloma

• Personal history of monoclonal gammopathy of undetermined significance

• Age greater than 60

• Male sex

• Obesity

• Alcohol consumption

In addition, exposure to radiation, insecticides, or organic solvents can also increase the risk of multiple myeloma.

Treatment options

Treatment for multiple myeloma should be guided by an oncologist or hematologist-oncologist. According to the National Cancer Institute, treatment depends on factors such as whether the disease is newly diagnosed or has come back, whether symptoms are present, the stage of the disease, age, and overall health.

The main treatments for multiple myeloma are:

1. Active surveillance

In the early stage of multiple myeloma, when there are no symptoms, treatment may not be needed. In this case, regular monitoring of the cancer may be recommended.

This means having regular medical appointments and tests to evaluate how multiple myeloma is progressing.

In these cases, the doctor may also recommend collecting a small amount of the person’s own bone marrow, which may be used later if symptoms appear.

2. Chemotherapy

Chemotherapy for multiple myeloma is recommended when symptoms are already present or when myeloma is in a more advanced stage.

This type of treatment is done with a combination of anti-cancer medications, immunomodulatory drugs, and corticosteroids, such as bortezomib, lenalidomide, and dexamethasone, to stop plasma cells from multiplying.

In addition, the doctor may recommend pain relievers to help relieve pain and other medications, such as bisphosphonates, to treat bone problems.

2. Radiation therapy

Radiation therapy for multiple myeloma may be recommended by the doctor to relieve bone pain caused by the tumor.

This type of treatment may be done together with chemotherapy.

3. Stem cell transplant

A stem cell transplant may be recommended in some cases to replace bone marrow cells that have been destroyed.

Before a stem cell transplant is performed, healthy bone marrow cells are collected from the person. Then, high-dose chemotherapy is given to destroy the diseased bone marrow.

After this, the bone marrow cells are infused into the person’s bloodstream, restoring normal bone marrow function and helping keep the cancer in remission for longer.

4. Gene therapy

Gene therapy for multiple myeloma may be recommended in refractory cases, meaning when other treatments have not been effective.

This type of treatment, called CAR T-cell therapy, is done by removing leukocytes, which are white blood cells, from the person and then reprogramming them in a laboratory.

This allows tumor cells to be more easily recognized and eliminated from the body by the immune system.

Is multiple myeloma curable?

Multiple myeloma cannot be cured. However, with proper treatment guided by a hematologist, it is possible to stabilize the disease for several years, relieve symptoms, and improve quality of life.