Multiple myeloma is a rare type of cancer that affects the bone marrow and alters your blood’s plasma cells. Plasma cells are a type of white blood cell and are responsible for recognizing foreign infections and making antibodies to fight them.

Multiple myeloma plasma cells

Plasma cells live in your bone marrow, the soft tissue that fills hollow bones. In addition to plasma cells, bone marrow is also responsible for producing other healthy blood cells.

Multiple myeloma leads to an accumulation of cancer cells in your bone marrow. Eventually, the cancer cells overtake healthy blood cells, and your body becomes unable to produce disease-fighting antibodies. Instead, it creates harmful proteins that damage your kidneys and cause other signs and symptoms.

Knowing the most common signs and symptoms of multiple myeloma may help you detect it before it becomes advanced. Make an appointment with your doctor if you notice any of the potential warning signs.

While doctors are still unsure of the exact cause of multiple myeloma, they do know it involves changes in the genes that are in charge of plasma cell growth and division. According to the American Cancer Society, the most common genetic mutations are in:

  • oncogenes such as MYC and RAS
  • tumor suppressor genes such as p53 genes
  • deletion of chromosome number 17

Dendritic cells in bone marrow can also contribute to multiple myeloma. They release a hormone called interleukin-6 (IL-6) to stimulate cell growth in plasma cells. However, overproduction of IL-6 can promote abnormal cell growth and an increased risk for plasma cell tumors.

Signs and symptoms of multiple myeloma aren’t always easy to detect. You may not experience early symptoms of multiple myeloma. As the cancer advances, symptoms vary greatly.

The most common signs and symptoms of multiple myeloma include:

  • Fatigue. Healthy cells allow your body to fight invading germs easily. As myeloma cells replace bone marrow, your body has to work much harder with fewer disease-fighting cells, and you tire more easily.
  • Bone problems. Myeloma can prevent your body from making new bone cells, causing problems like bone pain, weakened bones, and broken bones.
  • Kidney problems. Myeloma cells produce harmful proteins that can cause kidney damage and even failure.
  • Low blood counts. Myeloma cells crowd out healthy blood cells, leading to low red blood counts (anemia) and low white blood cells (leukopenia). Unhealthy blood cell levels make it harder to fight infections.
  • Frequent infections. Fewer antibodies in your blood make fighting infections more difficult.

Other common signs and symptoms of multiple myeloma include:

If your doctor suspects cancer, they may order several tests such as a CT scan, MRI scan, or a bone X-ray to confirm its presence. Doctors diagnose multiple myeloma when there is evidence of a plasma cell tumor or a minimum of 10 percent of plasma cells in the bone marrow. Doctors also need to find at least one of the following symptoms:

  • high blood calcium levels
  • poor kidney function
  • low red blood cell counts, known as anemia
  • tumor with holes in the bones
  • 60 percent or more plasma cells in the bone marrow
  • increased or elevated levels of light chains

One of the first tools for diagnosing multiple myeloma is performing lab tests, such as blood and urine tests. These can include:

  • complete blood counts
  • blood chemistry tests
  • different types of urine tests
  • quantitative immunoglobulins
  • electrophoresis
  • serum free light chains
  • beta-2 microglobuin

Unlike blood tests that take a liquid sample, a biopsy takes a tissue sample from the tumor, lymph node, or bone marrow. Common biopsies to diagnose multiple myeloma are:

  • bone marrow biopsy
  • fine needle aspiration biopsy
  • core needle biopsy

Once your doctor has confirmed a diagnosis of multiple myeloma, the next step is to see how far it has spread in the body. Multiple myeloma is categorized into three different stages and each stage can determine a person’s survival rate and treatment options.

A person in Stage I will have:

  • Serum beta-2 microglobulin less than 3.5 milligrams/liters (mg/L)
  • Albumin level equal to or greater than 3.5 grams/deciliters (g/dL)
  • Bone marrow tests do not classify a patient as high risk
  • Normal LDH levels

Doctors may classify you as Stage II if you do not fall into the criteria for stage I or stage III.

A person in Stage III will have:

  • Serum beta-2 microglobulin equal to or greater than 5.5 (mg/L)
  • Bone marrow tests classify a patient as high risk
  • High LDH levels

Unlike healthy, normal cells, cancer cells don’t mature and function properly, or undergo apoptosis (meaning they die away when they are no longer needed). Instead, they live and accumulate. In the case of multiple myeloma, cancer cells rapidly multiply and eventually overwhelm bone marrow.

The production of cancer cells outpaces the production of healthy blood cells, and the cancer cells crowd out the healthy ones. This leads to anemia, fatigue, and frequent infections.

Instead of producing helpful antibodies like normal plasma cells, myeloma cancer cells produce abnormal and harmful antibodies. Your body can’t use these antibodies, called monoclonal proteins, or M proteins. Over time, these proteins build up in your body and can damage your kidneys.

Several factors increase your risk for developing multiple myeloma, including:

  • Age. Risk increases with age. Most people who receive a diagnosis for this disease are in their mid-60s. According to the American Cancer Society, less than 1 percent of people diagnosed with multiple myeloma are younger than 35.
  • Race. African Americans are twice as likely to develop this type of cancer as Caucasians.
  • Sex. Men are more likely to develop multiple myeloma than women.
  • Family history. If you have a sibling or a parent with myeloma, you’re more likely to be diagnosed than someone without a family history of the cancer. However, family history only accounts for a small number of myeloma cases.
  • Obesity. Research shows that obesity during early and late adulthood increases the risk of multiple myeloma.
  • MGUS. In almost all cases, multiple myeloma begins as a benign condition called monoclonal gammopathy of undetermined significance (MGUS), with low levels of monoclonal proteins, or M proteins.

As multiple myeloma advances, it can sometimes cause complications, including:

  • Frequent infections. As myeloma cells crowd out healthy plasma cells, your body becomes less able to fight infections.
  • Anemia. Normal blood cells will be pushed out of your bone marrow and replaced by cancer cells, which can lead to anemia and other blood problems.
  • Bone problems. Bone pain, weakened bones, and broken bones are all common complications of multiple myeloma.
  • Reduced kidney function. M proteins are harmful antibodies produced by the myeloma cancer cells. They can damage your kidneys, cause problems with kidney function, and eventually lead to kidney failure. In addition, damaged and eroding bones can increase your blood’s calcium levels. These higher calcium levels can interfere with your kidneys’ ability to filter waste.

Multiple myeloma is typically not curable and patients often need many treatments over the course of their illness, especially as some treatments may stop working and new ones will need to be engaged. There are multiple drug therapies available to manage symptoms, eliminate multiple myeloma cells, and slow the spread of the cancer. If you have multiple myeloma, your doctor may offer you one or more of the following treatments:

  • Proteasome inhibitors. Destroys cancer cells by preventing them from removing old proteins.
  • Immunomodulatory drugs. Activates immune cells to better detect and dispose of myeloma cells.
  • Histone deacetylase inhibitors (HDAC). Drugs that suppress the cell cycle and stop cancer cells from growing and dividing.
  • Monoclonal antibodies. Boost your immune system by bringing in antibodies that target specific proteins on myeloma cells.
  • Chemotherapy. Drugs with powerful chemicals that destroy rapidly growing and dividing cells.
  • Radiation therapy. High-energy particles are administered to the body or a specific bone area to injure cancer cells and stop them from growing.
  • CAR-T therapy. Used for relapsed or refractory myeloma.

Steroids are another common treatment for patients with multiple myeloma. They help to manage pain and pressure by decreasing inflammation. Steroids also work to reduce side effects from chemotherapy such as nausea and vomiting. Dexamethasone and prednisone are two prescribed steroids that at high doses can reduce the number of myeloma cells.

To better manage multiple myeloma symptoms such as kidney failure, your doctor may add supportive care drugs to your treatment regimen.

Every patient is different, as is their outlook and how the disease will ultimately affect them. You should always be aware of any persistent and unexplained symptom, even minor ones. In many cases, these unusual signs or symptoms can easily be explained. However, if unusual symptoms persist, see your doctor.

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