Multiple myeloma is a type of cancer that occurs when an atypical plasma cell develops in the bone marrow and reproduces quickly. The rapid reproduction of cancerous, myeloma cells eventually overtakes the production of healthy cells in the bone marrow.
The cancerous myeloma cells produce atypical antibodies called monoclonal (M) proteins that can cause kidney damage and other serious health issues.
Multiple myeloma is rare. In the United States, the National Cancer Institute estimates that there will be
In this article, we take a look at the symptoms of multiple myeloma, along with what causes it and how it’s treated.
Types of multiple myeloma
There are two main types of multiple myeloma:
- Indolent myeloma. This type usually develops slowly without noticeable symptoms. It doesn’t cause bone tumors, only small increases in M protein and M plasma cells.
- Solitary plasmacytoma. This type causes a tumor to form, typically in the bone. It usually responds well to treatment, but it needs close monitoring.
The symptoms of multiple myeloma vary depending on the person. Initially, symptoms may not be noticeable. However, as the disease progresses, most people will experience at least one of four major types of symptoms.
These symptoms are generally referred to by the acronym CRAB, which stands for:
- C = calcium (elevated levels)
- R = renal failure
- A = anemia
- B = bone damage
What are the first signs of multiple myeloma?
- bone pain (particularly in your back or chest)
High levels of calcium symptoms
High levels of calcium in your blood come from affected bones leaking calcium. Too much calcium can cause:
Kidney failure symptoms
High levels of M protein in your body can cause kidney damage or failure. Potential symptoms of kidney damage or failure include:
- a reduced amount of urine
- swelling of your legs, ankles, and feet
- unexplained shortness of breath
- excessive drowsiness or fatigue
- persistent nausea
- pain or pressure in your chest
Anemia can occur when cancerous cells outnumber red blood cells in your bone marrow. Symptoms of anemia include:
Bone damage symptoms
Bone injuries and fractures occur when cancerous cells invade your bone and bone marrow. The lesions caused by the cancer cells can cause bone pain, especially in the:
Additional symptoms of multiple myeloma
Additional symptoms of multiple myeloma may include:
The exact cause of multiple myeloma is unknown. However, it starts with one atypical plasma cell that rapidly multiplies in the bone marrow.
The resulting cancerous myeloma cells don’t have a typical life cycle. Instead of multiplying and eventually dying, they continue dividing indefinitely. This can overwhelm your body and impair the production of healthy cells.
Risk factors for multiple myeloma
You may have a higher risk of developing multiple myeloma if you’re:
- over age 50
- African American
- overweight or have obesity
- exposed to radiation
- employed in the petroleum industry
Another risk factor for multiple myeloma is a history of monoclonal gammopathy of undetermined significance (MGUS). This is a condition that causes plasma cells to produce M proteins. It usually doesn’t cause any problems.
However, MGUS can sometimes develop into multiple myeloma over time.
Doctors often detect multiple myeloma before any symptoms are present. Routine physical exams, blood tests, and urine tests can uncover evidence of this cancer.
More tests will be needed if your doctor finds signs of myeloma when you don’t have symptoms. Using the following tests, your doctor can monitor the progression of the disease and determine whether you need treatment.
Blood and urine tests
Blood and urine tests are used to check for M proteins. These proteins may be caused by multiple myeloma or other conditions. Cancerous cells also make a protein called beta-2 microglobulin, which can be found in your blood. Blood tests can also be used to assess:
- the percentage of plasma cells in your bone marrow
- kidney function
- blood cell counts
- calcium levels
- uric acid levels
The following tests can be used to determine whether bones have been damaged by multiple myeloma:
During a biopsy, a doctor removes a small sample of bone marrow, which will be checked for cancerous cells in a laboratory. Various tests can determine the types of atypical characteristics in the cells and how quickly the cells are multiplying.
These types of tests are used to determine whether you have multiple myeloma or another plasma cell condition.
Other plasma cell disorders
- Monoclonal gammopathy of undetermined significance. MGUS causes your body to create extra M proteins. It’s usually not a cause for concern, but it does require monitoring as it increases the risk of blood and bone marrow diseases.
- Solitary plasmacytoma. This rare disorder is similar to multiple myeloma, but the plasma cells are located in a single tumor, rather than throughout your body. Radiation or surgery is typically used to destroy or remove the tumor.
- Light chain amyloidosis. This condition occurs when atypical amyloid proteins (called light chains) build up in organs such as the kidneys, heart, or liver. It isn’t curable, but treatments can slow production of the amyloid proteins.
- Waldenstrom macroglobulinemia. Waldenstrom’s disease is a rare cancer that occurs when your body produces too much of an antibody known as immunoglobulin M (IgM). This causes your blood to thicken, making it difficult for your organs to function properly. There is no cure, but treatment focuses on alleviating symptoms.
Staging of multiple myeloma
If multiple myeloma is found during diagnosis, doctors will then use certain tests to determine how far it’s progressed. This is known as staging the cancer. Tests look at:
- blood cell counts
- protein levels in blood and urine
- calcium levels in blood
There are two ways to stage multiple myeloma:
- Durie-Salmon Staging System. This is based on the levels of M protein, calcium, and red blood cells as well as the degree of bone damage.
- International Staging System. This is based on the levels of blood plasma and beta-2 microglobulin.
Both systems divide the condition into three stages, with the third stage being the most severe. Staging helps your doctor determine your outlook and treatment options.
There’s no cure for multiple myeloma. However, there are treatments that can help ease the pain, reduce complications, and slow the progression of the disease. Treatments are only used if the disease is getting worse.
Your doctor is unlikely to suggest treatment if you aren’t experiencing any symptoms. Instead, your doctor will closely monitor your condition for signs that the disease is progressing. This often involves regular blood and urine tests.
If you need treatment, common options include the following:
Targeted therapy medications block a chemical in myeloma cells that destroys proteins, causing the cancer cells to die.
The drugs that may be used during targeted therapy include bortezomib (Velcade) and carfilzomib (Kyprolis). Both are administered intravenously, or through a vein in your arm.
Biological therapy medications use your body’s immune system to attack myeloma cells. The pill form of thalidomide (Thalomid), lenalidomide (Revlimid), or pomalidomide (Pomalyst) is usually used to boost the immune system.
Lenalidomide is similar to thalidomide, but it has fewer side effects. It also appears to be more potent.
Chemotherapy is an aggressive form of drug therapy that helps kill fast-growing cells, including myeloma cells. Chemotherapy drugs are often given in high doses, especially before a stem cell transplant. The medications may be given intravenously or taken in pill form.
Corticosteroids, such as prednisone and dexamethasone, are often used to treat myeloma. They can balance the immune system by reducing inflammation in the body, so they’re often effective in destroying myeloma cells. They can be taken in pill form or given intravenously.
Radiation therapy uses strong beams of energy to damage myeloma cells and stop their growth. This type of treatment is sometimes used to kill myeloma cells quickly in a certain area of the body.
For example, it may be done when a cluster of atypical plasma cells form a tumor called a plasmacytoma that causes pain or destroys bone.
Stem cell transplants
Stem cell transplants involve replacing diseased bone marrow with healthy bone marrow. The healthy marrow comes from either a donor’s stem cells (allogenic) or your own stem cells (autologous).
Before the procedure, blood-forming stem cells are collected from the blood. The multiple myeloma is then treated with radiation therapy or high doses of chemotherapy.
Once the diseased tissue can be destroyed, the stem cells can be infused into your body, where they move into the bones and start rebuilding bone marrow.
Complementary medicine (also called integrative medicine) has become a popular way to cope with the symptoms of multiple myeloma and the side effects of treatment for the condition.
While these therapies can’t treat or cure multiple myeloma, they may help ease some of your symptoms.
Talk with your doctor about these therapies before trying them. You’ll want to make sure they’re right for you and your current health condition. Therapies might include:
Multiple myeloma can cause many complications, but they’re usually treatable:
- Back pain can be treated with medications or a back brace.
- Kidney complications are treated with dialysis or a kidney transplant.
- Infections can be treated with antibiotics.
- Bone loss can be slowed or prevented with drug therapy.
- Anemia can be treated with erythropoietin. This medication stimulates your body to produce more red blood cells.
If you’ve received a multiple myeloma diagnosis, you might find it helpful to do one or more of the following:
Learn more about multiple myeloma
Educate yourself by learning about multiple myeloma so you can make informed decisions about your treatment. Talk with your doctor about your treatment options and the side effects of treatment.
Establish a support system
Establish a support system by gathering a group of friends and family members who can lend a helping hand or emotional support when you need it. Support groups can also be helpful and may be found online.
If you prefer to meet with a support group in person, visit the
Set reasonable goals
Stay motivated by setting reasonable goals that give you a sense of control over your condition. Try not to set goals that are unattainable at the moment. Doing so can lead to exhaustion and frustration.
For example, you may not be able to work a full 40 hours per week, but you may still be able to work part time.
Focus on your overall health
Keeping your body and mind as healthy as possible can help you cope better with the stress and fatigue you may experience with cancer. To make sure you get enough time to rest and recover, try not to overload your schedule.
People who’ve recently received a diagnosis of multiple myeloma may not experience symptoms for several years. Once the disease has progressed and symptoms do occur, most people’s bodies respond well to treatment.
However, serious complications can develop, even after years of successful treatment.
An exact timetable for the disease is difficult to predict, but the
- Stage 1: 62 months, which is approximately 5 years
- Stage 2: 44 months, which is approximately 3 to 4 years
- Stage 3: 29 months, which is approximately 2 to 3 years
It’s important to keep in mind that these are general estimates based on previous outcomes of numerous people who’ve had multiple myeloma. Your specific outlook depends on various factors, including your age, overall health, and how well your cancer responds to treatment.
Talk with your doctor about your particular situation to learn more about your outlook.