Multiple Myeloma

Multiple myeloma is cancer of a type of white blood cell called a plasma cell. Plasma cells live in your bone marrow, where they make proteins that help your immune system fight infection.

Your bone marrow produces:

• Red blood cells, which carry oxygen
• White blood cells, which are part of your immune system, and
• Platelets, which help blood to clot

With multiple myeloma, your plasma cells, which are a type of white blood cells, grow out of control (become cancerous) and crowd your bone marrow so it can’t produce enough of these healthy cells. These cancerous cells are called myeloma cells.

With fewer red blood cells, you become anemic. With fewer healthy white blood cells, you may get life-threatening infections. All of these problems can affect your quality of life and eventually your life itself.

Myeloma cells produce abnormal proteins, called monoclonal or M-proteins, and free light chains. These proteins are toxic for your kidneys and can lead to kidney problems. If not treated promptly, some patients can suffer from irreversible kidney damage and become dialysis-dependent.

Myeloma cells also damage cells that keep your bones healthy by keeping them from rebuilding. This can lead to bone loss and fractures that don’t heal. As your bones degenerate, they release calcium into your blood, which causes fatigue, constipation, and confusion.

Beyond affecting a patient's bone marrow, myeloma can also form solid tumors call plasmacytomas. These tumors are often treated with radiation therapy.

The American Cancer Society estimates that about 36,000 people in the US will be diagnosed with multiple myeloma this year. It affects more men than women. This is considered a rare cancer.

Risk Factors

If you’re diagnosed with multiple myeloma, it’s not your fault. Risk factors for multiple myeloma are out of your control. They include:

• Age. Most cases of multiple myeloma are diagnosed in people age 65 and older. Only 2% of cases happen in people under 40.
• Race. Black people are twice as likely to get multiple myeloma as white people.
• Family history. A person is more likely to develop multiple myeloma if a close family member (i.e. parent, siblings, etc.) has the disease. However, most people do not have a family history of the disease.
• Plasmacytoma. People who’ve had this solid tumor have increased risk of developing multiple myeloma.
• Gender. Men have multiple myeloma slightly more often than women do.
• Radiation exposure. People who are exposed to high levels of radiation, such as what’s found at a malfunctioning nuclear power plan, have increased risk of multiple myeloma.
• Monoclonal gammopathy of unknown significance (MGUS). Patients with a monoclonal (M) protein in their blood but no other evidence of myeloma are diagnosed with MGUS. These patients have a slightly increased chance (1% per year) of developing multiple myeloma and need a lifelong follow up.

Symptoms

People with multiple myeloma may not have symptoms until the disease has advanced. At that point, they usually experience symptoms of hypercalcemia, which happens when your bones degenerate and release calcium into your bloodstream. Hypercalcemia affects your heart, kidneys, gastrointestinal tract, and brain. It can be reversed if it’s caught early. Those symptoms include:

• Constipation
• Fatigue
• Frequent urination
• Frequent thirst
• Muscle weakness
• Drowsiness or confusion

People with multiple myeloma may also experience bone pain, weight loss, repeated infections, fatigue and shortness of breath, leg weakness or numbness, back pain, rib pain, and broken bones, usually in the spine.

Some people with multiple myeloma may not have any symptoms. In these cases, myeloma protein is found in the blood or urine when tests are done for other purposes.

Screening and Diagnosis

Currently, there is no role of universal screening for multiple myeloma, but research is underway to determine whether screening general population improves survival. The diagnosis of multiple myeloma and related disorders involves multiple tests, which will depend on your unique case. Your primary care doctor may detect something abnormal in your routine blood test and request additional diagnostic testing. Here at the HICCC, we evaluate each patient individually and thoroughly, performing a comprehensive interview and examination. You may have one or several of the following tests:

• MRI (magnetic resonance imaging) test uses powerful magnetic fields to create detailed 3D pictures.
• CT (computed tomography) scan takes data from several X-ray images and converts them into pictures on a monitor. It can show tissues and blood vessels in addition to bones.
• Bone marrow aspiration or biopsy uses a needle to sample marrow fluid (aspiration) and/or solid bone marrow tissue (core biopsy). This sampling usually happens at the back of your hip after numbing the area. A pathologist will then examine the cells under a microscope for abnormalities.

In addition to these tests, we risk stratify each newly diagnosed patient based on the stage as well as the genomic characteristics of the disease.

Related Conditions

There are several other diseases related to multiple myeloma that we also evaluate:

• Solitary plasmacytoma
• MGUS (monoclonal gammopathy of undetermined significance)
• MGRS (monoclonal gammopathy of renal significance)
• Smoldering multiple myeloma
• Waldenstrom macroglobulinemia
• Primary (or AL) amyloidosis
• Light chain and heavy chain disease
• POEMS syndrome

Monoclonal Gammopathy of Unknown Significance (MGUS) and Smoldering Multiple Myeloma

These are premalignant clonal plasma cell disorders that are diagnosed incidentally in most patients. The disorders included in this category are called MGUS (monoclonal gammopathy of unknown significance) and smoldering multiple myeloma. In the majority of patients, these disorders are asymptomatic and do not require treatment. However, in some patients these disorders can lead to complications, including peripheral neuropathy and renal disorders called monoclonal gammopathy of renal significance (MGRS).

Monoclonal Gammopathy of Renal Significance (MGRS)

Our colleagues in Columbia University Renal Pathology have been leaders in describing and characterizing the renal disorders associated with MGUS and are a major referral center for renal biopsies done in the US. The management of patients presenting with these disorders can be challenging and requires a multidisciplinary approach. At the HICCC, we collaborate closely with nephrologists and renal pathologists to discuss our patients with these disorders, and we develop individually tailored and cutting-edge strategies to treat these disorders, and we develop individually tailored and cutting-edge strategies to treat these disorders.