Multiple Myeloma
What is multiple myeloma?
Multiple myeloma is a cancer of plasma cells – a type of white blood cell in the bone marrow that makes antibodies. A cancerous or malignant plasma cell is called a myeloma cell.
Myeloma cells produce a large amount of a single type of antibody, called paraprotein, that can damage other organs. In addition, the accumulation of myeloma cells in the bone can stop healthy blood cells being made.
Multiple myeloma can appear as a tumour, an area of bone damage, or both. Bone damage is referred to as 'lesions'. Multiple myeloma affects the places where bone marrow is active in an adult.
Symptoms with multiple myeloma can vary, however, it’s important that when they do arise they are managed correctly. You can find a list of some of the most commonly experienced symptoms below, or visit the Managing Multiple Myeloma page for further information:
- Bone pain
- Nerve damage
- Fatigue
- Increased risk of infection
- Kidney damage
Remember, though, always talk to your doctor or nurse to get advice if you are experiencing symptoms, especially if there has been a sudden change.
Globally, multiple myeloma is the second most common form of blood cancer.
Multiple myeloma is most common in people aged over 65 years old.
There is a slightly higher prevalence of multiple myeloma in men than women.
Diagnosis and tests
There are a few ways to test for multiple myeloma.
Your condition may have been diagnosed through one or a combination of the following:
Blood test
Multiple myeloma is often discovered from a blood test. The main method to identify the condition is a type of analysis called 'protein electrophoresis'. This is done on the proteins in the blood. It can show whether there is an abnormal level of immunoglobulin (antibodies) in the blood, called M proteins. Higher than normal levels of M proteins suggest a sign of multiple myeloma, but this needs to be confirmed using bone marrow samples.
Urine test
Electrophoresis can also test your urine. This is because a part of the immunoglobulin can often be found there.
Imaging techniques
An X-ray of the bone can help to identify changes in the bone and if there are cavities in the bone (called bone lesions). Other, more sensitive imaging techniques may also be used to detect any tumours outside the bone marrow, like:
- magnetic resonance imaging (MRI)
- a computerised/computed tomography (CT) scan
- a positron emission tomography (PET) scan
Bone marrow analysis
Bone marrow can be analysed by:
- drawing a small amount of bone marrow fluid (aspiration)
- surgically removing a small amount of tissue (biopsy)
These tests can determine the presence and extent of cancerous cells in the bone marrow. The samples can also undergo 'cytogenetic testing', which may show genetic changes that would suggest a more aggressive disease and might be associated with worse prognosis.
Classifying and staging
You may have heard myeloma referred to as having different classifications and different stages. It’s important to note these are two different things, although both help to determine the most appropriate treatment for you.
Classification refers to the type of myeloma you have. This could be:
Classification monoclonal gammopathy of unknown significance (MGUS)
If you have MGUS it means that there is a very low level of M-protein in your bone marrow, but it has not caused you any symptoms or damaged any of your organs. MGUS is a benign condition – it doesn’t actually mean that you have cancer, but it is an early indicator; 20% of people with MGUS will progress to active myeloma. If you have MGUS your condition will be monitored but you won’t receive treatment for it.
Solitary plasmacytoma9
In rare cases, a single lesion (group of malignant myeloma cells) is seen. This is often in the bone, but without signs of bone marrow abnormalities. Various treatments are possible, but radiotherapy is often preferred.
Asymptomatic or smouldering/indolent myeloma
Smouldering multiple myeloma is an early precursor of active multiple myeloma (MM).10 People living with smouldering multiple myeloma tend not to show signs or symptoms typically associated with active myeloma, such as bone pain, bone fractures, kidney problems or anaemia.1011 Because smouldering multiple myeloma is asymptomatic, most people will have had it for some time before a diagnosis.12 Smouldering multiple myeloma is usually detected incidentally, when people undergo routine testing for other symptoms and results show elevated levels of protein in their blood or urine.13 Abnormal cells may also be detected in the bone marrow via biopsy.14
The standard approach following a smouldering multiple myeloma diagnosis continues to be observation to track the diseases for signs of biochemical progression and/or end organ damage, when treatment tends to be initiated, or enrollment in a clinical trial for certain patients.1415
You can learn more about SMM, here.
Active or symptomatic myeloma
Active or symptomatic myeloma means that as well as abnormal M proteins and malignant plasma cells that are present in your bone marrow, you have damage to your bones and various organs, for example the kidneys. If you have active or symptomatic myeloma, you will likely already be receiving one or more treatments that your doctor will have discussed with you.
Myeloma staging reflects the extent of the disease.
Staging is essential to set up appropriate treatment. The most common way to stage myeloma is by using the Revised International Staging System (R-ISS). It looks at the levels of specific blood proteins and takes into account individual genetic traits to classify myeloma at Stage 1, Stage 2 or Stage 3.
Remember, though, that your haematologist should be the first person you talk to about more specific queries.
To find out more information on Multiple Myeloma, download the ‘Understanding Multiple Myeloma and treatments’ booklet.
Understanding MM and treatment
If you have multiple myeloma, you may be have an increased risk of developing amyloidosis.14 You can learn more about AL amyloidosis, the most common form of this disease, here.