Multiple Myeloma - Early Signs, Risk Factors, Diagnosis, and Treatment Explained

Multiple myeloma is a rare type of blood cancer that affects plasma cells in the bone marrow. Because it isn't very common, many people may hear about it for the first time only after a diagnosis. This guide explains what multiple myeloma is, its symptoms, how doctors diagnose it, and the treatments available---so you know what to expect at every step.

What Is Multiple Myeloma?

Multiple myeloma is a cancer that starts in a specific type of white blood cell called a plasma cell. Plasma cells are a crucial part of your immune system, and their job is to produce antibodies that help your body fight off infections. In multiple myeloma, the plasma cells become cancerous, multiply uncontrollably, and build up in the bone marrow, the soft, spongy tissue inside your bones where all blood cells are made.

These cancerous plasma cells crowd out healthy blood cells (red blood cells, white blood cells, and platelets), leading to a shortage of normal blood cells. They also produce large amounts of an abnormal protein called a monoclonal protein, or M protein, which can build up in the body and cause damage to organs, especially the kidneys. Myeloma cells also damage the bones, causing them to become weak and brittle.

While multiple myeloma is a serious condition, it is often manageable as a chronic disease. With the many advances in treatment, the prognosis for patients has improved dramatically, and many people can live for many years with a good quality of life.

Types of Multiple Myeloma

Multiple myeloma is not a single disease. It is a diverse group of cancers that are classified in several ways. The most common classification is based on the type of abnormal protein (M protein) produced by the cancerous plasma cells.

• Immunoglobulin G (IgG) Myeloma: This is the most common type, accounting for about 50% of all myeloma cases.
• Immunoglobulin A (IgA) Myeloma: This is the second most common type, making up about 20% of all cases.
• Light Chain Myeloma: In this type, the cancerous plasma cells only produce the small "light chain" part of the antibody. These proteins can collect in the kidneys and cause damage.
• Non-secretory Myeloma: This is a rare type of myeloma where the cancerous cells do not produce enough M proteins to be detected in blood or urine tests. A bone marrow biopsy is needed to diagnose this type.
• Other Rare Types: Other, very rare types of myeloma include Immunoglobulin D (IgD) and Immunoglobulin E (IgE) myeloma.

It's also important to understand the pre-cancerous and related conditions that can lead to multiple myeloma.

• Monoclonal Gammopathy of Undetermined Significance (MGUS): This is a benign (non-cancerous) condition where a small amount of M protein is found in the blood. MGUS doesn't cause any symptoms and is often found by chance. It is a very common condition, but in about 1% of cases per year, it can progress to multiple myeloma.
• Smoldering Multiple Myeloma (SMM): This is a pre-cancerous condition that is more advanced than MGUS but does not yet cause any symptoms or organ damage. People with SMM are at a much higher risk of developing active multiple myeloma and are often monitored closely.

What Are the Causes and Risk Factors for Multiple Myeloma?

The exact cause of multiple myeloma is unknown. It is not caused by a single factor, but rather a combination of genetic and environmental influences that lead to DNA mutations in the plasma cells.

Key Risk Factors:

• Age: The risk of developing multiple myeloma increases significantly with age. Most people are diagnosed in their late 60s, and it is very rare in people under 35.
• Gender: Men are slightly more likely to develop multiple myeloma than women.
• Race: Multiple myeloma is more than twice as common in Black people as it is in White people. The reason for this is not yet known.
• Family History: Having a sibling or a parent with multiple myeloma or MGUS increases your risk, but most people with myeloma have no family history of the disease.
• Having MGUS or Smoldering Myeloma: As these are pre-cancerous conditions, having them significantly increases your risk of developing active multiple myeloma.
• Excess Body Weight: Research suggests that being overweight or obese can increase a person's risk of developing myeloma.
• Exposure to Certain Chemicals or Radiation: People who have been exposed to high doses of radiation or to certain chemicals like Agent Orange have a higher risk of developing myeloma.

What Are the Symptoms of Multiple Myeloma?

In its earliest stages, multiple myeloma often does not cause any symptoms. It is frequently discovered by chance during routine blood tests for another condition. However, as the cancer progresses and damages the bones, kidneys, and blood, a person may experience a variety of symptoms.

Common Symptoms:

Doctors often use the acronym CRAB to remember the main signs of multiple myeloma:

• C - High Calcium Levels (Hypercalcemia): High calcium in the blood, caused by bone damage, can lead to confusion, mental fogginess, extreme thirst, and frequent urination.
• R - Kidney Problems (Renal Failure): The abnormal M proteins can build up in the kidneys and cause damage. This can lead to a feeling of weakness and swelling in the legs and feet.
• A - Anemia: The cancerous plasma cells crowd out healthy red blood cells, causing a low red blood cell count. This can lead to severe fatigue, weakness, and shortness of breath.
• B - Bone Damage: Myeloma cells can cause thinning and weakening of the bones, which can lead to bone pain (especially in the back, hips, or ribs), and an increased risk of fractures.

Other Common Symptoms:

• Frequent Infections: A shortage of healthy white blood cells can make you more susceptible to infections.
• Nausea and Constipation: Can be caused by high calcium levels.
• Unexplained Weight Loss

If you have any of these persistent symptoms, especially bone pain, it is important to see a doctor for a proper evaluation.

How Is Multiple Myeloma Diagnosed?

A diagnosis of multiple myeloma requires a series of tests to confirm the presence of cancer, determine its specific type, and see how it is affecting the body.

Diagnostic Steps and Tests:

1. Physical Exam and Blood Tests: The diagnosis often begins with a physical exam and a simple blood test. A complete blood count (CBC) can show a low red blood cell count. Blood tests can also check for high calcium levels and look for the presence of M proteins.

2. Urine Tests: A 24-hour urine collection is often done to check for M proteins (also called Bence Jones proteins) that the kidneys are trying to excrete.

3. Bone Marrow Aspiration and Biopsy: This is the most definitive test for multiple myeloma. A small sample of both liquid and solid bone marrow is removed, typically from the hip bone, and sent to a lab for examination. This test helps doctors confirm the diagnosis, determine the percentage of cancerous plasma cells, and look for any genetic changes.

4. Imaging Tests: Imaging scans are crucial for seeing how the cancer is affecting the bones.

• Skeletal Survey: A series of X-rays of all the major bones in the body.
• CT (Computed Tomography) Scan: A CT scan provides more detailed images of the bones and can find tumors that X-rays might miss.
• MRI (Magnetic Resonance Imaging) Scan: An MRI is particularly useful for looking at the spine and other bones to find tumors.
• PET (Positron Emission Tomography) Scan: A PET scan can help find cancer cells throughout the body and see how active the disease is.

Staging and Grading of Multiple Myeloma

Multiple myeloma is staged to help doctors predict the patient's prognosis and choose the best treatment. The Revised International Staging System (R-ISS) is the most common system. It is based on three factors from blood tests and whether the cancer cells have certain high-risk genetic features.

• Stage I: The myeloma is low-risk and growing slowly.
• Stage II: The myeloma is intermediate-risk.
• Stage III: The myeloma is high-risk and growing quickly.

In addition to this staging system, doctors also classify myeloma as either smoldering (asymptomatic), meaning there are no symptoms or organ damage, or symptomatic, meaning the myeloma is causing problems in the body.

What Are the Treatment Options for Multiple Myeloma?

The treatment for multiple myeloma is highly personalized and depends on the stage, the specific genetic features, and the patient's age and overall health. A key aspect of myeloma treatment is that for smoldering myeloma, the standard approach is often to "watch and wait" until symptoms appear.

1. Medical Treatment (Chemotherapy, Targeted Therapy, Immunotherapy)

• Chemotherapy: Chemotherapy uses powerful drugs to kill cancer cells throughout the body. It is a standard part of the treatment for myeloma.
• Targeted Therapy: These drugs have revolutionized myeloma treatment. They are designed to target specific proteins that help the cancerous plasma cells grow and survive. Examples include proteasome inhibitors (like bortezomib) and immunomodulatory drugs (like lenalidomide).
• Immunotherapy: Immunotherapy helps a patient's own immune system recognize and attack cancer cells. These drugs, such as monoclonal antibodies (like daratumumab), have become a standard part of myeloma treatment.
• Stem Cell Transplant (Bone Marrow Transplant): A stem cell transplant is a high-dose treatment that can be a very effective part of a myeloma treatment plan. It involves giving the patient high-dose chemotherapy to destroy the cancerous bone marrow and then replacing it with healthy, blood-forming stem cells. This is usually done with the patient's own stem cells (autologous transplant) and is often used to get the patient into a long-lasting remission.

2. Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells in a specific area. It is not used as a primary treatment for widespread myeloma but is a valuable tool for:

• Relieving severe bone pain caused by a tumor in a bone.
• Shrinking a tumor that is pressing on a nerve, such as in the spine.
• Treating a single tumor (solitary plasmacytoma).

3. Surgery

Surgery is not used to treat multiple myeloma. However, a surgeon may be needed to repair a bone fracture caused by the disease.

Prognosis and Survival Rates for Multiple Myeloma

The prognosis (the likely outcome of the disease) for multiple myeloma has improved dramatically in the past two decades. With modern treatments, it is now considered a manageable chronic disease. The prognosis depends on the stage of the cancer and the specific genetic features of the myeloma cells.

• Prognostic Factors: The most important factors affecting prognosis are the stage of the cancer, the patient's age and overall health, and the presence of high-risk genetic features.
• Survival Rates: The overall 5-year survival rate for multiple myeloma has been steadily improving and is now around 62%. However, these numbers can be misleading. For many patients, the disease is a chronic condition that can be managed for many years with a good quality of life.

It is important to discuss your specific prognosis with your hematologist (a doctor who specializes in blood diseases), as they can provide a more accurate picture based on your individual case.

Screening and Prevention of Multiple Myeloma

There are no routine screening tests for multiple myeloma in the general population. The best way to reduce your risk is to live a healthy lifestyle and be aware of the symptoms.

Prevention Strategies:

• Since the causes are not fully known, there are no specific prevention strategies.
• If you have been diagnosed with MGUS or smoldering myeloma, your doctor will monitor you closely to check for any signs of progression.

For International Patients: Your Seamless Journey to Apollo Hospitals

Apollo Hospitals is a leading medical destination for international patients seeking high-quality and affordable cancer care. Our dedicated International Patient Services team is here to ensure your entire experience is as smooth and comfortable as possible, from your initial inquiry to your return home. We have extensive experience treating patients with multiple myeloma from around the world.

Our Services for International Patients Include:

• Travel and Visa Assistance: We will provide you with a visa invitation letter and help with travel arrangements.
• Airport Transfers: We will arrange for a car to pick you up from the airport.
• Personalized Care: A dedicated patient coordinator will be your single point of contact, assisting with hospital admission, language interpretation, and any other needs you may have.
• Accommodation: We can assist you with booking suitable accommodation for you and your family near the hospital.
• Post-Treatment Follow-up: We will stay in touch with you after your return home to ensure a smooth recovery.

Frequently Asked Questions (FAQs) About Multiple Myeloma

Q1: Is Multiple Myeloma curable?

A: With current treatments, multiple myeloma is generally not considered curable, but it is highly treatable. The goal of treatment is to manage the disease as a chronic condition, allowing patients to live a long, healthy life.

Q2: What is the survival rate for Multiple Myeloma?

A: The survival rate for multiple myeloma has improved significantly. The overall 5-year survival rate is now around 62%. However, many patients live much longer than five years, with the disease being managed like a chronic illness. Your doctor can provide a more accurate prognosis based on your specific case.

Q3: What are the side effects of Multiple Myeloma treatment?

A: Side effects vary with the type of treatment. Chemotherapy can cause fatigue, nausea, and a weakened immune system. Targeted therapies often have different side effects, such as nerve damage or a rash. A stem cell transplant has the most significant side effects. Your medical team will work closely with you to manage these side effects.

Q4: Can Multiple Myeloma come back (recurrence)?

A: Yes, multiple myeloma is a relapsing and remitting disease, meaning it is expected to come back after a period of remission. This is why regular follow-up appointments and continued monitoring are crucial.

Q5: What is the typical recovery time after a stem cell transplant?

A: The recovery time from a stem cell transplant is much longer than for other treatments. You may need to stay in the hospital for a few weeks, and a full recovery can take several months or more. Your medical team will provide a detailed recovery plan.

Q6: Can a person with multiple myeloma live a normal life?

A: Yes. With modern therapies, many people with multiple myeloma can live a completely normal life, with few or no limitations. The goal of treatment is to control the disease, allowing you to maintain your quality of life.