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Myeloma, also known as multiple myeloma, is a cancer of the bone marrow which affects the plasma cells, a type of blood cell.
Normally, new plasma cells are produced to replace old, worn-out cells in an orderly and controlled way. They produce antibodies, also called immunoglobulins, to help fight infection.
However, in myeloma, the process becomes out of control and large amounts of abnormal plasma cells are produced releasing only one type of abnormal antibody. This is known as paraprotein or M protein – which has no useful function and can’t fight infection effectively.
The abnormal plasma cells release chemicals that impair the normal breakdown and remodeling of bone and this can cause bone thinning, which in turn causes pain and sometimes fractures. An area of damaged bone is known as a lytic lesion.
The production of paraprotein and M protein can also cause damage to the kidneys (renal impairment) which in some cases can be enough to require kidney dialysis. Kidney impairment and the level of myeloma cells in the bone marrow also impair the production of red blood cells causing anaemia.
There are several types of myeloma which are classified depending on the type of immunoglobulin (Ig) produced by the myeloma cells. Around 1 in 3 people have a type of myeloma that produces light chains only. This is called light chain or Bence Jones myeloma. A rare type of myeloma, non-secretory myeloma, produces little or no immunoglobulin.
The type of myeloma you have doesn’t usually affect the treatment you’re offered but it can influence how the disease will affect you.
There are some other conditions that affect the plasma cells and can sometimes develop into myeloma.
The two most common are MGUS (monoclonal gammopathy of unknown significance) and smouldering myeloma, which is also known as indolent or asymptomatic myeloma. MGUS is a non-cancerous condition that has a small risk of developing into myeloma. Smouldering myeloma is when you have enough myeloma cells in the bone marrow to signify myeloma but these cells are not affecting other parts of your body like kidneys, bones or bone marrow function.
If you’re diagnosed with either of these conditions, you’ll be monitored with blood tests, but may not need to have any treatment unless the condition progresses.
Around 4,800 people in the UK are diagnosed with myeloma each year. No single cause has been identified. However, there are a number of risk factors which can increase the risk of developing it including:
Many people do not have any signs and symptoms in the early stages of the disease and myeloma is often diagnosed following a routine blood test. Symptoms occur because of a build-up of abnormal plasma cells in the bone marrow, and by the presence of the paraprotein in the blood.
The most common symptom of myeloma is bone pain, especially in the spine but other bones may be affected such as the ribs, skull or pelvis.
Other symptoms include:
If you have any of these symptoms, it’s important to see your doctor as soon as possible. But remember, these symptoms can also occur in other conditions and most people with these symptoms won’t have myeloma.
Myeloma can only be diagnosed by laboratory tests. Initially you will see your GP who will arrange for blood tests or x-rays that may be necessary.
Your doctor will then refer you to hospital and to see a haematologist for further tests and for specialist advice and treatment.
Tests used in the diagnosis of myeloma include:
Blood tests are an important way to diagnose and monitor myeloma and can investigate the following:
Bone marrow biopsy
If there are paraproteins in your blood or urine, your doctor will take a sample of bone marrow (a biopsy) from the back of your hipbone (pelvis) or, sometimes (but rarely), the breast bone. The doctor will then take a small core of marrow from the bone (trephine biopsy). It’s then examined to see if it contains any myeloma cells.
In myeloma, there may be changes in the structure of the chromosomes within the myeloma cells, but not in the normal cells of the body. Cytogentic tests on the bone marrow samples will look for changes in these chromosomes and can help to decide on the best treatment and predict how well the myeloma may respond to that treatment. Not all centres do this test routinely so please ask your haematologist.
X-rays and scans
X-rays will be taken to check for any possible damage to the bones from the myeloma cells (lytic lesions). The x-rays are done by a skeletal survey that involves up to 20 plain x-rays. It is now also becoming routine for an MRI or CT scan to be performed at diagnosis.
Knowing the stage of the myeloma can help doctors plan the most appropriate treatment for you.
A commonly used staging system for myeloma is the International Staging System (ISS). This system looks at the levels of the blood proteins beta-2 microglobulin and albumin.
Stage 1 - The beta-2 microglobulin level is less than 3.5 milligrams per deciliter (3.5mg/dL) and the albumin level is greater than or equal to 3.5g/dL. This is early-stage myeloma.
Stage 2 - Neither stage 1 or 3. This is intermediate-stage myeloma.
Stage 3 - The beta-2 microglobulin level is greater than or equal to 5.5 mg/dL. This is advanced myeloma.
If the myeloma has been diagnosed at an early stage and is a slower progressing myeloma such as asymptomatic or smouldering myeloma, you may not need treatment straight away. This is called watch and wait or active monitoring. You will see your doctor every few months who will monitor your progress and they will take blood samples and do other tests. Treatment will be started if the myeloma begins to get worse or if symptoms occur.
However, if you do require treatment, this is aimed at disease control, relieving the complications and symptoms it causes, and extending and improving the quality of patients’ lives.
Myeloma treatment is almost always with a combination of drugs over periods of time known as cycles which may last from weeks to months.
Treatment combinations are usually made up of two or three different types of drugs which work well together and can include chemotherapy drugs, steroids and other types of anti-myeloma drugs.
Commonly used initial treatment combinations for myeloma include:
The treatment choice is usually dependent on your suitability for stem cell transplant and also your own choice, you may not want to receive injections (bortezomib).
After receiving an initial course of treatment, you may be suitable to go on and have a stem cell transplant.
You may also be prescribed other treatment to help prevent or manage potential side-effects of treatment such as bone pain (pain killers) and anaemia (blood transfusions). It is also routine practice for newly diagnosed patients to be started on intravenous (into the vein) zoledronic acid (Zometa). This is a bisphosphonate which aids in bone repair and strengthening.
Last reviewed: June 2016
Next planned review: June 2018