Myeloma is a type of cancer that develops from plasma cells in the bone marrow. Myeloma is often called multiple myeloma because most people (90%) have multiple bone lesions at the time it is diagnosed.
Plasma cells are a type of white blood cell found in the bone marrow. They are part of the immune system and help fight infection. When cancerous, these abnormal plasma cells spread throughout the bone marrow so that there is not enough space to make enough normal blood cells.
Bone marrow is found in multiple areas of the body including the spine, skull, shoulders, ribs and pelvis.
The symptoms of myeloma can include:
- bone pain or a broken bone without an obvious injury
- frequent infections or an infection that is difficult to overcome
- tiredness, shortness of breath or a racing heart
- kidney problems
- heavy nosebleeds or easy bruising
- feeling sick, drowsy or confused
- abnormal blood counts.
Causes of myeloma
There are no known causes of myeloma. It is not hereditary, so it is rare for more than one person in a family to be affected.
Certain chemicals, radiation and viruses (such as HIV) have been linked to an increased risk of myeloma.
Screening for myeloma
There is no screening for myeloma available.
Diagnosis for myeloma
If your doctor suspects you may have myeloma, you will have one or more of the following tests:
Blood and urine tests
There are a number of blood and urine tests used to diagnose myeloma. The main blood test measures the amount and type of paraprotein in the blood. Paraprotein is an abnormal antibody that myeloma cells produce.
Urine tests can check for the presence of Bence Jones protein, which is paraprotein in the urine.
X-rays are usually taken of the head, spine, ribs, hops, legs and arms to see if there is any bone damage caused by myeloma cells.
A CT scan produces three-dimensional images to see a part of the body in more detail, or to look for areas of bone damage that may not appear on an X-ray.
An MRI scan may be used as it can sometimes find myeloma in the bones and outside the bones. Less commonly used scans include FDG/PET and Sestamibi scans.
Bone marrow biopsy
A bone marrow aspirate and trephine biopsy is used to examine cells from the marrow. It is usually done with a local anaesthetic. A thin needle is used to remove a sample of bone marrow to examine under a microscope.
Using the bone marrow biopsy, cytogenetic tests look for changes in the chromosomes within the myeloma cells, which are different to the normal cells in the body. This can help determine treatment options.
Treatment for myeloma
Active monitoring, which involves regular check-ups, is most often used for early-stage myeloma, when it is considered that immediate treatment will not affect prognosis.
Treatments to control myeloma
Initial treatment usually includes a combination of chemotherapy and other drugs such as thalidomide and steroids.
Chemotherapy aims to kill cancer cells, and it can be administered as tablets, injected into a vein (intravenously) or under the skin (subcutaneously).
Thalidomide works by blocking the blood supply to cancerous cells and by stimulating the body’s immune system to attack myeloma cells. It is taken in tablet form. A relatively new drug called lenalidomide works in a similar way, and is commonly used for people with relapsed myeloma.
Bortezomib, a drug that blocks the breakdown of protein within myeloma cells, causing them to stop growing and die, may also be used as a treatment for myeloma.
Steroids (corticosteroids) can be used to modify the body’s immune system responses, relieve swelling and inflammation and actively kill myeloma cells. Corticosteroids are usually taken as tablets, and can be given on their own, or more commonly, with chemotherapy or other anti-myeloma drugs.
Bisphosphonate drugs are used to reduce bone pain and prevent further bone weakness or damage caused by myeloma cells. They also prevent dangerous rises in blood calcium levels.
Radiotherapy, the use of x-rays to kill or injure cancer cells, can be used to relieve some of the symptoms of multiple myeloma, such as bone pain.
Plasma exchange may be used if the level of paraprotein in the blood is very high and interfering with blood circulation. It is a way of removing some extra proteins in the blood. The blood is removed via a needle in a vein in one arm, passing through a separating machine, which then puts the healthy portion of the blood combined with new replacement plasma back into a vein in the other arm.
Stem cell transplant
Stem cell transplant involves a high dose of chemotherapy to destroy the bone marrow, followed by transplanted blood-forming stem cells to rescue the bone marrow and help restore the blood cell numbers. This is an intense form of treatment which is completed in several stages. The entire procedure can take several months to complete and it is not suitable for everyone.
Most people who undergo a stem cell transplant receive their own previously collected stem cells (autologous transplant). Sometimes stem cells from another person are used (allogeneic transplant).
Although it is most often used by people with advanced cancer, palliative treatment can be used at any stage of cancer treatment. It is intended to improve a person’s quality of life by alleviating the symptoms of cancer, without trying to cure the disease. It can include pain relief, and the management of other physical and emotional symptoms.
Depending on your treatment, your treatment team may consist of a number of different specialist staff, such as the:
- haematologist, who specialises in diagnosing and treating diseases of the blood, the lymphatics and bone marrow
- radiation oncologist, who prescribes and coordinates the course of radiotherapy
- nurses, who help administer chemotherapy and provide care, information and support throughout your treatment
- pain management team, who treat pain, particularly if it is difficult to control or severe
- dietitian, who recommends eating plans during treatment and recovery
- other allied health professionals, such as social workers, physiotherapists and counsellors.
Treatment if the disease comes back (relapse)
If there is a relapse and the myeloma returns, you may be offered a different type of chemotherapy or other drugs to regain control of the disease. If suitable, you may be considered for a stem cell transplant.
Prognosis for myeloma
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of myeloma you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Treatment for myeloma is constantly improving and it can help control the disease, manage the symptoms and improve quality of life, but currently cannot cure it. When the myeloma is under control, people usually return to a state of good health, which may last for several months or years before further treatment is needed.
People diagnosed with myeloma have a five year survival rate of 43%.
There is no known cause for myeloma, however certain chemicals (e.g. dioxins), radiation and viruses (such as HIV) have been linked to an increased risk of myeloma and related diseases