Multiple Myeloma



Cancer starts when cells begin to grow out of control. Cells in nearly any part of the body can become cancer and can spread to other areas. Multiple myeloma is a type of blood cancer that affects plasma cells. In multiple myeloma, malignant plasma cells accumulate in bone marrow — the soft, spongy tissue at the center of the bones — crowding out the normal plasma cells that help fight infection. These malignant plasma cells then produce an abnormal antibody called M protein, which offers no benefit to the body and may cause tumors, kidney damage, bone destruction and impaired immune function. The hallmark characteristic of multiple myeloma is a high level of M protein in the blood.

Multiple myeloma features

  • Low blood counts
  • In multiple myeloma, the overgrowth of plasma cells in the bone marrow can crowd out normal blood-forming cells, leading to low blood counts.
  • This can cause anemia (a shortage of red blood cells). People with anemia become weak and fatigued.
  • Multiple myeloma can also cause the level of platelets in the blood to become low (called thrombocytopenia). This can lead to increased bleeding and bruising.
  • Another condition that can develop is leukopenia (a shortage of normal white blood cells). This can lead to problems fighting infections.


Although the exact underlying cause of multiple myeloma is poorly understood, the specific symptoms of the condition result from abnormal and excessive growth of plasma cells in the bone marrow. Plasma cells help the body fight infection by producing proteins called antibodies. In people with multiple myeloma, excess plasma cells form tumors in the bone, causing bones to become weak and easily broken. The abnormal growth of plasma cells also makes it more difficult for the bone marrow to make healthy blood cells and platelets. The plasma cells produced in multiple myeloma produce abnormal antibodies that the immune system is unable to use. These abnormal antibodies build up in the body and cause a variety of problems.


People with multiple myeloma may experience a number of different symptoms and signs. Sometimes, people with multiple myeloma do not have any of these changes. For people with myeloma who have no symptoms, their cancer may be discovered by a blood or urine test that is performed for a different reason, such as for an annual physical exam. Or, the cause of a symptom may be another medical condition that is not cancer.

1. Anemia is a low level of red blood cells. This happens when myeloma plasma cells suppress or crowd out healthy red blood cells.

2. Fatigue is usually caused by anemia or other factors associated with myeloma, such as abnormal cytokine production. It occurs in most people with myeloma.

3. Bone pain is a common symptom. Myeloma cells grow in the bone marrow and cortical bone, causing local bone damage or generalized thinning of the bone, which is called osteoporosis. This makes the bone more likely to break. The back or ribs are the most common sites of bone pain, but any bone can be affected. The pain is usually worse when someone moves and at night. If cancer is in the spine, the vertebrae (the individual bones that make up the spine) can collapse, which is known as a compression fracture. In advanced multiple myeloma, a person may lose inches from their height due to compressed vertebrae over the course of their illness.

4. Pain, numbness, and weakness can sometimes happen when collapsed vertebrae press against the spinal cord or pinch a nerve coming out of the spine.

5. Too much M protein may lead to kidney damage or failure, an important issue to be aware of. Kidney damage in its early stages often does not cause any symptoms and may only be diagnosed through blood and urine tests. When the kidneys begin to fail, symptoms include itching, weakness, fatigue, shortness of breath, muscle cramps, nausea, appetite loss, trouble sleeping, urination changes, anemia, and swelling of the legs, feet, or ankles.

6. Hypercalcemia is a high level of calcium in the blood that can arise as a result of bone breakdown. It can cause drowsiness, constipation, and kidney damage.

7. Symptoms of weight loss, nausea, thirst, muscle weakness, and mental confusion are related to kidney failure, hypercalcemia, or other imbalances in blood chemicals.

8. Fever and infections, especially of the upper respiratory tract and lungs, may arise as a result of the lower immunity that people with myeloma have. This makes it harder to fight infection.

9. Blood clots, nosebleeds, bleeding gums, bruising, cloudy vision caused by hyperviscosity, which is thickened blood, and low platelets are other symptoms of multiple myeloma.

10. Drastic weight loss


Various treatments are used for multiple myeloma. Which is appropriate for you generally depends on the symptoms you are experiencing, among other factors. Patients with early-stage multiple myeloma with no symptoms, for example, maybe closely monitored by their doctor, through an approach called active surveillance. Those with symptoms may be treated with chemotherapy or targeted therapy, and sometimes, stem cell transplantation.

Other treatments, such as radiation therapy, interventional radiology, and surgery, may also be recommended in certain circumstances.


Chemotherapy for multiple myeloma is generally given in combination with other drugs to fight the disease and prevent a recurrence.

When chemotherapy drugs travel through the bloodstream to reach cancer cells, it’s known as systemic chemotherapy. When the drugs are directed to a specific area of the body, it’s called regional chemotherapy.

Chemotherapy may be used:

● As a primary treatment to destroy cancer cells

● Before another treatment to shrink a tumor

● After another treatment to destroy the remaining cancer cells

● To relieve symptoms of advanced cancer

Interventional radiology

Interventional radiology may be used to relieve pain during treatment. Interventional radiologists are specialists trained in using image-guided technology, such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI), to perform minimally invasive procedures to diagnose and treat various cancers. Interventional radiology procedures may reduce risk, pain, and recovery time for patients.

Radiation therapy

Radiation therapy for multiple myeloma is used when plasma cells have grown into the bone marrow and caused bone damage and pain.

Radiation therapy uses targeted energy (e.g., X-rays, radioactive substances) to destroy cancer cells, shrink tumors, and/or alleviate certain cancer-related symptoms.

It may be used:

● As a primary treatment to destroy cancer cells

● In combination with other treatments to stop the growth of cancer cells

● Before another treatment to shrink a tumor

● After another treatment to stop the growth of any remaining cancer cells

● To relieve symptoms of advanced cancer

Stem cell transplantation

A stem cell transplant may be used for multiple myeloma patients to help infuse bone marrow with healthy cells.

A stem cell transplant infuses healthy stem cells into the body. Stem cells are collected from the bone marrow, circulating (peripheral) blood, and umbilical cord blood. There are two main types of stem cell transplants:

Autologous stem cell transplant

This procedure collects, or harvests, the patient’s own stem cells, and freezes them before returning them to the patient following intensive chemotherapy and/or radiation therapy.

Allogeneic stem cell transplant

Unlike an autologous stem cell transplant, an allogeneic stem cell transplant uses stem cells from a matching donor, such as a relative, an unrelated individual or from saved umbilical cord blood.

Targeted therapy

Targeted therapy may be used alone or in combination with other therapies to treat the disease.

Targeted therapy drugs are designed to attack specific targets, such as receptors or proteins, found on and in cancer cells. The goal of targeted therapy is to stop or slow tumor growth by attacking genetic features on cells that regulate growth and division. These drugs may also help other cancer treatments, such as chemotherapy, work better.

While chemotherapy targets fast-growing cells throughout the body, whether they are cancerous or not, targeted therapy directs drugs to specific features on cancer cells that may be identified through advanced genomic testing or other laboratory tests or diagnostic procedures.

Exams and Tests

The health care provider will perform a physical exam and ask about your symptoms.
Blood tests can help diagnose this disease.

These tests include:

• Albumin level

• Calcium level

• Total protein level

• Kidney function

• Complete blood count (CBC)

• Immunofixation

• Quantitative nephelometry

• Serum protein electrophoresis

Bone x-rays, CT scans, or MRI may show fractures or hollowed-out areas of bone. If your provider suspects this type of cancer, a bone marrow biopsy will be performed.

Bone density testing may show bone loss.

If tests show that you have multiple myeloma, more tests will be done to see how far cancer has spread. This is called staging. Staging helps guide treatment and follow-up.