If you would like to learn about symptoms of Myeloma, and treatment of the condition, you will find the following information of help.
Myeloma is a cancer that affects cells in the bone marrow called plasma cells. As the cancerous plasma cells fill the bone marrow, you are not able to make enough normal blood cells. This leads to anaemia, bleeding problems and infections. Other symptoms include bone pain, fractures due to bone damage, and kidney damage. Myeloma cannot usually be cured, but in many cases chemotherapy and other treatments can control the disease, ease symptoms, and prolong survival for a number of years.
What is myeloma?
Myeloma is a cancer of white blood cells called plasma cells. The cancerous plasma cells build up in the bone marrow and also make a lot of one particular antibody. As a result, various symptoms develop. Myeloma is sometimes called multiple myeloma or myelomatosis.
What are the bone marrow, plasma cells and antibodies?
The bone marrow is where blood cells are made by stem cells. The bone marrow is the soft 'spongy' material in the centre of bones. Stem cells constantly divide and produce new cells. Some new cells remain as stem cells, and others go through a series of maturing stages ('precursor' or 'blast' cells) before forming into mature blood cells. The blood cells made by stem cells are red blood cells, white blood cells and platelets.
You make millions of blood cells every day. There is normally a fine balance between the number of blood cells that you make, and the number that die and are broken down. Various factors help to maintain this balance. For example, certain hormones in the bloodstream and chemicals in the bone marrow called 'growth factors' help to regulate the number of blood cells that are made.
Plasma cells are one type of white blood cell. White blood cells are a main part of the immune system which defend the body from infection. There are various types of white blood cells. One type of white blood cell is called a B-lymphocyte. A plasma cell is a mature B-lymphocyte.
Antibodies (immunoglobulins) are made by plasma cells. Antibodies are proteins that attach to, and help to destroy, bacteria, viruses, etc. Normally, the plasma cells make a large number of different antibodies, each being able to attack different bacteria, viruses, etc.
What is cancer?
Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and do not respond to normal control mechanisms. Large numbers of cancer cells build up either because they multiply 'out of control', or they live much longer than normal cells would do, or both. Myeloma is one type of cancer.
What happens in myeloma?
As with other cancers, what seems to happen is that the cancer starts with one abnormal cell. In the case of myeloma, one plasma cell at first becomes cancerous. This abnormal cell then multiplies to produce many abnormal identical plasma cells (a 'clone' of cells). The cancerous plasma cells mainly collect in the bone marrow and continue to multiply without any control.
In the vast majority of cases of myeloma, the abnormal plasma cells make large quantities of one antibody. This single type of antibody is called a para-protein (or sometimes called a monoclonal antibody, as it is an antibody which comes from a single clone of plasma cells.) There are several different types of antibody. These are called IgM, IgG, IgA, IgD and IgE. (Antibodies are sometimes called immunoglobulins or Ig for short.) Myelomas are sub-classified by the type of antibody that they make. For example, IgG myeloma is the most common type.
What causes myeloma?
It is not known why a plasma cell becomes cancerous. Factors such as infection, or chemicals, or other environmental factors may play a part in damaging cells and causing cancers such as myeloma, but non have been proven as a cause for myeloma. It is not a hereditary disease.
Who gets myeloma and how common is it?
Myeloma is uncommon. It develops in about 3500 people in the UK each year. Most cases occur in people over the age of 50, and it becomes more common with increasing age. The average age it is diagnosed is 65. Rarely it occurs in younger adults, and it does not occur in children. Men are affected more often than women.
What are the symptoms and problems with myeloma?
There may be no symptoms at first in the early stages of the disease. Some people are diagnosed by chance because they have a blood test done for other reasons which may detect early myeloma. As the disease progresses, symptoms develop. The symptoms and problems which develop are mainly due to the uncontrolled production of plasma cells in the bone marrow, and the excess amount of antibody (para-protein) that the plasma cells make.
Bone damage and related problems
The increasing numbers of plasma cells in the bone marrow act like growing tumours ('plasmacytomas') inside the bones. They also make a chemical that can damage bone. In time, small parts of bone are destroyed and are called 'lytic lesions'. The term 'multiple myeloma' is sometimes used which means there are multiple (lots of) areas in bones throughout the body which are affected. The damage to bone can cause:
- Bone pain. This is often the first symptom and can become severe. Any bone can be affected but the most common sites where pain first develops are the lower back, pelvis, and the ribs. The pain tends to be persistent, and made worse by movement.
- Fractures. Affected bones may easily fracture (break) following a mild injury.
- Compression of nerves coming out of the spinal cord (spinal cord or nerve root compression due to fractures of vertebrae). This can cause a variety of symptoms such as weakness in muscles of the legs, numbness, or bladder problems.
- Hypercalcaemia. This means a high level of calcium in the blood (due to the bone breaking down). This can make you very thirsty, and can cause vomiting, dehydration, constipation, and kidney damage. Kidney damage in turn can cause an even higher blood level of calcium - so a vicious circle of an increasing calcium level may develop.
Bone marrow failure
Much of the bone marrow fills with abnormal plasma cells. Because of this, it is difficult for normal cells in the bone marrow to survive and develop into normal mature blood cells. Therefore, problems which can develop include:
- Anaemia. This occurs as the number of red blood cells goes down. This can cause tiredness, breathlessness and other symptoms. You also look pale.
- Blood clotting problems. This is due to low levels of platelets. This can cause easy bruising, bleeding from the gums, and other bleeding-related problems.
- Serious infections. The abnormal plasma cells only make one type of antibody. This does not protect against infection. There is a reduced number of normal plasma cells and other types of white blood cells which usually combat infection. Therefore, serious infections are more likely to develop.
Kidney damage
The kidneys may be damaged by an increased calcium level in the bloodstream, and/or by the high level of the abnormal antibody (para-protein).
Hyperviscosity
This means that the blood may become too thick due to a very high level of para-protein. Symptoms of hyperviscosity occur in less than 1 in 10 cases of myeloma and include problems such as bruising, nose bleeds, hazy vision, headaches, sleepiness, and a various other symptoms.
Amyloidosis
This is an uncommon complication of myeloma. This is a condition where abnormal protein (amyloid) accumulates on various parts of the body. it can cause various symptoms.
How is myeloma diagnosed?
Tests commonly done to confirm the diagnosis of myeloma include:
- A blood or urine test to detect fragments of the para-protein (excess antibody).
- X-rays of bones. The areas of damaged bones often show up as typical patterns on x-rays.
- A bone marrow sample. For this test a needle is inserted into the pelvis bone (or sometimes the breastbone (sternum)). Local anaesthetic is used to numb the area. A small amount of marrow is removed using a syringe. The sample is put under the microscope to look for abnormal cells. The diagnosis is confirmed when large numbers of plasma cells are seen in the bone marrow sample. (A separate page describes bone marrow biopsy in more detail.)
These test may be repeated from time to time to monitor the progress of the disease, and to monitor the response to treatment. Other tests which are commonly done to assess the severity of the disease and to monitor the response to treatment include:
- Blood tests to check on your kidney function.
- Blood level of calcium.
- Blood test to check the ESR (erythrocyte sedimentation rate) or plasmaviscosity. A high level of these tests indicates a high level of para-protein in the blood.
Other disorders related to myeloma
The following are other plasma cell abnormalities. If you are diagnosed with any of these conditions, myeloma may develop sometime later, but not always.
- Isolated (solitary) plasmacytoma of bone. In this condition only one plasma cell tumour is found in a bone. There is no other evidence of myeloma anywhere else in the body.
- Extramedullary plasmacytoma. In this condition, one or more plasma cell tumours occur outside the bone marrow. These most commonly occur in the tonsils or the tissues around the nose.
- Monoclonal gammopathy of unknown significance (MGUS). In this condition a para-protein is found in the blood without other symptoms or signs of myeloma. (Monoclonal gammopathy is another way of saying a high level of a monoclonal, or single type of, antibody.)
- Smouldering myeloma. This is similar to MGUS, but the level of para-protein is higher than in MGUS.
What is the aims of the treatment for myeloma?
Myeloma is not usually curable. Treatments may be used to:
- control the myeloma (put it into remission or control it's progression).
- ease symptoms.
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the treatment options for myeloma.
In some cases, where the disease is in the early stages and you do not have any symptoms, then no active treatment may be advised. You will be advised to have check ups every so often, and treatment may be advised when symptoms or problems develop.
Treatments to control the myeloma
In many cases, treatment can control the myeloma and put the disease into 'remission'. Remission is not a cure. Full remission means that tests cannot detect the abnormal plasma cells in the blood or bone marrow, and the bone marrow is producing normal blood cells again. Some remissions are 'partial' which means there is some improvement. However, at some point in the future the disease usually returns (relapses). Further treatment may be considered if the disease relapses. However, in time the relapses become more difficult to treat. Treatments include the following:
Chemotherapy
Chemotherapy is a treatment which uses anti-cancer drugs to kill cancer (myeloma) cells, or to stop them from multiplying. Various drugs are used and myeloma may be treated with chemotherapy drugs given as tablets or injections. The exact combination of drugs used, and the length of the course of chemotherapy depends on various factors such as the severity of the myeloma, the exact type of myeloma, if you have kidney damage, etc. (There is a separate section which gives more details about chemotherapy).
If a course of chemotherapy achieves a remission, you may then be advised to take drugs such as interferon, steroids or thalidomide as a regular 'maintenance' treatment. This is in effect 'low level' chemotherapy which aims to keep you in remission for as long as possible.
Stem cell transplant
A stem cell transplant (sometimes called a bone marrow transplant) may be an option. Stem cells are the immature cells that develop into mature blood cells in the bone marrow. Plasma cells are derived from blood stem cells. Briefly, a stem cell transplant involves high dose chemotherapy (and sometimes radiotherapy) in an attempt to kill all the abnormal plasma cells. However, this also kills the stem cells that make normal blood cells. So, after the chemotherapy you are given a transplant of stem cells which then make normal blood cells, including plasma cells. (See page called 'Stem Cell Transplant' for details.)
Radiotherapy
Radiotherapy is a treatment which uses high energy beams of radiation which are focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. For myeloma, radiotherapy is mainly used to treat severe localised problems. For example, to treat severe pain and/or pressure on nerves due to a damaged spinal bone due to a a build up myeloma cells in the bone. (There is a separate page which gives more details about radiotherapy.)
Treatments to ease symptoms
Depending on the effects of the myeloma, one or more of the following may be needed.
- Painkillers - to ease any pain
- A bisphosphonate medicine. This reduces the bone destruction that occurs with myeloma and helps to counter a high calcium level.
- Erythropoietin. This is a hormone that helps to increase the number of red cells made in the bone marrow. It may be used to help counter anaemia.
- Blood transfusions to correct anaemia.
- Plasma exchange or exchange blood transfusions if you have a very high level of para-protein in your blood which is making it very thick and causing hyperviscosity symptoms.
- Antibiotics if you develop infections.
- Surgery is sometimes needed to help heal fractured bones, or to ease pain from fractured bones, or to ease pressure on a trapped nerve due to fractures of the spinal bones.
- Kidney dialysis if you develop kidney damage and kidney failure.
Most people with myeloma will also be advised to drink plenty of fluids. This helps to counter a high calcium level.
What is the prognosis (outlook)?
Myeloma cannot usually be cured. Treatments aim to prolong survival. In general, with treatment, about half of people with myeloma are alive and well 3-4 years after diagnosis. However, this is the general overview. In some cases the disease responds very well to treatment and survival is much longer. In some cases the disease does not respond to treatment very well, or complications such as kidney failure develop quite quickly.
The treatment of cancer and myeloma is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about the outlook for your particular situation.
Further help and information
International Myeloma Foundation
A registered charity which aims to assist those affected by myeloma and their families. They also produce a range of information about various aspects of myeloma and it's treatment.
CancerBACUP
3 Bath Place, Rivington Street, London, EC2A 3JR
Tel: 0808 800 1234 Web: www.cancerbacup.org.uk
3 Bath Place, Rivington Street, London, EC2A 3JR
Tel: 0808 800 1234 Web: www.cancerbacup.org.uk
Provides information and support to anyone affected by cancer.
Other support groups
See Self Help UK for a list of self help and support groups for cancer patients.
See Self Help UK for a list of self help and support groups for cancer patients.
© EMIS and PIP 2005 Updated: February 2005 Review Date: July 2006 CHIQ Accredited
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