Myeloma is a cancer that arises in the plasma cells of the bone marrow. Plasma cells produce antibodies that help the immune system fight infections. Myeloma cells do not function like healthy plasma cells, and they can crowd out normal plasma and blood cells.
Approximately 22,000 people in the U.S. are diagnosed with myeloma every year. The risk of developing myeloma generally increases with age, and most patients diagnosed with this cancer are over 65.
Myeloma is more common among men than women, and African Americans are twice as likely as Caucasians to develop the disease. The myeloma program at Froedtert & the Medical College of Wisconsin is one of the largest in the U.S.
Myeloma cells accumulate in the bones, where they can form tumor masses. Myeloma cells also produce chemicals that stimulate bone breakdown and hinder bone replacement. As a result, common early symptoms of myeloma are bone pain and broken bones.
Since myeloma can crowd out normal blood cells, patients typically suffer from low blood counts. Low red cells leads to anemia, with symptoms of fatigue, weakness and paleness. Low platelet counts can result in abnormal bruising and bleeding. Low white cell and plasma cell counts can lead to frequent infections, especially pneumonia.
Myeloma cells also produce a protein that causes kidney damage. Symptoms of kidney disease include loss of appetite and nausea. About one-third of myeloma patients have no symptoms when they are first diagnosed.
Types of Myeloma
Physicians characterize myeloma based on how extensively the cancer has spread throughout the body. Several terms are used:
- Multiple myeloma. In about 90 percent of patients, the disease is present in multiple sites throughout the body. This form of myeloma is called “multiple myeloma.” Typical sites of involvement include the bones, skin, muscles and lungs.
- Plasmacytoma. A plasmacytoma is a single mass of myeloma cells. A patient who has only one detectable myeloma tumor is said to have plasmacytoma. (Only about 5 percent of myeloma patients have just one disease site.)
- Localized myeloma. Localized myeloma is disease that is evident in a few neighboring sites within the body and has not yet spread extensively.
- Extramedullary myeloma. Myeloma typically arises in the marrow (or “medulla”) of the bone. Any myeloma cells that are evident outside the bone marrow are called “extramedullary” disease. This could refer to a single plasmacytoma in skin, muscle or lung, or any disease sites outside the bone in a patient with multiple myeloma.
- Plasma cell leukemia. Plasma cell leukemia (PCL) is a rare and aggressive variation of myeloma. Malignant cells accumulate in bone marrow and circulate in high numbers in the bloodstream. Most patients who are diagnosed with PCL do not have a prior history of myeloma.
Myeloma is staged according to the extent of the disease and its impact on other organs. “Smoldering” myeloma is early disease that has been diagnosed through lab tests, but which is not causing any symptoms. Stage 1 myeloma generally refers to a case with only one bone tumor. Stages 2 and 3 denote more advanced disease with progressing kidney disease.
Myeloma treatment plans are highly individualized and tailored to each patient’s specific disease, stage and overall health. The elements of a care plan can include:
- Watchful waiting. For patients with very early stage myeloma, the best approach may be to hold off treatment until symptoms develop. Patients are carefully monitored through periodic testing and regular check-ups.
- Chemotherapy. Most myeloma patients with disease symptoms begin treatment with chemotherapy. The aim is to eradicate as many cells as possible and induce remission of the disease. A wide variety of drugs are used, including traditional chemotherapy agents, newer “targeted” drugs and steroids. Most patients receive a combination of several drugs. Chemotherapy can also be used to treat recurrent myeloma.
- Stem cell transplant. Some patients with myeloma can benefit from a stem cell transplant as follow-up treatment to high-dose chemotherapy. Transplant can also be used to treat recurrent myeloma.
- Radiation therapy. Radiation can sometimes be used to treat a single plasmacytoma. Radiation therapy can also help relieve pain caused by myeloma tumors in bone or other sites.
- Surgery. Isolated tumors can sometimes be removed surgically. Surgery may also be used to treat tumors that are compressing the spinal cord.
A Condition Related to Myeloma
Hematologists also treat a condition related to myeloma.
- Monoclonal gammopathy of undetermined significance (MGUS). MGUS is similar to myeloma in that it involves abnormal plasma cells. MGUS is not a cancer, but about one-third of patient with MGUS eventually develop myeloma or lymphoma. Patients with MGUS undergo regular lab tests to monitor the disease’s progress.
Myeloma Clinical Trials
Clinical trials give many patients access to innovative drugs and treatment approaches. Search our list of clinical trials for myeloma studies available at Froedtert & the Medical College of Wisconsin.