About multiple myeloma
Multiple myeloma, also known as myeloma or plasma cell myeloma, is a type of cancer that begins in the bone marrow plasma cells. Bone marrow is the part of the body where blood cells are made.
The normal role of plasma cells is to produce antibodies, which are part of your immune system. In multiple myeloma, the bone marrow produces too many abnormal plasma cells. As a result, the kidneys can be damaged, bones become brittle and prone to fracture, tumors can develop that can cause damage by compressing the spinal cord or other parts of the body. Multiple Myeloma may also affect your immune system, leaving you likely to get more infections or illness.
Multiple myeloma is the second most common blood cancer. There are about 20,000 new cases diagnosed each year in the United States. The peak age of onset is around 65 years of age; however multiple myeloma may affect younger people as well.
Symptoms of multiple myeloma depend on how advanced the disease is. They may range from no symptoms to the following:
- Bone pain and fractures
- Confusion due to high levels of calcium in the blood or kidney failure
- Increased number and severity of infections
- Spinal cord compression
- Multiple myeloma can cause fractures or tumors in the spine or vertebrae leading to numbness or tingling, sudden weakness of leg muscles or sudden problems with urinating or bowel movements. This is a medical emergency that needs to be treated right away. The treatment may include radiation therapy, surgery or both.
You may be diagnosed with multiple myeloma during routine blood work or following the onset of symptoms.
Myeloma is diagnosed via these tests:
- Blood and urine tests to detect the abnormal protein that plasma cells produce (called the M-protein or light chain)
- X-rays and/or additional imaging tests, including magnetic resonance imaging (MRI) and positron emission tomography (PET) scans
- Bone marrow aspirate and biopsy
- This is a routine procedure done in the doctor’s office, and is performed by inserting a needle into the back of your pelvis. This test is usually done using local anesthesia, pain and anti-anxiety medication.
Newly diagnosed myeloma
Myeloma treatment is needed if you are experiencing symptoms. If the disease is not yet active, it is referred to as “smoldering myeloma.” Smoldering myeloma requires close monitoring, but may not need to be treated.
Although multiple myeloma is usually not curable, it is very treatable. You can expect to return to near normal levels of activity when the disease is in remission.
Initial treatment may consist of combination chemotherapy or stem cell transplants; the specific drugs and duration of therapy depends on the person, and may last anywhere from six to 18 months. If you require maintenance therapy, you may need to continue treatments at a lower dose.
Standard treatments for newly diagnosed multiple myeloma include:
- Bortezomib (Velcade)
- Lenalidomide (Revlimid)
- Cyclophosphamide (Cytoxan)
- Corticosteroids (dexamethasone or prednisone)
- Radiation therapy
- Stem cell transplant
Other treatments that may be used include thalidomide, mephalan (Alkeran) and doxorubicin (Adriamycin or Doxil). The Myeloma Program at the Knight Cancer Institute participates in clinical trials that are designed at OHSU or are part of national and international collaborations. Clinical trials are research studies in which people help doctors find ways to improve health and treat diseases. The results of these research studies, called outcomes, give health care providers the information necessary to make advances and improvements in the way doctors treat or prevent disease.
- Stem cell transplant involves using high-dose chemotherapy (usually melphalan) followed by an infusion of harvested stem cells to replace diseased or damaged marrow. The stem cells can come from you (autologous) or from a donor (allogeneic). Autologous stem cell transplant is used more commonly to treat myeloma, due to the low rate of life-threatening complications, and high remission rates and duration of remission. Allogeneic transplant is associated with higher complication rates.
At the OHSU Knight Cancer Institute, you have access to the newest and most advanced bone marrow transplant treatments. Our doctors are among the United States’ top specialists in blood diseases.
Many people will relapse after initial treatment. At this time, you may be treated with a similar combination of therapies as the initial treatment if it was effective and if you tolerated it well. Multiple myeloma may become resistant to prior therapies, however, which means you may require new treatments.
There is a lot of research going into developing new treatments for myeloma, and there may be a clinical trial that is right for you. In addition to the standard treatments listed above, the following drugs are now FDA-approved for relapsed myeloma:
- Carfilzomib (Kyprolis)
- Pomalidomide (Pomalyst)
In addition to the treatment for the multiple myeloma, you may need other treatments to address complications of myeloma or your treatment. These include:
- Bisphosphonates -- zolendronic acid (Zometa) or pamidronate (Aredia) to prevent further bone loss
- Pain medication -- usually narcotic medications are the safest and most effective for the pain associated with myeloma bone disease
- Growth factors and erythropoietin -- to stimulate the growth of white and red blood cells, if anemia or low white blood cells occur
At the OHSU Knight Cancer Institute, our team of doctors, nurses and therapists is dedicated to diagnosing, treating and managing multiple myeloma. Our multiple myeloma doctors are fellowship trained and have extensive knowledge about the diagnosis, treatment and care of people with multiple myeloma. Our team includes doctors and nurses who meet weekly to discuss all of our patients, giving you the benefit of the entire team’s knowledge and expertise. We work together to find the best treatments for multiple myeloma
Hematology/oncology (non-translplant)Phoebe Trubowitz, M.D.
Eva Medvedova, M.D.