What is Myeloma?
Myeloma, also known as multiple myeloma, is a relatively rare cancer that affects a person's blood cells, specifically plasma cells, and treatment options are available. Plasma cells are responsible for our immunity; they are a specific type of white blood cell that create antibodies when we are exposed to a pathogen.
As with many types of cancers, we don’t know what causes myeloma. Researchers have been able to identify various risk factors that increase the risk for myeloma:
- Increasing age. Most people are diagnosed with myeloma in their mid-60s.
- Family history of myeloma.
- Having a personal history of monoclonal gammopathy of undetermined significance (MGUS). Myeloma frequently begins as MGUS. MGUS is typically a benign condition where the body produces an abundance of M proteins.
The American Cancer Society estimated that, in 2022, approximately 34,470 people will be diagnosed with myeloma. Of this number, 19,100 will be diagnosed in men and 15,370 will be diagnosed in women.
Early Signs and Symptoms of Myeloma
Signs and symptoms will vary from person to person. Some people don’t have any symptoms until later in the progression of myeloma; this is often called smoldering multiple myeloma.
Common symptoms of myeloma include:
- Bone pain, most typically in the back and the ribs.
- Fractures.
- Frequent urination.
- Increased thirst.
- Frequent infections.
- Fevers.
- Fatigue.
- Weakness.
- Weight loss.
- Nausea.
- Constipation.
- Loss of appetite.
- Mental fogginess or confusion.
Treatment Options for Myeloma
If someone is experiencing no symptoms or is in the early stages of myeloma, treatment may not be recommended. In these instances, the provider will likely closely monitor blood and urine tests to determine when treatment is necessary.
Treatment typically begins when blood and urine tests indicate that the disease has progressed, or when symptoms develop.
There are various treatment options available. Providers will typically use a variety of treatments to produce the best results.
Chemotherapy
Chemotherapy is a common treatment for many types of cancers. It involves the use of drugs that are designed to stop the growth of cancer cells.
Though there are a variety of chemotherapy options available, the most used type in myeloma is orally, taken by mouth, or intravenously, injected into a vein. Both types offer a systemic response, which is needed because myeloma is a systemic type of cancer.
Targeted Therapy
This type of therapy uses specific treatments that can identify and subsequently attack different cancer cells. Because these treatments can attack specific cells, they are often less harmful to the other body than other treatment modalities.
Examples include:
- Proteasome inhibitor therapy. A proteasome is a type of protein that removes other proteins that are no longer needed. When proteasomes build up, they can cause the cancer cell to die. Specific types of proteasome inhibitor therapy include Bortezomib, carfilzomib and ixazomib.
- Monoclonal antibody therapy. According to the NIH National Cancer Institute, “Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading." These therapies are given intravenously. There are many types of monoclonal antibodies and they are given based on the specific needs of the patient.
- BCL2 inhibitor therapy. These therapies block a protein called BCL2, which can kill cancer cells and can also make the body more receptive to other treatments.
High-dose Chemotherapy with Stem Cell Transplant
Chemotherapy kills cancer cells; unfortunately, it also kills healthy cells. As you can imagine, when a doctor prescribes high-dose chemotherapy, many other healthy cells are also killed in the process.
Enter stem cell transplantation. Stem cells are immature bone cells. Though they are a different type of cell, they can become blood cells. When given alongside high-dose chemotherapy, the body attempts to use these cells to regenerate the healthy blood cells that are killed.
Immunotherapy
Immunotherapy uses the body’s own immune system to fight cancer. Though that may seem counterproductive when someone has cancer, the idea behind this therapy is that the “good stuff" that the body uses for immunity is administered, which subsequently fights cancer.
Examples include:
- Immunomodulator therapy. Types of immunomodulators are thalidomide, lenalidomide, and pomalidomide.
- CAR T-cell therapy. T-cells are important to our immune function. These cells attack certain proteins on cancer cells. According to the NIH National Cancer Institute, “T cells are taken from the patient and special receptors are added to their surface in the laboratory. The changed cells are called chimeric antigen receptor (CAR) T cells. The CAR T cells are grown in the laboratory and given to the patient by infusion. The CAR T cells multiply in the patient's blood and attack cancer cells."
Radiation Therapy
Radiation involves the use of high-intensity x-rays that are focused directly onto the body of the person with cancer.
The Bottom Line
Myeloma occurs relatively infrequently. It is a type of cancer that affects plasma cells of the body. Though it will eventually require treatment, it is often left untreated if the person is asymptomatic. The treatment plan uses a variety of treatment modalities and is designed for each patient by their healthcare team.