Multiple Myeloma

Multiple myeloma is a rare type of blood cancer. It affects the plasma cells in our bone marrow, which are white blood cells and form part of our immune system. Plasma cells are responsible for making antibodies called immunoglobulins, which help our body to fight infection.

What causes multiple myeloma?

Multiple myeloma happens in response to genetic changes in the plasma cells causing uncontrolled growth of these cells. This may lead to the production of abnormal proteins, which can be detected in the blood and the urine. These abnormal proteins are called M proteins. The abnormal cells affect your body’s ability to make red and white blood cells as well as affecting other organs, including your bones.

The cause of multiple myeloma is not clearly known, but there are some factors that are believed to increase the risk, including:

• Genetic mutations: There may be a link between certain mutating genes and multiple myeloma.
• Environmental factors: Researchers believe there may be a link between multiple myeloma and exposure to certain chemicals and radiation.
• Inflammatory condition: Diseases such as type 2 diabetes, heart disease, and rheumatoid arthritis may be linked to multiple myeloma.
• Obesity.

What are the symptoms of multiple myeloma?

There are many symptoms associated with multiple myeloma, but bone pain is often the first sign that is noticed. Other symptoms include:

• Anemia
• Bruising or bleeding easily
• Fatigue and extreme tiredness
• Feeling confused
• Fever
• Loss of appetite
• Nausea and vomiting
• Numbness in the arms and legs
• Weakness in the arms and legs
• Weight loss Some people may have a milder form of plasma cell disorder, which is not causing organ damage. The doctor will then monitor the overall health of a patient before starting treatment. Symptoms of multiple myeloma include:
• Anemia: Not enough red blood cells are made as the abnormal plasma cells suppress the ability of the bone marrow to make new red blood cells.
• Bacterial infections (such as pneumonia): Abnormal plasma cells suppress the immune system.
• Bone pain and fractures: This can happen when abnormal plasma cells destroy bone tissue.
• Hypercalcemia: Plasma cells cause erosion of the bone, which releases calcium into the blood.
• Hyperviscosity syndrome: The abnormal plasma cells make proteins which thicken the blood, which affect the fluidity of the blood making it harder to circulate in the blood vessels. This may cause stroke and other complications.
• Kidney problems: Abnormal proteins can block the kidney’s normal filtering process leading to damage. In addition, elevated uric acid and calcium level can also contribute to kidney failure.
• Thrombocytopenia: There aren’t enough platelets (the cells which help blood to clot) due to bone marrow suppression.

Who is affected by multiple myeloma?

Multiple myeloma affects men more than women. It is usually diagnosed in people between the ages of 40 and 70.

How is multiple myeloma diagnosed?

If your doctor suspects multiple myeloma they will perform a physical examination, discuss your symptoms, your medical history and any family history. Tests will be performed to confirm a diagnosis. Depending on these findings they will classify the condition and determine the cancer’s stage, its location or size. Diagnostic tests may include:

• Blood tests:
  • Complete blood count (CBC) measures the number of red and white blood cells, as well as how much hemoglobin is in the red blood cells.
  • A blood chemistry test will show creatine levels, indicating how well the kidneys are functioning. It will also measure albumin levels, lactic dehydrogenase levels (a tumor marker) and calcium levels.
  • A quantitative immunoglobulin test measures certain antibodies levels in the blood.
  • Electrophoresis tests for M proteins in the blood.
• Urine tests: Will look for the presence of abnormal proteins which is a sign of multiple myeloma.
• Imaging tests: Advances in imaging technologies have improved the ability to accurately diagnose multiple myeloma:
  • Computed tomography (CT) scan: Also shows signs of bone damage.
  • Magnetic resonance imaging (MRI): Produces detailed images of the spine and bones and spine. It can also show plasmacytomas, which are groups of abnormal plasma cells.
  • Positron emission tomography (PET) scan: It can assess the extent of the disease.
  • X-rays: Can show bones that have been damaged by multiple myeloma.
• Bone marrow biopsies: To confirm the presence of abnormal plasma cells. Once multiple myeloma is diagnosed, doctors may perform other tests to stage the cancer. Staging the cancer helps doctors to understand its location and size and helps to determine the most appropriate treatment plan. In addition to multiple myeloma, abnormal plasma cells can cause many diseases, such as:
• Amyloidosis: A disease that happens when abnormal amyloid proteins build up within the organs.
• MGUS: A blood test that shows small amounts of M protein.
• Plasmacytomas: Individual groups of abnormal plasma cells.
• SMM: A pre-cancerous form of multiple myeloma in which small amounts of M protein and increased plasma cells are found in the blood and bone marrow.

How is multiple myeloma treated?

Doctors can provide treatment options that help people to live longer whilst maintaining a good quality of life. Cleveland Clinic Abu Dhabi’s Multiple Myeloma and Amyloidosis Program offers patients the latest technological advances in multiple myeloma and amyloidosis treatment, which are helping to improve outcomes for patients, providing more targeted and effective treatment options with fewer side effects. The treatment given will depend on factors such as how advanced the cancer is and your symptoms. Treatment may include:

• Immunomodulator: Drugs stimulate the immune system to kill the abnormal plasma cells.
• Targeted therapy: Uses drugs that specifically target cancer cells, minimizing side effects and improving outcomes.
• Immunotherapy: Utilizes the immune cells to kill the abnormal plasma cells.
• Pain medications: To treat bone pain.
• Radiation therapy: Kills cancer cells and reduces bone tumors.
• Stem cell transplants: Used to replace the good stem cells in the bone marrow after receiving treatment with chemotherapy. Recent advances in stem cell transplant techniques have improved outcomes and reduced side effects.
• Precision Medicine: Doctors use the patient's unique genetic profile to tailor their treatment. This can help to identify the most effective drugs for an individual patient, minimizing side effects and improving outcomes.
• Chemotherapy: Reduces the amount of abnormal plasma cells.

If you have been diagnosed with multiple myeloma, talk to your doctor about the treatment options available to you.

Our Multiple Myeloma and Amyloidosis Program offers advanced treatment options and specialized care and support for people diagnosed with multiple myeloma and other plasma cell disorders.

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