Multiple myeloma is a condition that affects plasma cells, a type of white blood cell. These plasma cells either produce too much abnormal protein and/or make too many copies of themselves. Although it isn’t curable yet, it is highly treatable. At Tufts Medicine, we offer the latest and most effective treatment options, including clinical trials.
How does multiple myeloma develop?
Under normal circumstances, white blood cells act as the security guards of your bloodstream, constantly on patrol for disease and infection. When they’re alerted to potential harm, they spring into action by changing into plasma cells that ultimately produce proteins known as antibodies (also called immunoglobulins). These antibodies bind to the harmful substances, remove them from your body and leave your bloodstream once their job is done.
Myeloma occurs when plasma cells multiply and produce atypical antibodies that no longer help your body fight off infection. This can lead to damage to your organs, such as your kidneys and also your bones, increasing the risk of fracture.
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Conditions
Myeloma can present in different ways:
- Multiple myeloma is the most common and presents with anemia, low blood counts, kidney abnormalities, and/or bone lesions (plasmacytomas).
- A solitary plasmacytoma is a condition where plasma cells form a single tumor, with minimal or no disease present in other areas of your body.
- Extramedullary myeloma occurs when plasma cells form tumors in soft tissues outside of your bone marrow.
No matter how your multiple myeloma presents, you can trust that our team has experience in treating it in all forms. Other conditions we treat include:
Lymphoplasmacytic lymphoma
Monoclonal gammopathy of renal significance (MGRS)
Monoclonal gammopathy of undetermined significance (MGUS)
Newly diagnosed multiple myeloma
Relapsed or refractory myeloma
Smoldering multiple myeloma
Solitary plasmacytoma
Multiple myeloma symptoms
Many people with multiple myeloma often experience mild symptoms of anemia and fatigue. Additional common symptoms include:
- decreased appetite
- weight loss
- changes in urination patterns (either decreased or frequent)
- swelling in the legs
- bone pain
- nausea
- mental confusion or fog
- increased thirst
- frequent infections.
If you notice any of these symptoms, it is important to contact your doctor. Early detection and treatment are important so that your organs can continue to function properly.
Testing
Properly diagnosing multiple myeloma requires examining your blood, bone marrow and urine for plasma cells and proteins. Testing may include:
- Bone marrow aspiration or biopsy: We'll test for increased bone marrow myeloma cells (malignant plasma cells).
- Blood and urine tests: Protein Electrophoresis and Immunofixation (SPEP/IFE), and Serum Free Light Chains (FLC) tests can help detect and measure abnormal proteins in the blood and urine.
- PET/CT or MRI: These tests examine your body for any bone or soft tissue lesions.
We can also measure the following levels to better understand your condition:
- Complete blood count (CBC): We'll look for lower-than-normal red blood cell, white blood cell and platelet cell counts to understand how much bone marrow is affected. Blood tests can also evaluate your kidney function.
- Chemistry Panel (CMP): Here we check calcium level, kidney function, liver function, albumin, total protein, and electrolytes.
- Beta-2 microglobulin: This protein helps estimate how big and fast the myeloma is growing. It's not a direct measurement, but it helps us understand how severe the disease might be and how quickly it might be spreading.
- Lactate Dehydrogenase (LDH): This test measures cell growth and turnover.
Creating effective prevention, monitoring + treatment plans
Once we've confirmed that you're living with a myeloma diagnosis, it's important to understand what risk category you fall into, such as standard or high risk. This process helps us design the most effective care plan for you.
We follow the Revised International Staging System (R-ISS) to stage myeloma. Staging is a process that helps us understand how far the myeloma has progressed and plan the best treatment for you.
Our experts can evaluate your genetic risk with a process known as interphase fluorescence in situ hybridization (FISH), where we select the purest plasma cells to examine.
Treatments
Myeloma isn't considered a curable condition yet, but it is very treatable for most people. We’ll explore the latest medications and therapies to prevent any organ damage (which leads to fewer symptoms) and empower you with more time to live on your terms.
Because multiple myeloma can take different forms from person to person, we’ll pay special attention to your:
- Overall organ health, especially the kidneys
- Bone health, including bone marrow function
- Blood counts
We offer several game-changing treatments that can extend survival for patients with myeloma.
- Monoclonal antibody therapy introduces a lab-made protein designed to bind to harmful, unwanted substances in your body, like antigens on the surface of cancer cells.
- Should your myeloma relapse, we can treat you with Immune Effector Cell Therapy including Chimeric Antigen Therapy (CAR-T) and Bispecific T- Cell Engagers (BiTE) therapies targeting specific protein markers on your plasma cells.
Stem cell transplant
Stem cell transplant is a powerful tool in the treatment of multiple myeloma.
Autologous stem cell transplant involves collecting your stem cells through a process called mobilization and apheresis, and later giving those cells back to you after you receive high doses of chemotherapy. The chemotherapy is designed to eliminate even microscopic amounts of myeloma in your body, while the stem cells allow the recovery of normal blood counts.
Autologous stem cell transplants have been used for decades and have proven effective in extending the survival rates of people with myeloma. Additionally, this treatment reduces the amount of therapy required during the maintenance phase.
Protecting your immune system
People living with multiple myeloma require continuous care. We can offer support by providing timely vaccinations after stem cell transplants to help protect your immune system while traveling. We can also help protect your immune system through periodic antibiotics or immunoglobulin injections.
Protecting your bone health
We prescribe medications called bisphosphonates or osteoclast inhibitors to patients with low bone mass or bone lesions. These drugs help reduce the long-term risk of fractures and promote the repair of existing bone damage.
Tracking your body’s response to treatment
It’s important to know that myeloma will require lifelong care because it is considered an incurable cancer. We have multiple ways of tracking your body’s response to treatment.
We use the following tests on the blood and urine to monitor treatment response:
- Complete blood count (CBC)
- Chemistry panel
- Protein electrophoresis and Immunofixation
- Quantitative immunoglobulins
- Serum-free light chains
Imaging is also a very important tool. We generally prefer to take a PET scan when yo are diagnosed, as well as during your course of therapy to assess your response to treatment.
In today's era of myeloma therapy, we have advanced techniques for detecting disease at microscopic levels, down to fewer than 1 in 100,000 or even 1 in a million cancer cells. This is known as measurable residual disease (MRD).
Clinical trials + research
Our research aims to turn data points into action plans that can positively impact your health. This translational research continues to advance our understanding of modern plasma cell diseases and how to best treat them.
A major focus of our research is identifying the genes and proteins that enable malignant plasma cells to cause disease and to survive despite modern treatments.
We encourage speaking with your care team about participating in clinical trials. Being at the forefront of these studies allows you to not only pursue what’s next in your health but possibly what’s next in the future of healthcare.
FAQs
What is smoldering myeloma?
Smoldering myeloma is when the abnormal protein has been detected and there are more than 10% abnormal plasma cells in the bone marrow.
Most people with smoldering myeloma are asymptomatic. Generally, this condition does not require treatment unless you fall into a high-risk category, in which case it is a shared decision made between you and your myeloma doctor.
What is monoclonal gammopathy of undetermined significance (MGUS)?
Monoclonal gammopathy of undetermined significance (MGUS) is when the abnormal protein is found, but the percentage of abnormal plasma cells is less than 10%. While not a cancer, this condition is also not completely benign and should be monitored over time.
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