Living with Multiple Myeloma

Living With Multiple Myeloma

Multiple myeloma is cancer of the cells that make plasma in bone marrow. When these abnormal plasma cells build up in the bone, they can form tumors: a single tumor is a plasmacytoma; more than one is referred to as multiple myeloma. Approximately 22,000 new cases of multiple myeloma are diagnosed each year in the United States; survival rates vary greatly depending on the stage at which the cancer is caught.

Multiple myeloma is more common in males, African-Americans, and patients over 65 years old. Other risk factors for developing multiple myeloma include obesity, radiation exposure, certain workplace toxins, and family history. The early stages of multiple myeloma may not present symptoms; advanced stages may cause bone damage, kidney failure, fatigue from anemia, and high calcium levels in the blood. The stages of multiple myeloma range from I to III, depending on the presence of certain proteins in the blood. Multiple myeloma treatments include surgery, chemotherapy, drug therapy, biologic therapy, radiation, stem cell transplantation, or a combination of these.

Multiple myeloma (MM) is one of the blood cancers. It is the second most common blood cancer, after Non-Hodgkin lymphoma. Multiple myeloma affects the bone marrow — malignant plasma cells replace normal plasma cells.

Multiple Myeloma

What do our plasma cells do?

Plasma cells play a critical role in our ability to fight infections. Plasma cells produce antibodies. Antibodies travel in our blood plasma and our lymphatic system to fight infections. Antibodies bind to antigens (foreign substances) and either neutralize them or destroy them. Antibodies are our defense against bacteria and viruses. The malignant plasma cells produce a substance called “M protein.” M protein causes tumors, kidney damage, bone damage and impairs the immune system.

Risk factors

Multiple myeloma occurs in one in every 143 people. Risk factors include:
Age. Most patients are over 60.

Race. Twice as many African-Americans develop MM than in white people. It is also more common in Middle Eastern, North African and the Mediterranean peoples.

Exposure to radiation or chemicals. Working around chemicals is a risk factor along with those in woodworking and carpentry. Firefighters and people exposed to Agent Orange are also at increased risk.

Personal history. Having a single bone lesion (plasmacytoma of the bone) or having a small amount of M protein (MGUS) in one’s bloodstream increases the risk of MM. Regular monitoring is suggested for people who have had a diagnosis of MGUS.

Prone To Infection

Symptoms of Multiple Myeloma

The earliest stages of multiple myeloma may only produce vague symptoms that can be confused with various other health issues. An annual physical exam might detect MM in a patient who has no symptoms.

As MM develops, it produces these symptoms. Not every patient experiences every symptom.

Low blood cell count. Patients develop low counts of red blood cells, white blood cells and platelets. Many medical conditions cause low blood cell counts — this symptom alone is not diagnostic.

Anemia. As red blood cell counts decrease, this causes anemia. Hemoglobin is found in our red blood cells. It carries the oxygen from our lungs to all of the tissues of our body. When our hemoglobin level falls, we become anemic — causing fatigue, tiredness, dizziness and shortness of breath. Normal hemoglobin levels are 12 to 16 g/dL for women and 14 to 18 g/dL for men. When the hemoglobin level falls below 6.5, it is life-threatening and requires an immediate blood transfusion.

Impaired immunity. MM patients are prone to frequent infections because of their reduced antibody levels. Patients are 15X more likely to get an infection.

Bone damage and bone loss. As more malignant M protein grows, this substance clumps together and damages the structure and strength of the bone. The most common areas where this happens are in the spine, pelvis and ribs. Patients experience bone pain and fractures.

Bone Fractures

Hypercalcemia. Bone destruction from the excess M protein causes the calcium level to rise in patients’ bloodstreams. Excess calcium is dangerous — if severe, it can cause cardiac arrest. Early symptoms of excess calcium are loss of appetite, increased thirst, restlessness and confusion.

Impaired kidney function. MM patients’ kidneys have to work harder because of increased M protein levels and increased calcium levels in their bloodstream. About half of MM patients suffer from decreased renal function.

Peripheral neuropathy. Circulating M protein in your bloodstream may damage the nerves in your hands or feet, causing numbness and tingling. Patients may not be able to pick up small objects and have trouble walking and maintaining their balance.

How is multiple myeloma diagnosed?

Physicians use a battery of tests plus a physical exam and review of symptoms to diagnose multiple myeloma . Blood work, urine tests and a bone marrow biopsy are critical parts of the diagnosis puzzle. Imaging tests include a CT scan, MRI or PET scan. The diagnosis process takes several weeks and is overwhelming for many patients.

Once diagnosed, what next?

Multiple myeloma is a less common cancer type and is complicated. A hematologist (a specialist in blood diseases) is the best specialist to treat multiple myeloma. If a hematologist is not close enough, then select a medical oncologist who is familiar with MM. Before you begin treatment, get a second opinion about your treatment plan.

Have your genome sequenced. Genetic testing helps guide your treatment options.

Surveillance and watchful waiting may be all that’s needed for early stage, “smoldering” multiple myeloma. Doctors wait until these patients develop symptoms or show signs of organ damage.

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Treatments for Multiple Myeloma

Patients with active symptoms face three phases of possible treatment.

Induction therapy. This therapy is to gain rapid control over the cancer and provide symptom relief. Targeted therapy, chemotherapy and corticosteroids are first phase treatments.

Consolidation. More chemotherapy and possibly other drugs, prepare a patient for a stem cell transplant.

Maintenance therapy. Given over a number of years to prevent recurrence.
Virtually all multiple myeloma patients receive bone-modifying drugs to strengthen their bones, prevent pain and reduce the risk of fracture.

Facts and Figures

About 30,770 people (slightly more men than women) will be diagnosed with MM in 2019. Although multiple myeloma is considered incurable, new treatments extend lifespans and quality of life for MM patients.

Almost 13,000 people in the U.S. succumb to multiple myeloma annually. But survival rates are increasing and length of survival time is increasing too. There are about 125,000 people in the U.S. living with multiple myeloma.
Many patients live fulfilling lives while treating multiple myeloma like a chronic illness.

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For more information on multiple myeloma, read the American Cancer Society's detailed guide.

If you have been affected by multiple myeloma, please be sure to take some time to read others' experiences, share your own experiences, and ask or answer questions. Don't forget to view our Beginner's Guide to Cancer.

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