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Myeloma

Published by Bupa's health information team, February 2008.

This factsheet is for people who have myeloma, or who would like information about it.

Myeloma, also known as multiple myeloma or myelomatosis, is a type of bone marrow cancer that affects the plasma cells.

• About myeloma
• Symptoms
• Causes
• Diagnosis
• Treatment
• Further information
• Questions and answers
• Related topics
• Sources

About myeloma

Myeloma is a rare form of cancer. It typically affects people aged 60 and over, and is rare in people under the age of 40. It affects more men than women.

Plasma cells are found in the bone marrow. The bone marrow is the spongy centre of large bones in your body where red blood cells, white blood cells and platelets are produced. Normal plasma cells are a type of white blood cell; they produce antibodies (also called immunoglobulins), which are proteins that fight against infection.

If plasma cells become cancerous (malignant) they are known as myeloma cells. They release only one type of antibody, called a paraprotein or M protein, which is no good at fighting infection.

Normally, new blood cells are produced in a controlled manner. If you have myeloma, the process becomes out of control. Large numbers of myeloma cells are produced, which build up in the bone marrow and crowd out the healthy cells. The myeloma cells divide in the bone marrow but they remain individual cells; they don't cause a lump (tumour) typical of many cancers. The myeloma cells can spread through the bone marrow and into the hard casing of the bone.

You may hear myeloma referred to as multiple myeloma. This is because it can affect multiple areas of your body where the bones have bone marrow, such as the spine, skull, pelvis, rib cage, shoulders and hips.

Symptoms

General symptoms of myeloma include bone pain (usually in your back or rib cage), loss of appetite, and feelings of tiredness and weakness.

Myeloma may also cause one or more of the following medical problems.

Weakened bones

Your bones may become weaker because of damage caused by the myeloma cells in your bone marrow. This can lead to pain and bone fractures. Bone pain is one of the most common early symptoms of myeloma. This is usually a persistent dull or aching pain in your back, ribs, neck or pelvis.

Anaemia

This is a condition when you have too few red blood cells or not enough haemoglobin in your blood. Myeloma cells can interfere with the production of red blood cells. Feeling tired is a main symptom of anaemia.

Kidney problems

The paraprotein produced by the myeloma cells can damage the kidneys. Kidney problems can cause tiredness and make anaemia worse.

Infections

Frequently having infections, particularly chest or urinary infections, is a feature of myeloma. This is due to the production of paraproteins, which don't fight infections like normal antibodies, and because myeloma cells crowd out the healthy antibody-producing cells.

Unexplained bruising or bleeding

The myeloma cells interfere with the production of platelets, causing bruising or bleeding. Platelets are responsible for blood clotting and when they are low you bruise more easily.

Hypercalcaemia

Hypercalcaemia means a high level of calcium in the blood. It's caused by excess calcium being released into your blood by damaged bones. Symptoms include confusion, loss of appetite, feeling sick, tiredness, pain in your abdomen (tummy) and constipation.

Spinal cord compression

This occurs when the excess myeloma cells damage the bones of the spine (vertebrae) causing pressure on your spinal cord. Symptoms may include back pain, weakness, numbness or tingling in your limbs and problems passing urine or having a bowel movement.

Although not necessarily the result of myeloma, if you have any of these symptoms you should contact your doctor.

Causes

The precise cause of myeloma has not been identified but exposure to certain chemicals, radiation and some viruses are thought to increase the risk of having it. There is little evidence to suggest that myeloma runs in families.

Rarely, myeloma can develop from a non-cancerous condition known as MGUS (monoclonal gammopathy of undetermined significance). MGUS is a condition where there are raised paraproteins in the blood but there are no other symptoms.

Diagnosis

Your GP will ask you about your symptoms, examine you and take a blood sample. Your GP may refer you to see a haematologist or haemato-oncologist - a doctor who specialises in treating cancers of the blood.

You will need several tests to see whether you have myeloma and to allow your doctors to plan your treatment. These tests may include the following.

• A blood sample - to test for paraproteins in your blood as well as the levels of healthy cells in the blood such as red blood cells, white blood cells and platelets. Blood tests can also check your kidney function.
• A urine sample - to test for paraproteins in your urine, in particular a paraprotein called Bence Jones protein.
• X-rays - to check for any damage to your bones caused by the myeloma cells; you will probably have an X-ray taken of your whole body. This is known as a skeletal survey (see Related topics).
• A bone marrow sample - this is usually done only after paraproteins have been found in your blood.

For the bone marrow sample, your doctor will put a needle into one of your bones (usually your hip bone) and remove a small sample of bone marrow. This test is usually done under local anaesthesia, which completely blocks feeling from the area while you stay awake. The sample will be sent to a laboratory for testing.

You may also need to have further scans to check for bone and organ damage such as:

• a CT scan, which uses X-rays to make a three-dimensional picture
• an MRI scan, which uses magnets and radio waves to produce images

Treatment

Treatment for myeloma won't cure the disease completely but it can control it and give you a remission or a partial remission. A remission is when myeloma cells can no longer be detected in your blood or bone marrow. A partial remission, also called a plateau phase, is when your paraprotein levels fall and remain stable at this lower level.

If your myeloma returns after a period of remission, this is known as a relapse. Relapse is extremely common in people with myeloma but the period of time in remission varies between individuals.

Your treatment will be tailored to you as an individual. You may have some of the following treatments.

Medicines

There are a number of medicines available to treat myeloma. These include:

• steroid therapy - this can kill myeloma cells and also help to enhance the activity of other treatments
• thalidomide - an anticancer drug that your doctor may prescribe at the beginning of your treatment or if your myeloma returns
• bortezomib (eg Velcade) - another type of anticancer drug that your doctor may prescribe at first the relapse

You may also need to take medicines to relieve your symptoms. The medicines you take to relieve the pain may be those you would normally take for a headache, or your doctor may prescribe stronger painkillers which can include opiates such as morphine. It's important that you don't take painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief because they can damage your kidneys.

Other medicines which you may be given to include the following.

• Bisphosphonates are medicines that help strengthen your bones, treat hypercalcaemia and relieve pain.
• Erythropoietin (EPO) injections .may be given to you if you have anaemia, to help increase your number of red blood cells
• Granulocyte-colony stimulating factor (G-CSF) encourages the bone marrow to produce more white blood cells as sometimes they decrease during chemotherapy.
• Interferon is a medicine that stimulates your body's immune system (which defends your body against infection) to attack the myeloma cells.

Your doctor may also prescribe antibiotics to help you fight infections.

Chemotherapy

This uses anticancer drugs (known as cytotoxic drugs), which kill the myeloma cells in the bone marrow. Some forms of chemotherapy can be given as tablets and others by injection into a vein. Your doctor may suggest that you have a plastic tube (such as a Hickman line) put into a vein. This can remain in place for a longer period of time so that you don't need a new needle inserted each time you have chemotherapy.

High-dose chemotherapy

This treatment may be an option, but it isn't suitable for everyone. High-dose chemotherapy kills more myeloma cells than standard doses of chemotherapy, but in doing so it severely damages the bone marrow. So, you will need a stem cell transplant after the treatment to allow your bone marrow to recover.

Stem cells are blood cells at their earliest stage of development and they become red blood cells, white blood cells and platelets. Stem cells are collected from your bone marrow or your blood (or sometimes from a donor) before you receive high-dose chemotherapy. They are stored during your treatment and then injected back into your vein afterwards. For more information, please see Related topics.

Radiotherapy

This is a treatment that uses radiation to kill cancer cells. You may have radiotherapy to strengthen weakened bones and help relieve pain. It can also help to relieve symptoms of spinal cord compression.

Blood transfusion

This is a treatment where blood or blood components are put into your bloodstream. You may need to have a blood transfusion to treat anaemia.

Dialysis

This is a treatment to filter out waste products from your blood. You may need to have dialysis if your kidneys are damaged.

Surgery

You may need to have an operation to repair your bones if they are weakened, or to treat spinal cord compression.

Self-help

It's important that you drink at least three litres of water each day to reduce the calcium levels in your blood. This will help minimise any damage to your kidneys. You should drink this amount of water for the whole time you have the myeloma, not just during your treatment. Your doctor will give you advice on this.

Further information

• Myeloma UK
  0800 980 3332
  www.myelomaonline.org.uk
• Leukaemia Research
  020 7405 0101
  www.lrf.org.uk

 

Related topics

• Bone marrow transplantation
• Cancer - a general overview
• Chemotherapy
• CT scan
• Leukaemia - a general overview
• MRI scan
• Radiotherapy
• X-rays

Sources

• Myeloma: your essential guide. Myeloma UK. December 2006. www.myelomaonline.org.uk
• Improving outcomes in haematological cancer. National Institute of Health and Clinical Excellence. October 2003. http://guidance.nice.org.uk
• Myeloma. Cancerbackup. www.cancerbackup.org.uk, accessed 24 August 2007
• Souhami R, Tobias J. Cancer and its management. 5th ed. Blackwell Publishing, 2005
• Hoffbrand A, Moss P, Petit J. Essential Haematology. 5th ed. Blackwell publishing, 2006
• Smith A et al. Guildelines on the diagnosis and management of multiple myeloma. British Journal of Haematology. 2005; 132: 410-451
• Myeloma (multiple). BMJ Clinical Evidence. www.clinicalevidence.bmj.com, accessed 24 August 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Premini Mahnedra MD, FRCP FRCPath Consultant Haemato-oncologist at Queen Elizabeth Hospital Birmingham and the Priory Hospital, Birmingham, and by Bupa doctors. It has also been reviewer by Myeloma UK. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: February 2008.