Understanding Multiple Myeloma: Diagnosis, Treatment, and What You Need to Know

Multiple myeloma is a type of cancer that affects plasma cells, which are a type of white blood cell in your bone marrow. Early and accurate diagnosis is crucial for effective management and treatment of this condition. This article provides a comprehensive overview of how multiple myeloma is diagnosed, the stages of the disease, available treatments, and ways to cope with this condition.

Diagnosing Multiple Myeloma: Key Tests and Procedures

Sometimes, multiple myeloma is discovered unexpectedly during routine blood tests conducted for other health concerns. In other instances, symptoms experienced by an individual may prompt a healthcare professional to investigate and test for multiple myeloma. A range of tests and procedures are employed to diagnose multiple myeloma effectively:

Blood tests. These are fundamental in detecting multiple myeloma. Myeloma cells produce abnormal proteins known as M proteins, which can be identified in blood samples. Additionally, blood tests can detect another protein produced by myeloma cells called beta-2-microglobulin. Beyond these specific markers, general blood tests provide a broader picture of your health and can offer clues about a potential diagnosis. These may include assessments of kidney function, complete blood cell counts, calcium levels, and uric acid levels.
Urine tests. Similar to blood tests, urine analysis can also reveal the presence of M proteins. When found in urine, these proteins are referred to as Bence Jones proteins. Urine tests are a complementary tool in identifying the abnormal protein production associated with multiple myeloma.
Bone marrow tests. Bone marrow biopsy and bone marrow aspiration are essential procedures for confirming a diagnosis. Bone marrow consists of both solid tissue and liquid components. A bone marrow biopsy involves extracting a small sample of the solid tissue using a needle, while bone marrow aspiration uses a needle to draw a sample of the liquid portion. These samples are typically collected from the hip bone. Once obtained, the samples are sent to a specialized laboratory for thorough examination. Lab tests specifically look for the presence of myeloma cells. Furthermore, advanced tests, such as fluorescence in situ hybridization (FISH), can provide detailed information about the myeloma cells, including any genetic changes or DNA abnormalities.
Imaging tests. To assess the impact of multiple myeloma on bones, imaging tests are crucial. These tests can identify bone problems associated with the condition, such as lesions or fractures. Various imaging techniques may be used, including X-rays, MRI scans (Magnetic Resonance Imaging), CT scans (Computed Tomography), and PET scans (Positron Emission Tomography). Each imaging type offers different perspectives and levels of detail, helping healthcare professionals understand the extent of bone involvement.

Staging and Risk Assessment: Understanding Myeloma Progression

The results from the diagnostic tests are critical in determining the stage of multiple myeloma. Staging is a system used to classify how advanced the myeloma is. For multiple myeloma, stages range from 1 to 3, with stage 1 indicating a slower growing myeloma and stage 3 representing a more aggressive, rapidly progressing form of the disease.

In addition to staging, multiple myeloma is also assessed for its risk level. This classification further describes the aggressiveness of the disease. The stage and risk level are vital for your healthcare team to understand your prognosis, which is the likely course of the disease, and to develop an appropriate and personalized treatment plan.

Multiple Myeloma Treatment Options: A Comprehensive Overview

Treatment for multiple myeloma is not always immediately necessary. In cases where there are no noticeable symptoms, a condition known as smoldering multiple myeloma, healthcare professionals may recommend watchful waiting. This involves regular testing to monitor the myeloma and observe if it progresses or worsens over time. However, when multiple myeloma starts to cause symptoms, treatment becomes essential. The primary goals of treatment are to alleviate pain, manage complications associated with the disease, and slow down the proliferation of myeloma cells.

When Treatment Starts and Monitoring

Smoldering multiple myeloma, an early, asymptomatic stage, might not require immediate intervention. If the myeloma is in its initial stages and progressing slowly, regular check-ups are scheduled to monitor the cancer’s behavior. These check-ups typically involve blood and urine tests to detect any signs indicating that the myeloma is becoming more active or aggressive. The decision to initiate treatment is a collaborative one between you and your healthcare team, usually prompted by the development of multiple myeloma symptoms.

Treatment Modalities

A variety of treatments are available for multiple myeloma, and the approach is tailored to the individual’s specific situation, stage, and overall health. Treatment options include:

Targeted therapy. This form of treatment utilizes medications that precisely target specific vulnerabilities within cancer cells. By blocking these specific chemicals or pathways, targeted therapies can induce cancer cell death.
Immunotherapy. Immunotherapy leverages the body’s own immune system to combat cancer cells. These treatments help the immune system recognize and destroy myeloma cells, which can often evade natural immune responses.
CAR-T cell therapy. Chimeric antigen receptor T-cell therapy (CAR-T) is a sophisticated immunotherapy. It involves modifying a patient’s T cells, a type of white blood cell, to target myeloma cells more effectively. This process begins with extracting T cells from the patient’s blood. In a lab, these cells are genetically engineered to produce special receptors (CARs) that recognize markers on myeloma cells. Once modified, these CAR-T cells are infused back into the patient, where they can actively seek out and destroy myeloma cells.
Chemotherapy. Chemotherapy employs potent drugs to kill cancer cells. These medications work throughout the body, targeting rapidly dividing cells, including myeloma cells.
Corticosteroids. These medications, such as prednisone and dexamethasone, are used to reduce inflammation and can also directly kill myeloma cells. They are often used in combination with other treatments.
Bone marrow transplant. Also known as stem cell transplant, this procedure aims to replace diseased bone marrow with healthy bone marrow. Prior to a transplant, stem cells (immature blood cells) are collected from the patient’s blood. High-dose chemotherapy is then administered to eradicate the existing diseased bone marrow. Subsequently, the collected stem cells are infused back into the patient. These cells migrate to the bone marrow and begin to regenerate healthy blood cells. When a patient’s own stem cells are used, it’s called an autologous bone marrow transplant. In some cases, stem cells from a healthy donor are used, known as an allogeneic bone marrow transplant.
Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays or protons, to destroy cancer cells. It can be effective in quickly reducing the size of myeloma cell masses, particularly in localized collections called plasmacytomas that cause pain or bone damage.

Treatment Plans

The treatment plan is highly individualized, considering factors like the patient’s eligibility for a bone marrow transplant. This decision is based on the myeloma’s likelihood of progression, the patient’s age, and overall health status.

Bone marrow transplant as an option. If a bone marrow transplant is deemed suitable, initial treatment usually involves a combination of drugs, potentially including targeted therapy, immunotherapy, corticosteroids, and sometimes chemotherapy. After several months of this induction therapy, stem cells are collected. The transplant may occur shortly after collection or after a relapse, if one occurs. In some situations, two bone marrow transplants might be recommended. Following a transplant, maintenance therapy with targeted therapy or immunotherapy is often administered to prevent myeloma recurrence.
Bone marrow transplant is not an option. For patients who are not candidates for or choose not to undergo a bone marrow transplant, treatment typically involves a combination of medications, similar to those used in induction therapy for transplant candidates.
Relapsed or refractory myeloma. If myeloma returns after treatment (relapses) or does not respond to initial treatment (refractory), further treatment is necessary. This might involve repeating the initial treatment regimen or exploring other available therapies, including newer drugs and clinical trials. Participating in clinical trials can provide access to cutting-edge treatments still under investigation.

Managing Complications of Multiple Myeloma

Treating complications arising from multiple myeloma is an integral part of overall care. Common complications and their management include:

Bone pain. Pain management strategies include pain medications, radiation therapy to targeted areas, and in some cases, surgical interventions to stabilize bones.
Kidney damage. Severe kidney damage may necessitate dialysis to filter waste products from the blood.
Infections. Vaccinations against common infections like influenza and pneumonia are crucial. Prompt treatment of any infections is also essential.
Bone loss. Medications that promote bone strengthening may be prescribed to prevent or treat bone loss and reduce fracture risk.
Anemia. Medications can stimulate red blood cell production, helping to alleviate anemia and reduce fatigue.

Coping and Support: Living with Multiple Myeloma

Receiving a cancer diagnosis can be overwhelming. Developing effective coping mechanisms is crucial for managing the emotional and physical challenges of living with multiple myeloma. Consider the following strategies:

Become informed. Educate yourself about multiple myeloma to actively participate in your care decisions. Discuss treatment options and potential side effects with your healthcare team. Reputable sources like the National Cancer Institute and the International Myeloma Foundation offer valuable information.
Build a strong support network. Lean on friends and family for emotional support. Joining a cancer support group, either online or in person, can provide valuable peer support and practical advice from others facing similar challenges.
Set achievable goals. Having goals can provide a sense of control and purpose. Adjust your goals to your current capabilities. For example, if full-time work is challenging, consider part-time employment, as many find that working during treatment can be mentally beneficial.
Prioritize self-care. Ensure you are eating well, getting adequate rest, and incorporating relaxation techniques into your routine. These practices can help manage stress and fatigue associated with cancer and its treatment.

Preparing for Your Doctor’s Appointment

If you are experiencing symptoms that concern you, schedule an appointment with your primary care physician or another healthcare professional. If multiple myeloma is suspected or diagnosed, you will likely be referred to specialists, such as a hematologist (a doctor specializing in blood disorders) or an oncologist (a doctor specializing in cancer treatment).

To make the most of your appointment, consider the following:

What you can do:

Symptom history: Document your symptoms, when they started, and how they have changed over time.
Medical history: List any other medical conditions you have, particularly any plasma cell disorders like monoclonal gammopathy of undetermined significance (MGUS).
Medications: Compile a list of all medications, vitamins, and supplements you are taking, including dosages.
Questions: Prepare a list of questions to ask your healthcare provider.

Questions to ask at your first appointment:

What are the possible causes of my symptoms?
Are there other potential conditions to consider?
What tests will I need?
What are the next steps to determine my diagnosis and begin treatment?

Questions to ask when seeing a specialist:

Do I have multiple myeloma?
What is the stage of my myeloma?
Are there any high-risk features associated with my myeloma?
What are the treatment goals in my case?
What treatment approach do you recommend?
How will my other health conditions be managed alongside myeloma treatment?
What are the potential side effects of the recommended treatment?
If the initial treatment is not effective, what are the alternative options?
Am I likely to be a candidate for a bone marrow transplant?
Will I need medication to strengthen my bones?
What is the overall outlook for my condition?

Do not hesitate to ask any other questions you have regarding your condition and treatment.

What to expect from your doctor:

Your doctor will ask you detailed questions about your symptoms and medical history, including:

Do you experience bone pain? If so, where?
Have you experienced nausea, increased fatigue or weakness, or unintended weight loss?
Have you had frequent infections, such as pneumonia, sinusitis, bladder or kidney infections, skin infections, or shingles?
Have you noticed any changes in your bowel habits?
Is there a family history of plasma cell disorders like MGUS?
Do you have a history of blood clots?

By being well-prepared and informed, you can actively engage in your healthcare and work collaboratively with your medical team to manage multiple myeloma effectively.