Multiple Myeloma: Symptoms, Causes, Diagnosis, Treatment, and Prognosis

~Introduction

Multiple Myeloma is a type of blood cancer that originates in plasma cells, a specialized form of white blood cells found in the bone marrow. Plasma cells play a vital role in the immune system by producing antibodies to fight infections. In multiple myeloma, abnormal plasma cells multiply uncontrollably, crowding out healthy blood cells and producing abnormal proteins that damage organs, particularly the bones and kidneys.

Accounting for about 1% of all cancers and around 10% of blood cancers, multiple myeloma is considered a chronic but treatable disease. Advances in targeted therapy, immunotherapy, and stem cell transplantation have significantly improved survival rates and quality of life for patients.

~What Is Multiple Myeloma?

Multiple myeloma is a malignancy of plasma cells characterized by their accumulation in the bone marrow and the overproduction of a single type of abnormal antibody, known as monoclonal protein (M protein).

Unlike solid tumors, multiple myeloma affects multiple areas of the bone marrow simultaneously, which is why it is called “multiple” myeloma.

~How Multiple Myeloma Develops

The disease usually evolves gradually through precursor conditions:

1. Monoclonal Gammopathy of Undetermined Significance (MGUS)

• Asymptomatic condition

• Low levels of abnormal plasma cells

• Small annual risk of progression

2. Smoldering Multiple Myeloma

• Higher levels of plasma cells

• No organ damage

• Increased risk of progression

3. Active Multiple Myeloma

• Causes symptoms and organ damage

• Requires treatment

~Causes and Risk Factors of Multiple Myeloma

The exact cause of multiple myeloma is unknown, but several factors increase the risk.

Risk Factors

• Age: Most patients are diagnosed after age 60

• Gender: More common in men

• Family history: Slightly increased risk

• Race: Higher incidence in people of African descent

• Obesity

• Exposure to radiation or certain chemicals

• History of MGUS

~Symptoms of Multiple Myeloma

Symptoms vary depending on disease stage and organ involvement. Early stages may be asymptomatic.

Common Symptoms (CRAB Criteria)

C – Calcium elevation

• Nausea

• Constipation

• Confusion

• Excessive thirst

R – Renal (kidney) dysfunction

• Reduced urine output

• Swelling in legs

• Fatigue

A – Anemia

• Weakness

• Shortness of breath

• Pale skin

B – Bone disease

• Bone pain (especially spine and ribs)

• Fractures

• Spinal cord compression

Other Symptoms

• Frequent infections

• Weight loss

• Numbness or tingling

• Vision problems

~Diagnosis of Multiple Myeloma

Diagnosis involves a combination of laboratory tests, imaging studies, and bone marrow examination.

Diagnostic Tests

Blood Tests

• Complete blood count (CBC)

• Serum protein electrophoresis (SPEP)

• Free light chain assay

• Calcium and kidney function tests

Urine Tests

• Bence Jones proteins

• 24-hour urine protein analysis

Bone Marrow Biopsy

• Confirms diagnosis

• Measures percentage of plasma cells

Imaging Studies

• X-rays (skeletal survey)

• MRI

• CT scan

• PET scan

~Staging of Multiple Myeloma

The Revised International Staging System (R-ISS) is commonly used.

R-ISS Stages

• Stage I: Low-risk disease

• Stage II: Intermediate-risk

• Stage III: High-risk disease

Staging considers:

• Beta-2 microglobulin

• Albumin levels

• LDH levels

• Cytogenetic abnormalities

~Treatment Options for Multiple Myeloma

Treatment is personalized based on age, fitness, disease stage, and genetic risk.

1. Targeted Therapy

Drugs that target specific abnormalities in myeloma cells:

• Proteasome inhibitors (Bortezomib, Carfilzomib)

• Immunomodulatory drugs (Lenalidomide, Thalidomide)

2. Immunotherapy

• Monoclonal antibodies (Daratumumab, Elotuzumab)

• CAR T-cell therapy (for relapsed disease)

• Bispecific antibodies

3. Chemotherapy

• Used less frequently as first-line therapy

• Often combined with targeted agents

4. Stem Cell Transplant

• Autologous stem cell transplant is common

• Helps achieve deep remission

• Not curative but prolongs survival

5. Radiation Therapy

• Used for pain control or localized bone lesions

~Supportive and Adjunctive Treatments

Managing complications is a crucial part of myeloma care.

• Bisphosphonates for bone health

• Erythropoietin for anemia

• Antibiotics and antivirals to prevent infections

• Dialysis for severe kidney failure

• Pain management

~Prognosis and Survival Rates

Multiple myeloma is considered treatable but not curable, though long-term remission is possible.

Survival Outlook

• 5-year survival rate: ~60%

• Patients diagnosed early have better outcomes

• High-risk cytogenetics may affect prognosis

Survival has improved dramatically over the past two decades due to modern therapies.

~Complications of Multiple Myeloma

• Bone fractures

• Kidney failure

• Infections

• Hypercalcemia

• Blood clots

• Peripheral neuropathy

Early intervention and regular monitoring reduce the risk of severe complications.

~Living With Multiple Myeloma

Many patients live active, fulfilling lives with ongoing treatment and monitoring.

Lifestyle and Care Tips

• Maintain bone health through nutrition and exercise

• Stay hydrated

• Avoid infections

• Attend regular follow-ups

• Seek emotional and psychological support

~Prevention and Early Detection

There is no proven way to prevent multiple myeloma. However:

• Monitoring MGUS patients regularly

• Early evaluation of persistent bone pain or anemia

• Routine health checkups in high-risk individuals

~Frequently Asked Questions (FAQs)

Is multiple myeloma hereditary?

It is not directly inherited, but family history may slightly increase risk.

Is multiple myeloma curable?

Currently, it is not considered curable, but it is highly treatable.

Can multiple myeloma go into remission?

Yes, many patients achieve long-term remission with treatment.

~Conclusion

Multiple myeloma is a complex blood cancer that affects plasma cells and multiple organ systems. While it remains a chronic condition, remarkable advances in medical science have transformed it into a manageable disease for many patients. Early diagnosis, personalized treatment, and comprehensive supportive care are key to improving survival and quality of life.

If you or someone you know is facing a multiple myeloma diagnosis, consultation with a hematologist-oncologist and access to modern therapies can make a significant difference.