Multiple Myeloma
Also known as: Myeloma, Plasma Cell Myeloma, Kahler Disease
Multiple myeloma is a cancer of plasma cells — white blood cells that produce antibodies — in the bone marrow. Abnormal plasma cells multiply uncontrollably, producing abnormal proteins (M proteins) that can damage bones, kidneys, and the immune system. It is the second most common blood cancer in the United States, and while there is no cure, modern treatments have significantly extended survival.
Symptoms
Causes
- Malignant transformation of plasma cells in the bone marrow
- Chromosomal abnormalities and gene mutations
- Often preceded by monoclonal gammopathy of undetermined significance (MGUS)
Risk Factors
- Age over 65 (median age at diagnosis is 69)
- Male sex (slightly more common in men)
- African American descent (twice the incidence of Caucasians)
- Family history of myeloma or MGUS
- History of MGUS or smoldering myeloma
- Obesity
Diagnosis
- Serum and urine protein electrophoresis (SPEP/UPEP) and immunofixation
- Serum free light chain assay
- Bone marrow biopsy showing ≥10% clonal plasma cells
- Skeletal survey, PET/CT, or low-dose whole-body CT for bone lesions
- Blood tests: CBC, creatinine, calcium, beta-2 microglobulin, LDH, albumin
Treatment
- Combination chemotherapy with proteasome inhibitors (bortezomib, carfilzomib), immunomodulatory drugs (lenalidomide, pomalidomide), and dexamethasone
- Autologous stem cell transplant for eligible patients
- Monoclonal antibodies (daratumumab, elotuzumab)
- CAR T-cell therapy (idecabtagene vicleucel, ciltacabtagene autoleucel) for relapsed disease
- Bispecific antibodies (teclistamab, elranatamab)
- Supportive care: bisphosphonates for bone disease, erythropoietin for anemia
Prevention
- No known prevention for multiple myeloma
- Monitoring of MGUS patients for progression (annual blood tests)
When to See a Doctor
- Persistent unexplained bone pain, especially in the back or ribs
- Unexplained anemia or fatigue
- Recurrent infections
- Elevated protein or calcium found on routine blood tests
Frequently Asked Questions
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