Multiple myeloma is an incurable but treatable disease. Also known as myeloma or plasma cell myeloma, it is a hematologic cancer, meaning it develops in the blood. It is a cancer of the plasma cell, an important part of the immune system that produces immunoglobulins (antibodies) to help fight infection and disease.
As tumors grow inside the bone marrow, they invade the hard, outer part of the bone. In most cases, the myeloma cells spread into the cavities of all the large bones of the body, forming multiple small lesions. Hence the name "multiple" myeloma. In some cases, however, the myeloma cells collect in a single bone and form a tumor called plasmacytoma.
A patient's myeloma is often referred to by the type of immunoglobulin or light chain (kappa or lambda type) produced by the cancerous plasma cell. The frequency of the various immunoglobulin types of myeloma parallels the normal serum concentrations of the immunoglobulins. The most common myeloma types are IgG and IgA. IgG myeloma accounts for about 60-70% of all cases of myeloma and IgA accounts for about 20% of cases. Few cases of IgD and IgE myeloma have been reported.
Multiple myeloma is the second most prevalent blood cancer after non-Hodgkin's lymphoma. It represents approximately 1% of all cancers and 2% of all cancer deaths. Although the peak age of onset of multiple myeloma is 65 to 70 years of age, recent statistics indicate both increasing incidence and earlier age of onset. At the time of writing, there are approximately 45,000 people in the United States living with multiple myeloma and an estimated 14,600 new cases of multiple myeloma are diagnosed each year.
Multiple myeloma affects slightly more men than women. African Americans and Native Pacific Islanders have the highest reported incidence of this disease and Asians the lowest. Results of a recent study found the incidence of myeloma to be 9.5 cases per 100,000 African Americans and 4.1 cases per 100,000 Caucasian Americans. Among African Americans, myeloma is one of the top 10 leading causes of cancer death.
Agricultural occupations, petroleum workers, workers in leather industries, and cosmetologists with exposure to herbicides, insecticides, petroleum products, heavy metals, plastics, and various dusts, including asbestos, seem to have a higher-than-average chance of multiple myeloma. In addition, individuals exposed to large amounts of radiation are at increased risk for myeloma.
There are often no symptoms in the early stages of myeloma. In some cases, myeloma may be discovered by accident during routine blood testing. When present, symptoms may be vague and similar to those of other conditions. Here are possible symptoms; rarely does one patient have all of them:
Much less frequent symptoms with multiple myeloma are related to complications that may occur with the disease. These complications include:
The diagnosis of multiple myeloma is often made incidentally during routine blood tests for other conditions. For example, the existence of anemia and a high serum protein may suggest further testing.
A diagnosis of myeloma is made based on the presence of an increased number of plasma cells in the bone marrow and, in most cases, the presence of excess protein (M protein) in the blood or urine. At that point, patients are generally classified into categories based on their clinical and laboratory evaluation. Patients are also staged according to the severity of their disease based on a number of criteria.
A number of laboratory tests and medical procedures are used to help confirm a diagnosis of myeloma. These tests should be conducted on all patients as part of an initial evaluation.
X-rays and other imaging tests can assess changes in the bone structure and determine the number and size of bone lesions. These tests include:
Patients may be classified into 1 of 4 myeloma categories to help to determine treatment options.
While a myeloma diagnosis can be overwhelming, it is important to remember that there are several promising, new therapies that are helping patients live longer, healthier lives.
Patients in some myeloma categories do not have to receive treatment immediately. In these cases, postponing therapy may help avoid unnecessary side-effects and the risk of complications associated with chemotherapy and delay development of resistance to chemotherapy. Thus, knowing your classification is very important in deciding when it is appropriate to begin treatment.
Many patients on high dose chemotherapy for lymphoma or myeloma test positive for prothrombin precursor PIVKA II. These are proteins induced by vitamin K absence or antagonism.
Your body is a highly complex, interconnected system. Instead of guessing at what might be wrong, let us help you discover what is really going on inside your body based on the many clues it is giving.
Our multiple symptom checker provides in-depth health analysis by The Analyst™ with full explanations, recommendations and (optionally) doctors available for case review and answering your specific questions.