Multiple Myeloma- Symptoms, causes, and treatment

Dr.Roshan Dikshit, 4 mins read

A multiple myeloma is a form of cancer that is caused by the development of an unusual plasma cell (that shouldn’t be there) or “atypical” plasma cell in the bone marrow, one that mutates and proliferates quickly. Presently, oncological research has been yet unable to categorically ascertain the clear cause of “multiple myeloma”, or rather, what exactly causes these atypical plasma cells in the bone marrow. This makes multiple myeloma diagnosis both equally and critical as this is a rather rapidly reproduced and potentially fatal form of cancer, wherein cancerous myeloma cells overtake the natural production of new and healthy cells in the bone marrow. Fortunately, not a lot of people will require multiple myeloma treatment as the disease is very rare and accounts for under two percent of all cancer cases. However, multiple myeloma can cause severe kidney damage along with other major health complications when the atypical plasma cells begin producing atypical antibodies (called monoclonal (M) proteins). Read to learn more about the symptoms, causes, treatment, and multiple myeloma stages. 

There are different presentations of multiple myeloma. Indolent myeloma, in most cases, develops rather slowly neither without causing any apparent symptoms nor without the formation of any bone tumors. Instead, there are tiny spikes in M protein and M plasma cells. The other type is Solitary plasmacytoma, which does cause the formation of tumors in most cases, mostly in the bone, this type of myeloma has also shown good responses to treatment, but patients need to be careful and closely monitored at all times. 

Symptoms of multiple myeloma

The symptoms of multiple myeloma are complex and vary quite a lot from person to person. Most early symptoms almost always go unnoticed, but as the disease progresses; a majority of people with multiple myeloma will begin to experience one (or in rare cases more) of the four major types of symptoms associated with this disease. 

The acronym CRAB can best encapsulate these 4 major symptom areas associated; 

C stands for calcium, R for renal failure, A for anemia, and B for bone damage. One major symptom from this group is most common in advanced cases of multiple myeloma. 

What is usually the first symptom of multiple myeloma?

As mentioned, the earliest or first signs of this disease do vary and sometimes won’t appear at all. The most common symptoms people experience early include fatigue, nausea, and bone pain, particularly in the back or chest areas. 

The specific symptoms associated with CRAB are:

Calcium related symptoms

Very high levels of calcium in the blood can be attributed to myeloma-stricken bones leaking out calcium. These spikes in calcium levels may cause vomiting, nausea, extreme thirst, an upset stomach, loss of appetite, constipation, and a sense of being dazed and confused regularly.  

Kidney failure

The increase in M protein in the body may damage the kidneys and cause kidney failure, the symptoms of kidney damage or failure are excessive drowsiness, fatigue, decreased amount of urine, swelling in the legs, ankles, and feet, sudden and unexplained shortness of breath, nausea, chest pain, and pressure, seizures, confusion and in some very rare instances, even going into a coma. 

Anemia related symptoms

Anemia will occur if cancerous cells begin to outnumber red blood cells in the bone marrow. Common symptoms of anemia are dizziness, fatigue, and general irritability without external instigation. 

Bone damage-related symptoms

As cancerous cells begin to enter the bone and bone marrow, bone injuries and fractures also begin to occur simultaneously. There will also be accompanying bone pain, which can be attributed to the lesions made by the cancerous cells. The areas that are most affected are the back, ribs, pelvis, and skull. 

Other symptoms 

Apart from the four major areas affected, other symptoms of multiple can also come to include weakness and/or numbness in the legs, feeling confused, nausea, problems with urination, unintended weight loss, vomiting, catching infections repeatedly, vision-related issues, or even vision loss.

What is the main cause of myeloma?

As stated, the exact cause of multiple myeloma is yet unknown, but it does begin with one “atypical” plasma cell that proliferates in the bone marrow. What sets cancerous myeloma cells apart from typical cancerous cells is that they don’t have a typical life cycle, by which we mean that rather than multiplying and eventually dying, these cells continue to 

divide without dying. This is the reason multiple myeloma spreads so rapidly and harms the body in equal measure.

Risk factors of multiple myeloma

Key findings in this field suggest men are at higher risk of developing multiple myeloma, along with those over the age of 50, obese individuals, and those who have been exposed to radiation or are/were working in petroleum refineries. 

Another risk factor can be a history of monoclonal gammopathy of undetermined significance (or MGUS). The condition usually doesn’t cause any problems but has been known (rarely) to develop into multiple myeloma. 

Diagnosis

Routine physical exams, and blood and urine tests can detect this and some further tests will help doctors discover signs of myeloma. 

Blood and urine tests check for M proteins and a protein called beta-2 microglobulin. Certain imaging tests are also used to determine whether bones have been damaged by multiple myeloma, X-Rays, CT Scans, MRIs, and PET scans are such tests. 

A biopsy may be used to check for cancerous cells in a laboratory. Various tests can see how quickly the cells are multiplying and determine whether it is multiple myeloma or another plasma cell condition.

Multiple myeloma stages 

There are two ways of staging multiple myeloma. The first is the Durie-Salmon Staging System, based on the M protein levels, calcium, and red blood cells as well as the extent degree of bone damage. The International Staging System is based on the levels of blood plasma and beta-2 microglobulin.

Both systems have three stages, the third being the most severe. The present classification system also integrates cytogenetic risk scoring to prognosticate and thus risk stratifies patients.

Multiple myeloma treatment 

There’s no known cure as of now for multiple myeloma. However, there are treatments to manage pain, and complications, and for slowing the disease’s progression. Treatment is based on symptoms and most doctors will not suggest treatment if there are no symptoms. Instead, they will closely lookout for signs of progression. 

If needed, common options include targeted therapy through medication to block a chemical in myeloma cells that kill proteins, killing the cancer cells. Biological therapy and chemotherapy are also options to kill fast-growing cells, including myeloma cells. 

Corticosteroids are used to treat myeloma as they reduce inflammation and destroy myeloma cells. 

Radiation therapy can kill and stop myeloma cells quickly in a certain area of the body.

Stem cell transplants are also an option that replaces the diseased bone marrow with new healthy bone marrow. Usually, a patient less than 70 years undergoes autologous (own stem cells) after initial treatment of myeloma to avoid an early relapse. Rarely a young patient may be advised of an allogeneic transplant (Stem cells from a healthy donor).

Also, Read: What You Need to Know About Bone Cancer