Myeloma

This factsheet is for people who have myeloma, or who would like information about it.

Myeloma, also known as multiple myeloma or myelomatosis, is a type of bone marrow cancer that affects the plasma cells.

  • About myeloma
  • Symptoms of myeloma
  • Complications of myeloma
  • Causes of myeloma
  • Diagnosis of myeloma
  • Treatment of myeloma
  • After your treatment
  • Prevention of myeloma

About myeloma


Myeloma is a rare form of cancer. It typically affects people aged 60 and over, and is unusual in people under 50. It affects more men than women.

Plasma cells are found in the bone marrow. The bone marrow is the spongy centre of large bones in your body, such as the spine, skull, pelvis, rib cage, shoulders and hips. The bone marrow produces stem cells which mature into red blood cells, white blood cells and platelets. Plasma cells are a type of white blood cell; they produce antibodies (also called immunoglobulins) to help fight against bacteria and viruses.

In myeloma, the DNA of the plasma cell is damaged causing it to produce only one type of antibody, called a paraprotein or M protein, which has no useful function. The damaged plasma cells are known as myeloma cells.

Myeloma cells are cancerous, meaning they multiply in an uncontrolled way. Most of the medical problems related to myeloma are caused by the build-up of myeloma cells in the bone marrow.

Symptoms of myeloma


The most common symptom of myeloma is bone pain (usually in your back or rib cage). Other symptoms may include:

  • tiredness and weakness because there are not enough red blood cells (this is called anaemia)
  • repeated infections, particularly chest or urinary infections, because there are not enough normal antibodies
  • unexplained bruising or bleeding, such as nose bleeds or bleeding gums, because there are not enough platelets which are responsible for blood clotting
  • confusion, loss of appetite, feeling sick, pain in your abdomen and constipation because of too much calcium in your blood

These symptoms aren’t always due to myeloma, but if you have them visit your doctor.

Complications of myeloma


If myeloma is left untreated serious complications can occur, these include:

  • kidney damage – caused by the paraprotein produced by the myeloma cells, the high levels of calcium in the blood and dehydration
  • bone disease – myeloma cells release chemicals which breakdown calcium in the bone, this eventually weakens the bones and increases the risk of bone fracture

Causes of myeloma


The precise cause of myeloma isn’t known but exposure to certain chemicals, radiation and some viruses are thought to increase the risk of having it. There is little evidence to suggest that myeloma runs in families.

Rarely, myeloma can develop from a non-cancerous condition known as MGUS (monoclonal gammopathy of undetermined significance). MGUS is a condition where there are raised paraproteins in the blood but no evidence of bone disease.

Diagnosis of myeloma


Your doctor will ask you about your symptoms and examine you, and take a blood sample. If the results show you may have myeloma, your doctor  will refer you to hospital for further tests.

At the hospital, you will need several tests to see whether you have myeloma. You may be asked to give:

  • a blood sample – to check for paraproteins, red blood cells, white blood cells and platelets; calcium levels and kidney function
  • a urine sample – to check for paraproteins
  • full body X-ray (skeletal survey) – to check for damage to your bones; sometimes a CT scan or an MRI are done

If paraproteins are found in your blood and urine, you will need a bone marrow biopsy. Your doctor will put a needle into one of your bones (usually your hip bone) and remove a sample of bone marrow. This test is usually done under local anaesthesia. This completely blocks feeling in the biopsy area and you stay awake. The biopsy is sent to a laboratory to check for myeloma cells.

You may need to have further scans or blood tests to determine the severity of the disease (called staging of myeloma). Knowing how advanced the myeloma is helps doctors decide the most appropriate type of treatment.

Treatment of myeloma


There isn’t a complete cure for myeloma, but there are treatments available to control symptoms and give you a remission or a partial remission. A remission is when myeloma cells are no longer detected in the blood or bone marrow. A partial remission is when myeloma cells are still present in the bone marrow but blood tests show lower levels of paraprotein.

If the disease comes back after a period of remission or partial remission, this is known as a relapse. Relapse is extremely common in people with myeloma, but the period of time in remission varies between individuals.

Your treatment will be tailored to your needs. You may have a combination of the following treatments.

High-dose therapy with stem cell support

Chemotherapy is a treatment to destroy cancer cells with medicines. Very high-doses of anticancer drugs can be used to destroy more myeloma cells than standard doses of chemotherapy, but in doing so it severely damages the bone marrow. So, a stem cell transplant is usually needed afterwards to help the bone marrow recover.

Stem cells are blood cells at their earliest stage of development before they become red blood cells, white blood cells and platelets. Stem cells are collected from the bone marrow before high-dose chemotherapy and then put back into your blood through a drip into your vein after the treatment. This is known as high-dose therapy with stem cell support (stem cell transplant)|. It’s an intensive treatment that isn’t suitable for everyone.

Radiotherapy

This is a treatment that uses radiation to destroy myeloma cells. It’s usually used to target localised areas where cancer cells are damaging and weakening the bones causing pain or compression of nerves. It can strengthen weakened bones and help relieve pain.

Blood transfusion

This is a treatment where blood or blood components are put into your bloodstream. You may need to have a blood transfusion to replace or top-up your red blood cells, white blood cells or platelets.

Dialysis

This is a treatment to filter out waste products from your blood. You may need to have dialysis if your kidneys are damaged by the high levels of paraprotein in the blood caused by the myeloma.

Surgery

You may need to have an operation to repair damaged bones.

Self-help

It’s important that you drink at least three litres of water each day to reduce the risk of dehydration and lower calcium levels in your blood. This can help reduce your risk of kidney damage. You should drink this amount of water as soon as you know you have myeloma and not just during your treatment. Your doctor will give you advice on this.

After your treatment


There is no cure for myeloma. In remission or partial remission, maintenance treatment is continued to help prolong the period of remission or partial remission. You will have regular blood tests to check for a relapse.

Prevention of myeloma


You may be able to reduce your risk of developing myeloma through certain lifestyle changes such as stopping smoking and eating a healthy, balanced diet.

Getting enough vitamin D may reduce your risk of developing a number of cancers, including myeloma – although more research needs to be done to be certain. Vitamin D is also well known to be important for bone health.

Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, do not let your skin redden. If you don’t get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough.

Always read the patient information leaflet that comes with your supplements and if you are pregnant or breastfeeding, ask your pharmacist or doctor for advice first. Talk to your doctor before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

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