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Myeloma – Causes, Symptoms and Treatment

Myeloma is a malignant blood cancer originating in the bone marrow, where abnormal plasma cells multiply uncontrollably. It is one of the most common blood cancers worldwide.

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Things worth knowing about "Myeloma"

Myeloma is a malignant blood cancer originating in the bone marrow, where abnormal plasma cells multiply uncontrollably. It is one of the most common blood cancers worldwide.

What is Myeloma?

Myeloma – also referred to as multiple myeloma or plasmacytoma – is a malignant cancer of the bone marrow. In this disease, abnormal plasma cells (a type of immune cell) multiply uncontrollably, crowding out healthy blood-forming cells. These cancerous cells produce non-functional antibodies known as monoclonal proteins (also called M-proteins or paraproteins). Multiple myeloma is the second most common hematological cancer worldwide.

Causes and Risk Factors

The exact causes of myeloma are not yet fully understood. The following risk factors have been associated with the disease:

Age: The risk increases significantly after the age of 60.
Gender: Men are slightly more affected than women.
Genetic predisposition: Certain chromosomal abnormalities increase the risk.
Precursor conditions: Monoclonal Gammopathy of Undetermined Significance (MGUS) can progress to myeloma.
Radiation exposure and contact with certain chemicals are considered possible triggers.
Obesity and a weakened immune system may also increase risk.

Symptoms

Myeloma may remain asymptomatic for a long time. Common signs and symptoms include:

Bone pain, particularly in the back, ribs, and pelvis
Bone fractures (pathological fractures) due to bone destruction
Fatigue and weakness caused by anemia
Frequent infections due to a weakened immune system
Kidney problems from paraprotein deposits
Elevated calcium levels in the blood (hypercalcemia), causing nausea, confusion, and excessive thirst
Tingling or numbness from nerve compression

Diagnosis

The diagnosis of myeloma is established through a combination of examinations:

Blood and urine tests: Detection of paraproteins (M-protein), elevated calcium, and kidney markers
Bone marrow biopsy: A tissue sample is taken from the bone marrow to assess the proportion of plasma cells
Imaging: X-rays, computed tomography (CT), magnetic resonance imaging (MRI), or PET-CT to detect bone lesions
Cytogenetics and molecular genetics: Analysis of chromosomal abnormalities in tumor cells

A confirmed diagnosis requires meeting specific criteria set by the International Myeloma Working Group (IMWG), including a plasma cell proportion of at least 10% in the bone marrow and evidence of organ damage or specific biomarkers.

Treatment

While multiple myeloma is generally not curable in most cases, it is highly manageable with modern therapies. Treatment aims to control the disease, relieve symptoms, and improve quality of life. The approach depends on the disease stage, age, and general health of the patient.

Drug Therapy

Proteasome inhibitors (e.g., bortezomib, carfilzomib): Block protein degradation in cancer cells
Immunomodulatory drugs (e.g., lenalidomide, thalidomide): Strengthen the immune system and inhibit tumor growth
Monoclonal antibodies (e.g., daratumumab, elotuzumab): Target specific surface markers on myeloma cells
Corticosteroids (e.g., dexamethasone): Often used in combination with other agents

Stem Cell Transplantation

In eligible patients, high-dose chemotherapy is followed by an autologous stem cell transplantation (using the patient's own stem cells), which can lead to prolonged remission.

Radiation Therapy

Radiation therapy is used selectively to treat localized bone lesions and relieve pain.

Supportive Care

Additional supportive measures include bisphosphonates to protect bone integrity, blood transfusions for anemia, and treatment of infections and kidney complications.

Prognosis and Disease Course

The course of multiple myeloma varies greatly between individuals. Thanks to modern therapies, the prognosis has improved considerably in recent years. Many patients achieve long-lasting remissions. The disease typically follows a relapsing-remitting pattern with treatment phases and periods of remission. While a complete cure remains rare in most cases, intensive research is underway into new treatment strategies, including CAR-T cell therapies and bispecific antibodies.

References

Rajkumar SV et al. – International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncology, 2014.
National Cancer Institute (NCI): Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ). Available at: www.cancer.gov (2023).
Kumar SK et al. – Multiple myeloma. Nature Reviews Disease Primers, 2017. DOI: 10.1038/nrdp.2017.46

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