Understanding Myeloma in 2024: Symptoms, Causes, and Treatment Options
Discover the key symptoms, causes, and treatment options for myeloma in 2024. Learn how to manage this rare blood cancer and improve quality of life with advanced therapies.
Chris Willard
10/21/202417 min read
If you've recently heard the term "myeloma" from a doctor or while researching your health, you're not alone. Myeloma is a rare type of blood cancer, and it can be overwhelming to face such a diagnosis. In 2024, there are new advancements in treating myeloma that can significantly improve patient outcomes. But first, it's important to understand the basics—what myeloma is, its causes, how it progresses, and most importantly, the treatment options available. With the right knowledge and support, it's possible to navigate this challenging diagnosis.
Myeloma is a type of blood cancer that originates in the plasma cells, a specific kind of white blood cell responsible for producing antibodies, which help the body fight infections.
In a healthy person, plasma cells are a vital part of the immune system, helping to detect and eliminate harmful pathogens. However, in myeloma, these plasma cells become cancerous, multiplying uncontrollably and producing abnormal proteins known as monoclonal (M) proteins. These harmful proteins can accumulate in the body, leading to a variety of serious health problems.
When plasma cells become cancerous in myeloma, they crowd out normal, healthy blood cells in the bone marrow.
This can have several devastating effects on the body. First, it disrupts the production of red blood cells, which can lead to anemia and fatigue. It also hampers the creation of healthy white blood cells, weakening the immune system and making the body more vulnerable to infections. Additionally, a reduction in platelets, which help blood clot, increases the risk of bruising and bleeding.
Myeloma also affects the bones, as it often causes bone destruction, leading to pain, fractures, and elevated calcium levels in the blood (hypercalcemia). Over time, this bone damage can become severe, causing spinal compression or fractures in other areas of the skeleton.
Types of Myeloma
There are several types of myeloma, each varying in its severity and progression:
Multiple Myeloma
This is the most common form of myeloma, in which cancerous plasma cells are found in multiple locations throughout the bone marrow. Multiple myeloma typically progresses slowly but can cause significant damage to bones, kidneys, and the immune system if not treated.
Smoldering Myeloma
Smoldering myeloma is a slower-growing, asymptomatic form of the disease. While patients may have abnormal plasma cells in their bone marrow, they often do not experience symptoms initially. However, over time, smoldering myeloma can progress into active multiple myeloma, so regular monitoring is crucial for those diagnosed with this type.
Solitary Plasmacytoma
Unlike multiple myeloma, solitary plasmacytoma involves a single tumor of plasma cells, usually found in the bones or other tissues. Although it may remain localized for some time, solitary plasmacytoma can eventually progress into multiple myeloma if left untreated. Early treatment of this form can help prevent further spread of the disease.
Understanding the different types of myeloma is essential, as each has unique characteristics that influence treatment options and overall prognosis.
Common Symptoms of Myeloma
Recognizing the symptoms of myeloma early is crucial for timely diagnosis and treatment. While the symptoms of myeloma can vary depending on the individual and the progression of the disease, some signs are more common than others. Below are the key symptoms to watch for:
One of the most frequent and distressing symptoms of myeloma is bone pain.
This pain typically occurs in areas like the back, ribs, and hips because myeloma weakens the bones. The disease causes plasma cells to multiply uncontrollably in the bone marrow, leading to the erosion of healthy bone tissue. As the bones deteriorate, they become more fragile and susceptible to fractures, even with minimal stress. Patients may experience a dull, persistent ache or sharp pain, especially when moving. This bone pain can be one of the earliest indicators of myeloma, often prompting individuals to seek medical attention.
Myeloma weakens the immune system, making it harder for the body to fight off infections.
Plasma cells, a type of white blood cell, are essential for producing antibodies that help combat infections. However, when myeloma develops, the abnormal plasma cells crowd out healthy ones, leading to a deficiency in functioning antibodies. As a result, patients become more vulnerable to infections such as pneumonia, sinus infections, or urinary tract infections. Along with infections, fatigue is a common symptom. The disease can cause anemia (a shortage of red blood cells), further contributing to feelings of exhaustion and weakness. This persistent fatigue often does not improve with rest and can severely impact daily life.
Unexplained weight loss is another symptom that individuals with myeloma may experience.
This weight loss is not related to changes in diet or exercise but is instead a result of the body’s inability to maintain proper nutrition due to the effects of the cancer. As the disease progresses, myeloma can interfere with the body’s normal metabolism, causing muscle wasting and loss of appetite. Along with weight loss, many patients feel an overwhelming sense of weakness or lack of energy, which can affect mobility and the ability to carry out everyday tasks.
Hypercalcemia, or elevated calcium levels in the blood, is a dangerous condition that can occur in myeloma patients.
This happens when myeloma cells break down bone tissue, releasing calcium into the bloodstream. High calcium levels can lead to a range of symptoms, including nausea, vomiting, excessive thirst, frequent urination, and constipation. More severe symptoms of hypercalcemia include confusion, drowsiness, and even coma in extreme cases. If left untreated, hypercalcemia can be life-threatening, which is why recognizing and addressing this symptom promptly is vital.
By understanding these common symptoms—bone pain, frequent infections, fatigue, unexplained weight loss, and hypercalcemia—you can seek medical advice earlier, leading to a quicker diagnosis and better management of myeloma. If you notice any of these signs, especially in combination, it’s important to consult a healthcare professional for further evaluation.
Myeloma, like many cancers, doesn’t have a singular, easily identifiable cause.
Instead, it arises from a combination of genetic, environmental, and lifestyle factors. While the exact cause of myeloma remains unknown, research has identified several risk factors that may contribute to the development of this rare blood cancer.
One of the primary factors behind myeloma is genetic mutations.
In healthy individuals, plasma cells play a critical role in the immune system by producing antibodies to fight infections. However, in myeloma, these plasma cells undergo mutations that cause them to divide uncontrollably, leading to an overproduction of abnormal plasma cells. These mutated cells, rather than producing helpful antibodies, create proteins that can damage bones, kidneys, and other parts of the body.
Genetic mutations linked to myeloma often occur spontaneously and aren’t usually inherited. These mutations may accumulate in DNA over time, affecting genes responsible for cell growth, division, and survival. Some of the genetic abnormalities seen in myeloma include translocations, where a segment of one chromosome attaches to another, and deletions, where a portion of a chromosome is missing. These genetic changes disrupt normal cell regulation and contribute to the development of myeloma.
Risk Factors for Myeloma
Although the exact cause remains elusive, researchers have identified several key risk factors that can increase the likelihood of developing myeloma:
Age: Myeloma is more common in older adults, with the majority of cases diagnosed in individuals over the age of 65. As the immune system weakens with age, the likelihood of plasma cell mutations increases.
Family History: Having a close relative with myeloma or another form of blood cancer can elevate your risk of developing the disease. While myeloma itself isn’t directly inherited, a genetic predisposition to certain mutations may be passed down through families.
Race: Research has shown that African Americans are at a significantly higher risk of developing myeloma compared to other racial and ethnic groups. African Americans are diagnosed with myeloma at roughly twice the rate of Caucasians, though the reasons for this disparity are not fully understood. Some experts believe that genetic factors may play a role, alongside socio-economic and healthcare access variables.
Gender: Myeloma is slightly more common in men than in women, though the difference is not as pronounced as other risk factors.
Exposure to Radiation and Chemicals: People who have been exposed to high levels of radiation or certain chemicals may have an increased risk of developing myeloma. This includes individuals who have worked in environments where they were exposed to benzene, industrial solvents, or pesticides. Some studies have also linked myeloma to exposure to herbicides and insecticides.
Obesity: Emerging research suggests that obesity may increase the risk of developing myeloma. Excess body weight has been linked to changes in hormone levels and inflammation, both of which could contribute to the development of cancer, including myeloma.
Monoclonal Gammopathy of Undetermined Significance (MGUS): MGUS is a condition in which plasma cells produce abnormal proteins, but it doesn’t typically cause symptoms or require treatment. However, people with MGUS have a higher risk of progressing to myeloma over time, as MGUS can be a precursor to the disease. Monitoring and regular check-ups are essential for those diagnosed with MGUS to detect early signs of myeloma development.
Although lifestyle factors such as diet and physical activity aren’t direct causes of myeloma, they can still influence overall health and potentially impact cancer risk.
Certain lifestyle habits may indirectly contribute to the risk of developing myeloma:
Diet and Nutrition: While no specific diet has been linked to myeloma development, maintaining a balanced, nutrient-rich diet can strengthen the immune system and reduce inflammation in the body. Some studies suggest that chronic inflammation may contribute to the onset of various cancers, including myeloma.
Smoking: Smoking is a known risk factor for many cancers, including blood-related cancers. The harmful chemicals in cigarettes can damage DNA and increase the likelihood of mutations that lead to cancer. Quitting smoking can reduce cancer risk and improve overall health outcomes.
Exercise: Regular physical activity has been shown to reduce the risk of various cancers and improve immune function. While exercise cannot prevent myeloma, staying active may help to boost the immune system and support overall well-being, potentially lowering cancer risk in general.
Though there is no definitive way to prevent myeloma, understanding these risk factors can help individuals make informed decisions about their health. If you are at a higher risk due to family history, age, or other factors, it’s essential to have regular medical check-ups and maintain a healthy lifestyle. Early detection and intervention can make a significant difference in managing the disease effectively.
Understanding the stages of myeloma is essential for both patients and healthcare providers to determine the most appropriate treatment plan and to predict the course of the disease.
Myeloma is typically classified into three stages, which reflect the severity of the disease and the extent to which it has affected the body. Staging helps doctors assess how advanced the cancer is, how aggressively it may progress, and what the prognosis may be.
Stage I is considered the earliest and least severe stage of myeloma.
At this point, there are fewer cancer cells in the body, and the disease is often caught before major symptoms develop. Patients at this stage may have:
Low levels of the biomarker beta-2 microglobulin (a protein that is produced by myeloma cells).
Normal or near-normal albumin levels, which indicate healthy liver and kidney function.
No significant bone damage or organ impairment.
Patients diagnosed at Stage I generally have a more favorable prognosis compared to those in later stages. The disease tends to progress more slowly, and treatment options, if initiated, are often less aggressive. However, some patients in Stage I may not need immediate treatment and can be monitored closely through a "watchful waiting" approach.
Stage II myeloma is considered an intermediate stage, where the cancer cells have started to multiply at a faster rate, but the disease has not yet reached its most advanced form.
Patients in this stage typically have:
Moderate levels of beta-2 microglobulin, which indicates an increase in myeloma cell activity.
Normal or slightly lower albumin levels, reflecting potential stress on the body’s organs but not to a critical extent.
Some evidence of bone damage, anemia, or mild kidney dysfunction may be present.
Stage II myeloma can be more symptomatic than Stage I, with patients beginning to experience bone pain, fatigue, and increased vulnerability to infections. Treatment is often required to manage symptoms and slow the disease’s progression. The prognosis at this stage depends on how the myeloma responds to treatment, but it is generally still manageable with modern therapies.
Stage III is the most advanced stage of myeloma and is associated with a higher burden of cancer cells in the body.
Patients at this stage often exhibit:
High levels of beta-2 microglobulin, indicating a large number of cancerous plasma cells.
Low albumin levels, which may reflect significant organ impairment, particularly in the kidneys or liver.
Extensive bone damage, such as fractures or lesions, as well as other serious complications like severe anemia, kidney failure, or hypercalcemia (elevated calcium levels in the blood).
In Stage III, myeloma is considered more aggressive, and symptoms are more pronounced. Patients may experience intense bone pain, frequent infections, extreme fatigue, and other complications due to organ involvement. Treatment at this stage is often intensive, involving combinations of therapies such as chemotherapy, immunotherapy, and possibly stem cell transplants. While Stage III myeloma has a more guarded prognosis, advancements in treatment options have made it possible for many patients to manage the disease for longer periods.
Staging myeloma is based on specific biomarkers that provide insight into the activity of the cancer.
The two key biomarkers used in the Revised International Staging System (R-ISS) are:
Beta-2 Microglobulin (B2M): This protein is produced by myeloma cells, and higher levels indicate a greater number of cancerous cells in the body. As the disease progresses, B2M levels increase, making it a reliable marker for determining the stage of the disease.
Albumin: A protein produced by the liver, albumin levels help indicate overall health and organ function. Lower albumin levels may suggest that the disease is affecting vital organs like the liver or kidneys, which is common in more advanced stages.
Doctors may also take into account other factors, such as chromosomal abnormalities, lactate dehydrogenase (LDH) levels (an enzyme linked to tissue breakdown), and the presence of specific genetic mutations in determining prognosis and treatment plans.
The progression of myeloma refers to how the disease develops over time, particularly when it transitions from one stage to the next.
Myeloma is a progressive disease, meaning that it can become more severe and spread to different parts of the body, especially the bones and kidneys, as time goes on.
Progression in Stage I is usually slow, and patients may live many years with minimal symptoms or no need for immediate treatment.
In Stage II, the disease becomes more active, and without treatment, it can progress to Stage III more rapidly.
Stage III myeloma is the most severe and can lead to life-threatening complications if not managed effectively. However, with modern therapies, even patients in Stage III can experience remission or disease control.
The prognosis for myeloma patients has improved significantly with recent advances in treatment, such as targeted therapies, immunotherapies, and stem cell transplants. Early diagnosis and appropriate management can extend survival and improve the quality of life, even for patients diagnosed at later stages. Regular monitoring and adapting treatment plans based on disease progression are key to managing myeloma effectively.
In 2024, the treatment landscape for myeloma has significantly evolved, offering patients a variety of options that can help manage the disease more effectively.
These treatments focus not only on controlling the progression of myeloma but also on improving quality of life. Let’s explore the most commonly used therapies today.
Chemotherapy and Radiation Therapy: When They Are Used and Their Effectiveness
Chemotherapy and radiation therapy remain foundational treatments for myeloma, though they are often combined with more targeted therapies for better results.
Chemotherapy: This treatment uses drugs to kill cancer cells, stopping their growth and spread. Chemotherapy is often the first line of treatment for myeloma patients, especially during the initial stages or in preparation for a stem cell transplant. Common chemotherapy drugs used for myeloma include melphalan, cyclophosphamide, and doxorubicin. While effective in shrinking myeloma tumors and reducing symptoms, chemotherapy can cause side effects such as nausea, hair loss, fatigue, and increased risk of infection due to weakened immunity.
Radiation Therapy: Radiation is typically used in cases where myeloma has caused severe bone damage or pain. This therapy involves high-energy rays that target and kill cancer cells in specific areas. Radiation therapy is particularly useful for treating solitary plasmacytomas (localized tumors caused by myeloma) and reducing bone pain. However, radiation is generally not a standalone treatment for multiple myeloma, as the disease often affects multiple areas of the body simultaneously.
Both chemotherapy and radiation have been crucial in managing myeloma for decades. However, they are often combined with newer treatments to maximize their effectiveness and reduce long-term side effects.
Targeted therapies have revolutionized the treatment of myeloma by focusing on specific proteins or processes that allow cancer cells to thrive.
These therapies are more precise and generally cause fewer side effects compared to traditional chemotherapy.
Proteasome Inhibitors: Proteasome inhibitors are a class of drugs that block the action of proteasomes, which are enzymes that help cancer cells break down proteins. By inhibiting these enzymes, proteasome inhibitors can cause the myeloma cells to accumulate damaged proteins and die. Bortezomib (Velcade) and carfilzomib (Kyprolis) are commonly used proteasome inhibitors that have shown great efficacy in treating myeloma, especially when combined with other treatments.
Monoclonal Antibodies: Monoclonal antibodies are laboratory-made proteins that can specifically target cancer cells. In myeloma, these antibodies are designed to attach to certain proteins on the surface of myeloma cells, helping the immune system recognize and destroy them. Daratumumab (Darzalex) and elotuzumab (Empliciti) are examples of monoclonal antibodies used in myeloma treatment. These therapies are often combined with chemotherapy or other drugs to enhance their effectiveness.
Targeted therapies have improved survival rates for myeloma patients and have become a cornerstone in modern treatment plans, offering a more tailored approach to combating the disease.
New Treatment Approaches in 2024: CAR T-Cell Therapy, Bispecific Antibodies, and Immunotherapy
In recent years, cutting-edge therapies such as CAR T-cell therapy, bispecific antibodies, and other forms of immunotherapy have emerged as breakthrough treatments for myeloma, providing new hope for patients, especially those with advanced or refractory forms of the disease.
CAR T-Cell Therapy: CAR T-cell therapy is a form of personalized immunotherapy where a patient's own T-cells (a type of immune cell) are genetically modified to target and kill myeloma cells. In 2024, CAR T-cell therapy has shown remarkable success in treating patients with relapsed or refractory multiple myeloma. Two FDA-approved CAR T-cell therapies, idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel (Carvykti), have extended survival for patients who no longer respond to traditional treatments. While highly effective, CAR T-cell therapy can cause severe side effects, such as cytokine release syndrome (CRS), which requires careful management.
Bispecific Antibodies: Bispecific antibodies are designed to bind to two different proteins simultaneously—one on the myeloma cell and one on the T-cell—bringing the T-cell into close proximity to the cancer cell, which allows the immune system to attack the cancer more effectively. In 2024, bispecific antibodies such as teclistamab (Tecvayli) are being used to treat relapsed or refractory myeloma, offering another powerful tool for patients whose disease is resistant to other treatments.
Immunotherapy: Immunotherapy harnesses the body’s immune system to fight myeloma. In addition to CAR T-cell therapy and bispecific antibodies, other immunotherapies include immune checkpoint inhibitors, which help the immune system recognize and attack cancer cells. While immunotherapy is still being refined, its potential for long-term disease control is promising, particularly in patients with relapsed disease.
These advanced therapies have made a significant impact in the treatment of myeloma, offering new options for patients who have exhausted traditional therapies.
Stem cell transplantation remains one of the most effective treatments for multiple myeloma, particularly in younger or healthier patients.
In 2024, stem cell transplants continue to be a critical option for prolonging remission in myeloma patients.
Autologous Stem Cell Transplant (ASCT): The most common form of stem cell transplant in myeloma treatment is the autologous transplant, where a patient’s own stem cells are collected, frozen, and then reinfused after high-dose chemotherapy. ASCT does not cure myeloma but can extend the period of remission and improve survival rates. It is often used in combination with other therapies to maintain long-term control of the disease.
Allogeneic Stem Cell Transplant: In rare cases, an allogeneic stem cell transplant (using donor cells) may be considered, particularly in younger patients with aggressive disease. However, this type of transplant carries significant risks, including graft-versus-host disease (GVHD), and is less commonly used in myeloma treatment compared to ASCT.
Stem cell transplants are typically reserved for patients who respond well to initial chemotherapy or targeted therapies and are healthy enough to tolerate the procedure. For many, the transplant offers a significant extension of life expectancy and disease-free intervals.
Overall, the treatment options for myeloma in 2024 provide a broad range of therapies that can be tailored to individual patient needs. From traditional approaches like chemotherapy and radiation to advanced therapies such as CAR T-cell therapy and immunotherapy, patients have more hope than ever in managing their disease and improving their quality of life.
Living with myeloma can present unique challenges, both physically and emotionally.
However, by adopting proactive strategies and seeking support, patients can enhance their quality of life and better manage the complexities of this diagnosis. Here are some essential tips for navigating life with myeloma:
Maintaining a balanced diet and engaging in regular physical activity are crucial for overall well-being, especially for individuals living with myeloma.
A healthy diet can help:
Boost Immunity: Incorporating a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats can strengthen your immune system. Foods rich in antioxidants, such as berries, nuts, and green leafy vegetables, may help combat oxidative stress associated with cancer.
Manage Weight: Myeloma and its treatments can lead to changes in weight. Eating a nutritious diet helps maintain a healthy weight, reducing the risk of complications and improving energy levels.
Support Treatment: Certain foods can enhance the effectiveness of treatments and help manage side effects. For example, probiotics from yogurt can support gut health during chemotherapy, and hydration is essential to prevent dehydration caused by treatment-related nausea.
In addition to diet, regular exercise plays a significant role in improving physical and mental health. Activities such as walking, swimming, or yoga can enhance mobility, reduce fatigue, and improve mood. It's essential to consult with your healthcare team to create a safe and effective exercise plan tailored to your needs.
Coping with a chronic illness like myeloma can take a toll on mental health. Many patients experience feelings of anxiety, depression, or isolation.
Prioritizing mental health is vital, and there are several strategies to consider:
Mindfulness and Stress Reduction: Techniques such as meditation, deep breathing exercises, and yoga can help reduce stress and promote relaxation. These practices can provide a sense of control and help patients cope with anxiety related to their diagnosis.
Therapy and Counseling: Speaking with a mental health professional can offer valuable support. Cognitive-behavioral therapy (CBT) is particularly effective for addressing negative thought patterns and developing coping strategies.
Open Communication: Sharing feelings and concerns with loved ones can alleviate feelings of isolation. Encouraging open dialogues about emotions and fears helps build a supportive network.
Myeloma treatments can lead to various side effects, making symptom management a critical aspect of care.
Here are some tips for managing common symptoms:
Fatigue: It's common for patients to experience fatigue due to myeloma or its treatments. Prioritize rest, but also incorporate light physical activity when possible. Establishing a regular sleep schedule and practicing good sleep hygiene can improve energy levels.
Pain Management: Work closely with your healthcare team to develop an effective pain management plan. This may include medications, physical therapy, or alternative therapies such as acupuncture or massage.
Nausea and Digestive Issues: If nausea or digestive discomfort occurs, eating smaller, more frequent meals can help. Ginger tea or peppermint can provide relief for nausea. Always consult your doctor about medication options to manage these symptoms effectively.
Bone Health: Myeloma can weaken bones, increasing the risk of fractures. Regular bone density screenings and medications like bisphosphonates can help protect bone health. Additionally, weight-bearing exercises are essential to strengthen bones.
Support Groups and Counseling Options
Connecting with others who share similar experiences can provide invaluable support. Here are some options for finding help:
Support Groups: Joining a myeloma support group can foster a sense of community. Sharing experiences and learning from others can help reduce feelings of isolation and provide practical coping strategies. Many groups are available online or in person.
Patient Advocacy Organizations: Organizations such as the Multiple Myeloma Research Foundation or the Leukemia & Lymphoma Society often provide resources, support groups, and educational materials specifically for myeloma patients.
Counseling Services: Many hospitals and cancer centers offer counseling services for patients and their families. These professionals can help navigate emotional challenges, provide coping strategies, and support during difficult times.
Managing life with myeloma requires a holistic approach that considers both physical and emotional well-being. By focusing on nutrition, exercise, mental health, and leveraging support networks, patients can improve their quality of life and face the challenges of myeloma with resilience. Remember, each journey is unique, so work closely with your healthcare team to tailor these strategies to your specific needs. You are not alone; support is available, and a proactive approach can make a significant difference in your experience with myeloma.
Facing a myeloma diagnosis can feel overwhelming, but understanding the disease and available treatments can make a significant difference.
In 2024, the advancements in therapies offer hope for better management and improved outcomes. Remember, staying informed and working closely with your healthcare team are key to navigating this journey. If you or a loved one are battling myeloma, consider exploring the latest treatment options, seeking support, and staying proactive in your care. Always consult with your medical provider to create a treatment plan tailored to your specific needs.
These sources provide a wealth of information and are well-respected in the medical community.
American Society of Hematology (ASH)
Provides comprehensive resources on myeloma, including treatment options, management strategies, and support for patients.
Multiple Myeloma Research Foundation (MMRF)
Offers in-depth information about myeloma, including research updates, patient education resources, and tips for managing the disease and its effects.
Leukemia & Lymphoma Society (LLS)
A trusted organization that provides education, support, and resources for patients with blood cancers, including myeloma. Their site includes information on coping strategies, support groups, and financial assistance.
Mayo Clinic
Offers expert information on myeloma, including symptoms, diagnosis, treatment, and lifestyle management tips. Mayo Clinic is known for its high-quality patient care and reliable health information.
National Cancer Institute (NCI)
A government resource providing extensive information on various cancers, including myeloma. The NCI covers treatment options, clinical trials, and survivorship resources.