Risk Factors

Several factors influence the risk of developing multiple myeloma:

• Age: Growing older increases the chance of developing multiple myeloma. Most people with myeloma are diagnosed after age 65. This disease is rare in people younger than 35.
• Being male: More men are diagnosed with multiple myeloma each year than women. It is not known why.
• Family history of multiple myeloma: Studies have found that a person's risk of multiple myeloma may be higher if a close relative had the disease.
• Personal history of monoclonal gammopathy of undetermined significance (MGUS): MGUS is a benign (non-cancerous) condition in which abnormal plasma cells make M proteins. Some people with MGUS develop multiple myeloma. People with MGUS get regular lab tests and physical exams to watch for any signs of disease development.
• Race: The risk of multiple myeloma is highest among African Americans and lowest among Asian Americans. The reason for this is not known.

Researchers continue to study other risk factors such as being exposed to certain chemicals or viruses, having alterations in certain genes, eating certain foods, or being obese.

Symptoms

Common symptoms of multiple myeloma include the following:

• Bone pain
• Broken bones
• Feeling very thirsty
• Feeling weak and very tired
• Frequent infections and fevers
• Frequent urination
• Nausea or constipation
• Weight loss

Other health problems can also cause these symptoms. People with these symptoms should see their doctor.

Screening and Diagnosis

There is no routine test to screen for multiple myeloma. Myeloma is usually detected in patients that go to the doctor because of other health problems. Doctors often detect it after a blood test or suspect it after an x-ray of a broken bone.

To diagnose multiple myeloma, a doctor may order some of the following tests:

• Blood tests: Doctors check for specific substances in the blood that indicate myeloma, such as levels of certain proteins, calcium, and creatinine.
• Urine tests: The lab checks for Bence Jones protein, a type of M protein in urine, which is then collected over a 24-hour period. If the lab finds a high level of Bence Jones protein in the urine sample, doctors will monitor the kidneys. Bence Jones protein can clog the kidneys and damage them.
• X-rays: The patient may have x-rays to check for broken or thinning bones. An x-ray of the whole body can be done to see how many bones could be damaged by the myeloma.
• Biopsy: The doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether myeloma cells are in the bone marrow. There are two ways a doctor can obtain a bone marrow sample. Some people will have both procedures during the same visit:
• Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
• Bone marrow biopsy: The doctor uses a thick, hollow needle to remove a small piece of bone and bone marrow.

Staging

If the biopsy shows myeloma cells, it is important to know the stage (extent) of the disease to plan the best treatment. Staging may involve having more tests:

• Blood tests: The doctor tests for levels of specific substances in the blood, including albumin and beta-2-microglobulin.
• CT scan: Doctors often use CT scans to take pictures of tissue inside the body. An x-ray machine linked to a computer takes several pictures. The pictures may show whether cancer has spread to lymph nodes or other areas in the body.
• Magnetic resonance imaging (MRI): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.

Stages of Multiple Myeloma

Doctors may describe multiple myeloma as smoldering, stage I, stage II, or stage III. The stage is based on whether the cancer is causing symptoms and problems with the bones or kidneys.

• Smoldering is early disease without any symptoms.
• Stage I is early disease with symptoms (such as bone damage).
• Stage II or III is more advanced, and more myeloma cells are found in the body.

Treatment

At Huntsman Cancer Institute (HCI), multiple myeloma is treated by a team of specialists, including hematologic oncologists (doctors who specialize in cancers of the blood), medical oncologists, nurses, dietitians, social workers, and other professionals.

When a person visits HCI with a myeloma-related condition, our specialists first determine whether or not treatment is necessary. For example, those with MGUS or smoldering myeloma may not need treatment, but rather careful monitoring through lab tests and physical exams. Doctors run many tests to determine this and treatment decisions are made based on the results of these tests and other health-related problems that could impact treatment.

Tandem autologous stem cell transplants

There are many ways to treat myeloma. HCI specialists favor tandem autologous transplants when possible based on each patient's diagnosis. 

The process of a tandem autologous stem cell transplant involves the following:

1. Autologous means a person is treated with their own stem cells. Stem cells are collected from the person's bone marrow, blood stream, or umbilical cord blood or placenta (these stem cells would have been collected and stored at birth).
2. Stem cells are frozen until they are needed for transplant. They may be treated to kill any myeloma cells present.
3. To prepare for the transplant, the patient receives high-dose chemotherapy to destroy cancer cells and to prepare the body to receive new stem cells.
4. After being treated with high-dose chemotherapy, the patient receives their stem cells through a line that goes into a vein in the arm (called an IV line).
5. During a tandem transplant, a patient receives two sequential courses of high-dose chemotherapy with stem cell transplant within a period of six months or less.

Maintenance therapy

In addition to two autologous stem cell transplants, patients typically receive one year of maintenance therapy to fight any myeloma cells still lingering in the body. Maintenance therapy involves taking a combination of certain drugs on a timetable to help keep myeloma from coming back after a transplant. Drugs such as velcade, thalidomide, and dexamethasone are used during maintenance therapy.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.