Myeloma
Myeloma
Myeloma is a type of blood cancer that starts in abnormal, or cancerous, plasma cells. Normal plasma cells are a kind of white blood cell that help fight infection, and they are made in the bone marrow.
In myeloma, the bone marrow starts producing large numbers of these abnormal plasma cells, known as myeloma cells. Because myeloma cells can turn up in the bone marrow of several bones throughout the body, this condition is often called multiple myeloma.
As myeloma cells build up, they crowd the bone marrow, leaving less room for it to make enough other normal blood cells. This is what leads to many of the symptoms of myeloma, including a reduced ability to fight infection.
Normal plasma cells produce several different types of antibodies. These antibodies circulate in the blood and help defend the body against viruses and bacteria. Antibodies are also known as immunoglobulins.
In myeloma, the cancerous plasma cells usually produce one abnormal immunoglobulin. This abnormal immunoglobulin is sometimes referred to as a paraprotein, or M protein.
Macmillan Cancer Support offers more detailed information on the different types of myeloma.
Types of myeloma
Myeloma is not a single, uniform disease. Each type is named after the particular abnormal immunoglobulin, or paraprotein, that its myeloma cells produce. The symptoms can vary somewhat between types, but treatment approaches are generally similar.
Plasma cell conditions related to myeloma
There are also some other conditions affecting plasma cells that, in certain cases, can go on to develop into myeloma.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
What causes myeloma?
Doctors don't fully know what causes myeloma. Certain risk factors can raise a person's chance of developing it.
Anyone who has had MGUS (monoclonal gammopathy of unknown significance) in the past has a higher risk of going on to develop myeloma. It's also more common in people over 65. Macmillan Cancer Support have more information about the causes and risk factors of myeloma.
Diagnosis
Myeloma can come to light in a few different ways. Some people first go to their GP because of symptoms such as:
- bone pain
- feeling constantly tired
- one infection after another (recurrent infections)
Your GP may organise some blood tests or scans. If needed, they'll then refer you to a doctor who specialises in blood conditions, called a haematologist, at the hospital. The haematologist can arrange further tests and start treatment.
Some people find out they have myeloma only after being admitted to hospital with more serious symptoms, such as:
- being very unwell with an infection
- problems with the bones
- spinal cord compression
- kidney problems
Tests
Once you're at the hospital, the haematologist will examine you and arrange further tests.
Blood tests
Your blood can be tested for a number of things. These tests help confirm myeloma and keep track of how it's behaving.
Urine tests
You may be asked to collect samples of your urine. This checks for a substance called Bence Jones protein and shows how well your kidneys are working. Sometimes you'll be given a container to take home so you can collect your urine over 24 hours. The nurses will walk you through exactly how to do this.
Bone marrow biopsy
In a bone marrow biopsy, a small sample of cells is taken from the bone marrow, the spongy tissue inside bone where blood cells are made. This sample is sent to a laboratory and checked for myeloma cells.
Cytogenetic tests
If myeloma cells are found, the sample may be tested further with cytogenetic tests. Cytogenetics is the study of chromosomes, the structures made up of genes that carry the instructions our cells need to function. These tests look for changes in the chromosomes of the myeloma cells, which helps show more about the cells and how they're likely to respond to treatment.
One such test is the FISH test (fluorescence in situ hybridisation). Your doctor may describe your FISH or other cytogenetic results as high-risk or low-risk.
Further tests
You may also need scans, such as a CT scan or an MRI scan, to check the bones. An MRI is often done alongside a CT scan. Further tests can include:
- CT scan
- MRI scan
- PET-CT scan
In rare cases, if an MRI or CT scan isn't suitable, an X-ray of the bones is done instead. This is known as a skeletal survey.
Waiting for test results can be an anxious time. Macmillan Cancer Support has more information that may help.
Stages of myeloma
The stage of myeloma describes how advanced it is and gives an idea of how well treatment is likely to work. Myeloma is usually staged from 1 to 3. Since the stage doesn't generally change the treatment offered, doctors don't always bring it up.
Macmillan Cancer Support has more information on the staging of myeloma.
Treatment
Treatment for myeloma
There are different treatments for myeloma. A team of specialists meet to discuss and plan the best treatment for you. This is called a multidisciplinary team (MDT).
Your doctor and nurse will explain the different treatments and their side effects. They can talk to you about things to consider when making treatment decisions.
The type of treatment your doctor offers you depends on a number of things, including your general health.
If the myeloma isn’t causing symptoms, you don’t usually need treatment straight away. Myeloma with no symptoms, is called smouldering or asymptomatic myeloma. You’ll have regular check-ups and tests. This is called active monitoring.
If the myeloma begins to cause symptoms, you’ll start treatment. Myeloma with symptoms is called active or symptomatic myeloma. If you have active myeloma, you may have intensive treatment or less intensive treatment.
Less intensive treatments include:
- targeted therapies
- chemotherapy
- steroids
- managing symptoms
Usually, a combination of these treatments is used.
Some people might have intensive treatment. This depends on how the myeloma is affecting you and your general health. If your doctor thinks this treatment is suitable for you, they’ll talk with you about this.
Maintenance or continuous treatment
Your doctor may suggest continuing treatment until they get the best possible response for you. Or you may be given treatment for as long as it controls the myeloma. This is called continuous or maintenance treatment.
Macmillan Cancer Support have more information about treatment for myeloma.
You may be offered some treatments as part of a clinical trial.
Treatment for myeloma that comes back
Treatment for myeloma is usually very effective and most people respond well to treatment.
After a time, myeloma usually comes back and needs further treatment. This is called relapsed myeloma.
Macmillan Cancer Support have more information about treatment for relapsed myeloma.
After myeloma treatment
You usually have regular follow-up appointments at the hospital during your treatment and when you are in remission. Or you may have follow-up appointments with your GP. This is sometimes called a shared care agreement (follow-up care).
If you have smouldering myeloma (myeloma without symptoms) you’ll also have follow‑up checks every few months.
If you have any problems, or notice any new symptoms between appointments, tell your doctor or specialist nurse as soon as possible.
Coping with myeloma after treatment
There are different things you can do after treatment to look after yourself and recover from treatment.
Macmillan Cancer Support have more information on living with treatment.
Getting support
Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse.
Macmillan Cancer Support also has further information to support you. You can:
- phone the Macmillan Support Line on 0808 808 00 00
- chat to Macmillan specialists online
- use the Macmillan myeloma forum – you can talk to others affected by myeloma, ask questions and share your experience
Other organisations who offer information and support include:
- ACLT (African Caribbean Leukaemia Trust) – offers support for people from ethnic minorities affected by leukaemia and related illnesses
- Anthony Nolan – the UK’s largest stem cell and bone marrow register
- Blood Cancer UK – a blood cancer research charity that provides information and support on any type of blood cancer
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