Myeloma Center

Myeloma, also known as multiple myeloma or myelomatosis, is a cancer of plasma cells. These cancer cells are known as myeloma cells.

Blood cells look and work differently, but they all repair and reproduce themselves in the same way. Normally, this division of cells takes place in an orderly, controlled manner but with myeloma, the process gets out of control and abnormal plasma cells multiply, producing many myeloma cells. These fill up the bone marrow and interfere with production of the normal white cells, red cells and platelets.

The myeloma cells usually produce a large amount of one type of abnormal antibody. This is known as a paraprotein or M protein. This paraprotein cannot fight infection effectively and will often reduce the production of normal antibodies.

The myeloma cells have the ability to spread throughout the bone marrow and into the hard outer casing of the bone in many parts of the body. This spread has led to the term multiple myeloma.

Myeloma can cause thinning of the outer bone and bone pain. Myeloma occurs in middle aged and in elderly people; it is unusual before age 50 and very rare under age 40.

Myeloma is just one disease in a range of disorders of the plasma cells. There are some conditions that can progress to myeloma but may not necessarily do so. The two commonest of these are monoclonal gammopathy of uncertain significance (MGUS) and smouldering myeloma (also known as indolent myeloma). If you are diagnosed with these conditions, you will be monitored with blood tests but will not need treating unless the condition progresses.

Sometimes abnormal plasma cells are found in only one area of the body, commonly in a bone. This condition is known as a solitary plasmacytoma. It is treated with radiotherapy and you will be monitored with blood tests in case you develop myeloma in the future.

 

What causes myeloma?

Although the causes of myeloma are unknown, research is going on all the time into the possible causes of the disease. Myeloma, like other cancers, is not infectious and cannot be passed on to other people.

 

What are the symptoms of myeloma?

The first symptom of myeloma is often back pain, sometimes spreading to the ribs, neck or pelvis. Other symptoms may include any of the following:

• Excessive tiredness and lethargy due to a lack of red blood cells in the blood (anaemia). Kidney problems caused by the paraproteins produced by the myeloma cells. Kidney damage can increase tiredness and anaemia.
• Repeated colds, coughs and other infections (particularly chest infection) because of a shortage of normal antibodies.
• Weakening of the bones by the myeloma cells, which may increase the risk of fractures. Loss of appetite, feelings of sickness, constipation, depression and drowsiness caused by too much calcium in the blood (hypercalcaemia). The excess calcium comes from the damaged bones.
• Unexplained bruising and abnormal bleeding (nosebleeds or bleeding gums) because the number of platelets in your blood has decreased.
• Pins and needles, numbness, tingling or weakness in the feet or legs. Difficulty passing urine or opening your bowels. Any of these symptoms could mean that a myeloma tumour is pressing on your spinal cord (cord compression). You should contact your doctor immediately if you suspect this is happening to you.

If you have any of the above symptoms, you must see your doctor. But remember many of these symptoms can occur in other conditions. Most people with the above symptoms will not have myeloma.

How is it diagnosed?

Usually you begin by seeing your family doctor (general practitioner), who will examine you and arrange for you to have any tests or x-rays that may be necessary. Your GP will need to refer you to hospital for these tests and for specialist advice and treatment.

At the hospital, the doctor will take your full medical history before doing a physical examination.

Samples of your blood and urine will be taken and examined at a laboratory to see if they include paraproteins produced by myeloma cells.

Although taking the blood sample itself is straightforward, the tests for myeloma are quite complicated and it may be a week or two before you hear the results.

 

Further tests

If the blood test shows that a paraprotein is present, your doctor will want to take a bone marrow sample and do some further tests so that the best treatment for you can be planned.

Bone marrow sample
For this test, a sample of bone marrow is taken from the breast bone or hip bone and examined to see if it contains any myeloma cells. The test can be done on the ward or in the outpatients department.

Before the test, a local anaesthetic is used to numb the area and a needle is passed gently through the skin into the bone marrow. Using a syringe, a tiny sample of the bone marrow is taken for examination under the microscope.

The whole procedure takes about a quarter of an hour and if you do experience any discomfort, it only lasts a few seconds as the bone marrow is taken into the syringe. Often a small core of marrow is needed (a trephine biopsy) and this procedure takes a few minutes longer. You may be given a sedative before this procedure. It is not uncommon to have some discomfort for a few days after the test and painkillers may be necessary.

X-rays
These will be taken to check for any damage that may have been done to your bones by the myeloma cells. Usually x-rays are taken of the skull, spine, chest, ribs, pelvis, arms and legs.

Urine tests
Samples of your urine will be taken to test for a particular paraprotein known as the Bence Jones protein. This may involve taking a container home and collecting your urine over 24 hours.

Blood tests
If you do have myeloma, your doctor will want to do regular blood tests to measure the level of paraprotein in your blood, to check for anaemia and hypercalcaemia, and to make sure your kidneys are working properly.

It will probably take a few days or weeks before you receive your test results. A follow-up appointment will be arranged for you before you go home. Obviously, this waiting period is an anxious time for you and it may help you to talk things over with a close relative or friend.