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What is myeloma?

Myeloma is a type of blood cancer that develops from plasma cells in the bone marrow. Myeloma is often called multiple myeloma because most people (90%) have multiple bone lesions at the time it is diagnosed.

Plasma cells are a type of white blood cell found in the bone marrow. They are part of the immune system and help fight infection. When cancerous, these abnormal plasma cells spread throughout the bone marrow so that there is not enough space to make enough normal blood cells.

Bone marrow is found in multiple areas of the body including the spine, skull, shoulders, ribs and pelvis.

In 2016, 1948 Australians were diagnosed with the disease. It usually occurs in people aged over 60, and is more common in men.

In 2018, there were 2148 deaths caused by myeloma in Australia.

The five year survival rate for myeloma is 51%.



Myeloma symptoms

  • bone pain or a broken bone without an obvious injury

  • frequent infections or an infection that is difficult to overcome

  • tiredness, shortness of breath or a racing heart

  • kidney problems

  • heavy nosebleeds or easy bruising

  • feeling sick, drowsy or confused

  • abnormal blood counts.



Causes of myelmoma

The causes of myelmoma are unknown. Certain chemicals, high levels of radiation (such as from working in a nuclear power plant) and viruses (such as HIV) have been linked to an increased risk of myeloma.

Myeloma is not considered hereditary, so it is rare for more than one person in a family to be affected.



    Diagnosis of myeloma

    Tests to diagnose myeloma may include:

    Blood and urine tests

    There are a number of blood and urine tests used to diagnose myeloma. The main blood test measures the amount and type of paraprotein in the blood. Paraprotein is an abnormal antibody that myeloma cells produce.

    Urine tests can check for the presence of Bence Jones protein, which is paraprotein in the urine.

    X-rays

    X-rays are usually taken of the head, spine, ribs, hips, legs and arms to see if there is any bone damage caused by myeloma cells.

    Scans

    A CT scan produces three-dimensional images to see a part of the body in more detail, or to look for areas of bone damage that may not appear on an x-ray.

    An MRI scan may be used as it can sometimes find myeloma in the bones and outside the bones. Less commonly used scans include FDG/PET and Sestamibi scans.

    Bone marrow biopsy

    A bone marrow aspirate and trephine biopsy is used to examine cells from the marrow. It is usually done with a local anaesthetic. A thin needle is used to remove a sample of bone marrow to examine under a microscope.

    Cytogenetic tests

    Using the bone marrow biopsy, cytogenetic tests look for changes in the chromosomes within the myeloma cells, which are different to the normal cells in the body. This can help determine treatment options.



    Treatment for myeloma

    Active monitoring

    Active monitoring, which involves regular check-ups, is most often used for early-stage myeloma, when it is considered that immediate treatment will not affect prognosis.

    Treatments to control myeloma

    Initial treatment usually includes a combination of chemotherapy and other drugs such as thalidomide and steroids.

    Chemotherapy

    Chemotherapy aims to kill cancer cells, and it can be administered as tablets, injected into a vein (intravenously) or under the skin (subcutaneously).

    Thalidomide

    Thalidomide works by blocking the blood supply to cancerous cells and by stimulating the body's immune system to attack myeloma cells. It is taken in tablet form. A relatively new drug called lenalidomide works in a similar way, and is commonly used for people with relapsed myeloma.

    Bortezomib

    Bortezomib, a drug that blocks the breakdown of protein within myeloma cells, causing them to stop growing and die, may also be used as a treatment for myeloma.

    Steroids

    Steroids (corticosteroids) can be used to modify the body's immune system responses, relieve swelling and inflammation and actively kill myeloma cells. Corticosteroids are usually taken as tablets, and can be given on their own, or more commonly, with chemotherapy or other anti-myeloma drugs.

    Bisphosphonate

    Bisphosphonate drugs are used to reduce bone pain and prevent further bone weakness or damage caused by myeloma cells. They also prevent dangerous rises in blood calcium levels.

    Radiation therapy (radiotherapy)

    Radiation therapy (also known as radiotherapy), the use of x-rays to kill or injure cancer cells, can be used to relieve some of the symptoms of multiple myeloma, such as bone pain.

    Plasma

    Plasma exchange may be used if the level of paraprotein in the blood is very high and interfering with blood circulation. It is a way of removing some extra proteins in the blood. The blood is removed via a needle in a vein in one arm, passing through a separating machine, which then puts the healthy portion of the blood combined with new replacement plasma back into a vein in the other arm.

    Stem cell transplant

    Stem cell transplant involves a high dose of chemotherapy to destroy the bone marrow, followed by transplanted blood-forming stem cells to rescue the bone marrow and help restore the blood cell numbers. This is an intense form of treatment which is completed in several stages. The entire procedure can take several months to complete and it is not suitable for everyone.

    Most people who undergo a stem cell transplant receive their own previously collected stem cells (autologous transplant). Sometimes stem cells from another person are used (allogeneic transplant).

    Palliative care

    In some cases of myeloma, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

    As well as slowing the spread of myeloma, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

    Treatment Team

    Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
    • GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
    • Haematologist- specialises in diagnosing and treating diseases of the blood and lymphatic system.
    • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
    • Cancer nurses- assist with treatment and provide information and support throughout your treatment.
    • Pain management team- treats pain, particularly if it is difficult to control or severe.
    • Dietitian- recommends an eating plan to follow while you are in treatment and recovery.
    • Other allied health professionals- such as social workers, pharmacists and counsellors.


    Screening for myeloma

    There is currently no national screening program for myeloma available in Australia.



    Preventing myeloma

    There are no proven measures to prevent myeloma. However, certain chemicals (e.g. dioxins), radiation and viruses (such as HIV) have been linked to an increased risk of myeloma and related diseases.



    Prognosis for myeloma

    It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person's individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of myeloma you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.

    Treatment for myeloma is constantly improving and it can help control the disease, manage the symptoms and improve quality of life, but currently cannot cure it. When the myeloma is under control, people usually return to a state of good health, which may last for several months or years before further treatment is needed.



    Sources

    Understanding Myeloma, Cancer Council Australia ©2018. Last medical review of source booklet: September 2018. 

    Australian Institute of Health and Welfare (AIHW). Australian Cancer Incidence and Mortality (ACIM) books: Myeloma. Canberra: AIHW. 

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