Test and Treatments for Multiple Myeloma

Blood Tests

When you have multiple myeloma, cancer cells crowd out healthy blood cells in your body. Instead of making normal proteins called antibodies, they make particles called M proteins. (The M stands for monoclonal.) To diagnose you, your doctor will take a small amount of blood from a vein in your arm. A lab then checks it for M proteins and another substance -- beta-2 microglobulin -- that are signs you have multiple myeloma.

Urine Tests

The proteins that myeloma cells make don’t just show up in your blood. They can appear in your urine as well, which gives doctors another way to diagnose the disease. Plus, multiple myeloma can damage your kidneys, so your doctor will want to check your pee for any sign they aren’t working properly. Some of the tests require you to collect urine over a 24-hour period, not give just one sample.

Skeletal Survey

In this test, your doctor takes a look at all the major bones in your body using X-rays. Multiple myeloma can cause bone problems, including pain, soft or thinning bones, and fractures. X-rays can show that kind of damage. A technician will show you how to position yourself and then take images from different angles to get views of all your bones.

Bone Marrow Biopsy

Multiple myeloma starts in bone marrow, the spongy tissue inside some bones. To test it, the doctor uses medicine to numb the area near your pelvis, then he takes a sample of the liquid inside your bone marrow using a needle that goes into your pelvic bone. He also removes a sliver of bone and marrow. Doctors will check the samples to see how your cells look and whether you have too many plasma cells, a sign of multiple myeloma.

Magnetic Resonance Imaging (MRI)

This scan will show your doctor if myeloma cells have replaced normal bone marrow. Your doctor might also look for a tumor in the plasma cells of your blood called a plasmacytoma. This type of imaging test is also good for spotting spine fractures from the bone damage the disease can cause. For an MRI, you’ll lie still inside a machine that looks like a large tube while high-energy magnets and radio waves make pictures of your insides.

Positron Emission Tomography (PET)

A PET scan is sometimes combined with another test, computed tomography, or a CT scan. Before you lie inside the scanner, you’ll get a substance injected into your veins through an IV in your arm or hand. It has a sugar and a radioactive chemical. Cancer cells absorb more of this substance, so the image gives your doctor a good idea of where those cells are in your body.

Fat Pad Aspirate

Multiple myeloma can make too many proteins build up in some organs, which can damage them. It’s called amyloidosis. If your doctor suspects that’s happening to you, the best way to find out is to check the fat around your belly. The doctor puts a needle into your belly and removes a small bit of tissue. (You’ll get numbing medicine first to make you more comfortable.) Then, he’ll look at it under a microscope.

Molecular Tests

These highly detailed looks at your bone marrow or tumor cells can identify chromosomes, genes, proteins, and other things that are unique to your cancer. The names of some of these tests are cytogenetics and fluorescent in situ hybridization (FISH). You and your doctors can use the information from these tests to decide on your treatment plan.

Watchful Waiting

Once you're diagnosed, you and your doctor may decide that the best treatment for your multiple myeloma is no treatment at all -- at least not right away. This approach is also called “active surveillance,” and it’s recommended if your disease is in the early stages and you don’t have any symptoms. You’ll have checkups often to make sure your status hasn’t changed. You might have blood and urine tests at these appointments.

Targeted Therapy

This treatment uses drugs that go after your cancer’s specific genes, proteins, or the tissue that helps it survive. This approach -- also called novel therapy -- targets the cancer but limits harm to healthy cells. Drugs in this group include those that stop myeloma cells’ growth in your bone marrow and others that help your own immune system fight the cancer. You take some of these drugs as pills; a needle is used to put others into a vein in your arm.

Chemotherapy

This type of treatment uses drugs to destroy cancer cells. You may take them in pill form or through a needle in one of your veins. You’ll get a series of these treatments on a set schedule, called a regimen. The length will depend on the drugs you take and how severe your condition is. Sometimes, doctors give a few chemotherapy drugs at once.

Radiation Therapy

Your doctor might order this treatment to shrink a tumor quickly if it’s causing pain or damaging a bone. High-intensity energy particles are beamed at your body from a machine, and the radiation from the particles kills the cancer cells. You’ll have a set number of treatments scheduled over a period of time.

Corticosteroids

Drugs such as prednisone and dexamethasone can boost your immune system, fight inflammation, and work against the myeloma cells in your body. Your doctor might have you take a steroid as part of your treatment plan. You can take these drugs in pill form, or get them as shots into a vein in your arm.

Stem Cell Transplant

This procedure replaces your damaged bone marrow with special blood-forming cells called hematopoietic stem cells. You can get them from a donor, or doctors can collect your own cells ahead of time and give them back to you. First, you’ll have chemotherapy to destroy the cancer cells in your body. Then the transplant puts new cells in to start making healthy bone marrow. The entire process takes several weeks. How much of that time you spend in the hospital depends on the specifics of your condition.

Bisphosphonates

Your doctor might add one of these drugs to your treatment plan if your multiple myeloma is causing a lot of bone problems. They can slow bone disease, prevent fractures, and ease your bone pain. Two common drugs are pamidronate (Aredia) and zoledronic acid (Zometa). You get them in a shot that goes into a vein.

Surgery

Operations can help deal with any bone fractures the disease causes -- they can reduce pain or help you move around better. Multiple myeloma often affects the spine. Nothing can undo the damage, but surgeons can help stabilize your back. You may have a procedure called vertebroplasty or another called kyphoplasty.

Multiple Myeloma -What Is It?

This blood cancer forms when plasma cells -- white blood cells that fight germs -- start to grow out of control. They’re found in marrow, the spongy tissue inside some of your bigger bones. Sometimes these abnormal plasma cells, known as myeloma cells, form a single tumor. That's called a solitary plasmacytoma. If you have more than one of these tumors, it’s called multiple myeloma.

Why Do You Get It?

Like many cancers, multiple myeloma has no known cause. However, there are some things that can raise your chances. Age plays a role: Most people who have it are over 65. It’s twice as common in African-Americans and slightly more likely to affect men than women. If someone in your family has it, you're more likely to get it, too.  

Can It Be Prevented?

You may wonder if there was anything you could have done to avoid this cancer. The answer is no. It doesn’t result from lifestyle choices, and you can’t discover it with early screening tests. In fact, multiple myeloma is hard to find early. Symptoms usually don’t show up until you’ve had it a while. But scientists learn more about what causes it every year, and new drugs are in the pipeline. 

Symptom: Low Blood Counts

Plasma cells aren’t the only ones formed in your bone marrow. Other white blood cells, red blood cells, and platelets are created there, too. However, myeloma cells can prevent bone marrow from making these healthy blood cells. That can lead to:

• Anemia (low red blood cells), which can cause fatigue
• Thrombocytopenia (low platelets), which can cause bruising or bleeding
• Leukopenia (low white blood cells), which raises infection risk

Symptom: Bone Fractures

Myeloma cells are a major enemy to bones. Believe it or not, your “old” bone is constantly being dissolved by cells called osteoclasts. Meanwhile, cells known as osteoblasts are making new bone. These things normally happen together. Myeloma cells speed up the breakdown process, but not the buildup. The result: Your bones get weak and can fracture easily.

Symptom: Infections

Plasma cells make antibodies, which fight germs. If you get a cold, they can create an antibody to attack the virus that’s making you sick. Abnormal plasma cells don’t do that. Myeloma cells multiply and quickly crowd out your healthy plasma cells, along with other white blood cells that protect you from infection. 

Other Things to Watch For

Multiple myeloma can lead to health problems like:

• Confusion and dizziness
• Numbness or muscle weakness in your legs
• Kidney problems

Because your bone dissolves faster than normal, you may have a high level of calcium in your blood. You might also feel really thirsty and dehydrated.

How Is It Diagnosed?

Blood tests can check for many red flags, like low blood cell counts and high calcium levels. X-rays can reveal bone loss. But the most important test for this cancer is a bone marrow biopsy. A doctor will insert a special needle into your bone and remove a tiny piece of tissue. He'll look at it with a microscope to see if you have myeloma cells.

Should I Get Treatment?

It sounds crazy, but if you don’t have symptoms yet -- a stage called smoldering myeloma -- the doctor may tell you not to. Many people wait months or years before they start treatment.

Are There Medications?

Yes. If you do need treatment, there are many types. You might try traditional cancer drugs like chemotherapy and corticosteroids. Or your doctor could try one of several new options:

• Immunomodulating agents: affect your immune system, but doctors don’t know how
• Proteasome inhibitors: stop cells from breaking down proteins
• Monoclonal antibodies: attack cells that are a threat

Other Treatment Options

If you’re under 65, or over 65 and otherwise healthy, your doctor may suggest a stem cell transplant. Before it, you’ll get a high dose of chemo or radiation to kill cells in your bone marrow. Then you’ll get a transplant of healthy stem cells -- the ones that create new blood. You might get your own cells. The doctor will call this an autologous transplant. Or they could come from a donor. This is known as an allogeneic transplant.

Related Health Issues

Drugs and blood transfusions improve anemia (low red blood cell counts) and the extreme fatigue it causes. There’s a special procedure that thins your thickened blood, a problem that can result in dizziness and confusion. Another treatment, intravenous immunoglobulin (IVIG), will help your body fight infections. You might also take drugs called bisphosphonates to lower your risk of bone fractures.

Questions to Ask Your Doctor

It’s always a good idea to bring up concerns and ask questions at your office visits. Put these on your list:

• How can I stay healthy?
• Are there ways to ease my pain?
• What stage is my disease in, and what does it mean for me?
• Does my treatment have side effects?
• Should I get a second opinion?
• Should I join a clinical trial?                                             
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