At Brown Cancer Center, we are at the forefront of discovering new, more effective multiple myeloma therapies. We're also leading the way toward advances in lowering the impact of the disease and its treatment on the body.
Our team of experts in our Blood Cancers, Cellular Therapeutics and Transplant Program are focused on myeloma. As one of the few comprehensive programs in the country, we continue to work every day to find new therapies for myelomas, a challenging and complex group of cancers.
Our pathologists are specially trained to accurately diagnose and stage all types of myeloma, important for choosing the most effective treatment plan.
We offer a range of innovative treatment options, including targeted therapies, vaccines and radio-immunotherapy, as well as clinical trials for new and relapsed disease.
Many times, treatment for multiple myeloma may continue for extended periods, with repeated remissions and recurrences. For this reason, our teams of experts, including specially trained support professionals, forge close medical relationships with you to be sure you receive personal, customized care. This individualized attention gives you the best chance of a full and healthy life.
Multiple myeloma is a cancer of the lymphoid system, which includes the lymph nodes, bone marrow, spleen and thymus. The lymphoid system also includes a specialized type of antibody-producing cell called the plasma cell. Multiple myeloma arises when these plasma cells experience uncontrolled growth and is thus a “cousin” of the lymphomas. About 24,000 people per year in the US will be diagnosed with NHL.
Plasma cell disorders occur on a spectrum of severity, ranging from MGUS (least severe) to symptomatic multiple myeloma (most severe). Plasma cell disorders are notable for their key feature of producing too much of a uniform, or monoclonal, antibody protein (called M protein). Occasionally, an abnormal growth of plasma cells can be localized, called solitary plasmacytoma. See the list below:
Monoclonal gammopathy of undetermined significance (MGUS):
- Monoclonal protein present, not in large quantity
- Bone marrow involvement by plasma cells less than 10 percent
- 1 percent per year risk of developing multiple myeloma (on average)
Smoldering multiple myeloma:
- Monoclonal protein present, may be in large quantity
- Bone marrow involvement by plasma cells from 10 to 59 percent
- 10 percent per year risk of developing multiple myeloma (on average)
Symptomatic multiple myeloma:
- Monoclonal protein present and/or at least one of the following:
- Bone marrow involvement by plasma cells 60 percent or greater
- Elevated calcium levels
- Renal insufficiency (reduced kidney function)
- Anemia (low red blood cell count)
- Bone lesions caused by plasma cells eating through bone
- A collection of plasma cells causing invasion of soft tissue or bone but without extensive bone marrow involvement, high calcium, kidney failure, anemia or multiple bone lesions
Multiple myeloma typically occurs in older persons, with the peak age of incidence in the 60s. Multiple myeloma is seen more commonly in men and in African-Americans.
Multiple myeloma’s key symptomatic manifestations are indicated by the acronym CRAB: calcium elevated, renal dysfunction, anemia and bone lesions.
Bone lesions can predispose to fractures. Other possible effects include osteoporosis and predisposition to infections. Low blood counts can occur if the bone marrow is heavily involved. Sometimes the presenting symptom is pain due to fractures of vertebrae or long bones of the thighs or arms. High calcium levels can pose a medical emergency, with patients experiencing lethargy and confusion. Frequently patients are diagnosed with MGUS or smoldering multiple myeloma based upon the incidental detection of a monoclonal protein in the blood.
Multiple myeloma is diagnosed based on a biopsy of the bone marrow or involved tissues that result in symptoms. A pathologist must look at the tissue under the microscope or perform an experiment called flow cytometry to look at characteristic molecules on the surfaces of the cells. Tests such as the measurement of proteins in the blood or urine (called protein electrophoresis), chemistry tests, X-rays of the entire skeleton, or CT scans and PET scans. CT and PET scans may be performed together as PET-CT scans. Two tests, measurement of albumin and beta-2-microglobulin, have special prognostic significance. A special test called cytogenetics, looking for chromosome breakages should be performed with biopsy of bone marrow or other affected tissues.
Patients with MGUS and smoldering multiple myeloma should be monitored until symptomatic disease arises. Some patients with smoldering multiple myeloma may be enrolled in clinical trials. Patients with symptomatic multiple myeloma are treated with chemotherapy and sometimes radiation to painful or at-risk load-bearing skeletal areas. Orthopedic surgery may be necessary in the case of fractures or bones at high risk of fracture.
Multiple myeloma typically responds well to initial therapy but almost always recurs and is generally considered to be incurable. Chemotherapy for multiple myeloma typically includes combinations of drugs such as the steroid dexamethasone, an immunomodulator drug (IMiD), and a proteasome inhibitor (PI) drug. Patients who are less than 75 years old, have generally good health and are physically active benefit from a procedure called autologous stem cell transplantation, in which patients receive a high dose of the drug melphalan followed by reinfusion of their own blood precursor cells (stem cells), while they are in remission after their initial therapy.
Patients who have return of disease after initial treatment or have an inadequate response to treatment may be candidates for stem cell transplantation or clinical trials. Other classes of drugs that stimulate the immune system to attack multiple myeloma cells are being introduced into practice.