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Plasma cells are a type of white blood cell found inside bone marrow. These specialized cells produce antibodies that defend the body from infection. When plasma cells grow out of control, they cause a type of blood cancer known as myeloma, or multiple myeloma.
Multiple myeloma is uncommon, only 1.8% of all cancers. The American Cancer Society estimates about 36,000 new cases will be diagnosed in 2025. There’s no cure for multiple myeloma, but thanks to advances in treatment for many patients it can often be considered a chronic disease that can be managed with expert care.
Stem cell transplant is one of the most effective treatments for multiple myeloma, and our Stem Cell Transplant and Cellular Immunotherapy program at Medstar Georgetown University Hospital (MGUH) is one few of its kind for adults in Washington, D.C. Our teams have decades of experience with this complex procedure. That’s why we are accredited by the Foundation for the Accreditation of Cellular Therapy (FACT). Patients who have been turned away at other programs due to age, health, or other reasons often find effective options at MGUH.
Patients can get the best treatment outcomes from MGUH because even though multiple myeloma is uncommon, our specialists treat patients with this cancer every day.
Risk factors and symptoms of multiple myeloma.
It’s not clear what causes the genetic variation that leads to multiple myeloma, but researchers have identified a few factors that can influence risk. These include:
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Age: The average age at diagnosis is 70.
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Exposure: Exposure to certain chemicals can increase your risk. Some veterans exposed to agent orange, those who served at Camp Lejeune, NC and people who were near the terrorist attacks on September 11, 2001, are at increased risk.
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Family history: People whose relatives have had multiple myeloma or related cancers of the immune system are more likely to develop this cancer.
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Obesity: Studies have shown that excess weight can increase risk.
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Race: Multiple myeloma is about twice as common in Black Americans than their white counterparts.
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Sex: Women are slightly less likely than men to develop multiple myeloma.
Multiple myeloma only has 3 stages, which are determined based upon blood and bone marrow tests. As it progresses, multiple myeloma can cause one of more of the following symptoms:
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Elevated blood calcium: Abnormal plasma cells stimulate cells in your bone marrow that remodel bone (osteoclasts) which may result in elevated calcium levels and weaking of the bones. Elevated calcium can cause confusion, nausea, constipation and kidney damage.
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Renal dysfunction: Multiple myeloma cells can produce proteins that can deposit in the kidneys, leading to kidney damage and kidney failure.
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Anemia: When red blood cells are crowded out, anemia can cause symptoms such as fatigue, weakness, and shortness of breath.
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Bones: Bone structure may be destroyed by myeloma leading to broken bones and bone pain.
If you or your doctor suspect you have multiple myeloma, it’s important to talk with a doctor who specializes in the condition because diagnosis, staging, and treatment can be complex. An average oncology practice only sees 6-10 multiple myeloma referrals a year.
Related reading: Multiple Myeloma Patients Can Lead Full, Happy Lives.
How is multiple myeloma diagnosed?
A multiple myeloma specialist will begin with a complete physical examination and an understanding of your personal and family history. Laboratory tests of a blood sample can find signs of the disease, and multiple myeloma-related proteins may appear in urine, too. A bone marrow biopsy is required. This procedure removes a small amount of tissue from inside the bone, called marrow, for study under a microscope and for genetic analysis of the multiple myeloma cells.
We sometimes use methods such as MRI, PET CT, or conventional CT scans to evaluate the integrity of the bones for signs of damage.
About 15% of newly diagnosed patients do not have any multiple myeloma-related symptoms, called smoldering myeloma. For most of these patients, treatment is not necessary. Careful monitoring with regular blood tests allows us to take steps to intervene when and if the disease progresses.
For patients with multiple myeloma at more advanced stages, effective treatments help people lead prolonged and good quality lives after diagnosis.
Innovative treatments can help manage myeloma.
One of the most effective treatments for multiple myeloma is a stem cell transplant, previously known as a bone marrow transplant. We collect the patient’s own bone marrow-like cells from the blood stream to use for the ‘transplant’.
During this process, the patients’ stem cells are collected and stored in a deep freeze. The patient will then receive a high dose of chemotherapy (called melphalan) which destroys the myeloma, but, unfortunately, the good bone marrow cells as well.
The next day, the stem cells are thawed and reinfused into the blood stream through a large venous catheter to allow the bone marrow to recover from the chemotherapy. Our experienced teams of dedicated transplant specialists have years of experience with patients and provide robust support services for our patients’ physical, emotional, and social needs.
Patients with multiple myeloma who are not eligible for a stem cell transplant may get chemotherapy, immunotherapy, or innovative medications known as targeted therapies. These can include monoclonal antibodies, bispecific antibodies, proteasome inhibitors, and immuno-modulating drugs.
Even without a transplant, with innovative treatments, we help many patients live long, high-quality lives after diagnosis.
Related reading: Transforming Treatments for Rare Blood Cancer
At the forefront of advances in myeloma treatment.
Our clinician researchers and patients are involved in several clinical trials that will advance our understanding of multiple myeloma and lead to even more effective treatments, including:
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CAR-T cell therapy: Our program is involved in ongoing clinical trials of this exciting immunotherapy, which involves collecting the individuals own immune cells, genetically modifying them in the lab, and returning them to the body to attack their cancer.
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Next generation genetic sequencing: Researchers can now sequence the entire myeloma genetic material. This work will help unlock the potential to understand which gene variations are behind an individual’s disease and tailor their treatment with precision medicine.
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New medications: A new type of drugs known as bispecific antibodies has been approved by the Food and Drug Administration. These next generation antibodies are lab-created proteins that create a bridge between the cancer cells and the patient’s immune cells to enhance the body’s ability to work against cancer.
Multiple myeloma is an uncommon and challenging condition, but effective treatments are available. Talk with a doctor who has experience treating patients with multiple myeloma—a specialist is best equipped to help personalize treatment to deliver the best results.
