Symptoms, diagnosis, and treatment for myeloma and other blood disorders
Myeloma is a blood cancer that affects plasma cells, which are a type of white blood cells. These cells originate in the spongy inner part of the bone called bone marrow. When plasma cells develop into cancerous myeloma cells, they multiply uncontrollably and reduce the production of healthy blood cells, which are necessary for helping your body fight infections. This can also weaken and destroy the affected bones over time.
When cancer cells develop in multiple locations in the bone marrow, or occasionally outside of the bone marrow, the disease is called multiple myeloma. The treatment approach will vary based on the stage of the disease. For example, smoldering multiple myeloma (SMM) is an early form of the disease and typically requires close monitoring until it begins to cause symptoms. Once the disease progresses to active myeloma, it requires prompt treatment.
Symptoms and risk factors
What are the signs of multiple myeloma?
This bone marrow disorder doesn't always cause symptoms. However, as the disease progresses, symptoms can be described with the acronym CRAB:
C - Calcium levels elevated: As bones break down due to the abnormal plasma cells overcrowding the healthy cells in the bone, calcium levels can rise. High calcium levels can cause patients to feel confused or experience an altered mental state.
R - Renal dysfunction: Malignant (cancerous) plasma cells make a protein that blocks the kidney's filtering process, which can lead to kidney damage, including kidney failure.
A - Anemia: As abnormal plasma cells crowd out red blood cells, it can cause anemia, leading to fatigue, weakness, and shortness of breath.
B - Bones: If myeloma cells destroy bone tissue, it can cause bone pain or fractures.
These symptoms may also be related to other conditions, so it's important to talk to a doctor who can help determine the cause.
What causes multiple myeloma?
We don’t know what causes most cases of multiple myeloma; most often, it develops in patients with no known risk factors. But risk factors that have been identified include:
Age: Almost everyone diagnosed is over 45, and most are over 65.
Race: African-Americans are twice as likely to get the disease as whites.
Medical history: You face a higher risk if you have a personal history of other plasma cell disorders, such as plasmacytoma (a single tumor rather than several) or monoclonal gammopathy of undetermined significance (MGUS).
Radiation and chemical exposure: Several studies have found a slight association between multiple myeloma and radiation or chemicals, such as pesticides.
Screening and prevention
Can I prevent multiple myeloma?
There is no known way to prevent this disease. However, we continue investigating ways to prevent further progression of the disease.
We use several tests to identify and determine the extent of the disease.
Successful multiple myeloma treatment depends on a complete and accurate diagnosis. Each of our patients receives a thorough evaluation so we can create an individualized plan. We diagnose with:
History and physical examination: We complete a thorough examination and take a full personal and family medical history.
Blood and urine lab work: We may take a blood sample to test your complete blood count (CBC), blood chemistry, and other factors. In addition, your doctor may recommend 24-hour urine studies to test for certain proteins that may be a sign of this disease.
Bone marrow biopsy: We use a hollow needle to remove a small sample of bone marrow, blood, and bone from the hipbone or breastbone. The samples are studied under a microscope and may undergo other testing, including analysis for genetic changes.
Additional tests may include:
MRI: Magnetic resonance imaging uses a powerful magnetic field and radio waves to create detailed 3D images at higher contrast than CT scans, which may be useful for clarifying other test results.
PET/CT: Positron emission tomography (PET) scans involve injecting a safe radioactive chemical before using advanced imaging to detect any abnormalities. We may recommend whole body low-dose computed tomography (CT) to effectively assess the stage of the disease with less radiation exposure than standard CT imaging.
Skeletal bone survey: X-rays of all the bones may be taken to find damaged areas.
Bone densitometry: A special X-ray may be used to measure bone density.
Types of cancer
How is multiple myeloma categorized?
Smoldering myeloma is the precancerous form of this plasma cell disorder that requires careful surveillance. Once symptoms develop, it becomes active myeloma which is categorized in three stages ranging from least aggressive to most aggressive. To determine the stage, the condition is scored based on the following factors:
Beta 2 microglobulin levels (B2M)
Lactate dehydrogenase (LDH) value
Genetics based on fluorescence in situ hybridization (FISH) studies
What are multiple myeloma treatments?
If you're diagnosed, you can count on the experts at our Myeloma Clinic to determine the best treatment based on the unique characteristics of your disease as well as your age, overall health, and goals. Your cancer team may include doctors and advanced practice clinicians in hematologic oncology, radiology, pathology, pain management, and bone marrow transplantation, along with experts in psychology, social work, and rehabilitation, to ensure all of your needs are met. Because multiple myeloma can cause anemia, bone damage, and kidney problems, your treatment may also involve other specialists who can help to manage pain or fatigue caused by these symptoms.
Although bone marrow disorder is not curable, innovative treatment options are helping patients with the condition live long, fulfilling lives. You may need support managing the disease for extended periods of time, which is why it's important to work with specialists like ours who focus exclusively on treating multiple myeloma with a personalized and comprehensive approach. Through our active research program, you'll benefit from emerging treatment options that may lead to improved outcomes, even after others have failed.
Chemotherapy is a common cancer treatment that uses drugs to enter the bloodstream and kills cancerous cells. There are many different types of these drugs available, and when appropriate, your care team will recommend the right medication for you.
Immunotherapy and targeted therapy
We use several classes of innovative drugs to treat multiple myeloma, with the goal of getting you ready for an autologous stem cell transplant when appropriate. These may include combinations of three or four different drugs that work together to improve the body's natural response to the cancer. Drug combinations may involve immunotherapies and targeted therapies such as monoclonal antibodies, proteasome inhibitors, immune-modulating drugs, and steroids. Our myeloma doctors are experts in choosing drugs that are well-tolerated with the least amount of toxicity, and they'll work closely with you to minimize and manage any potential side effects.
Stem cell transplantation
Also called a bone marrow transplant, stem cell transplants provide patients with new, healthy bone marrow, improving their immune system. For myeloma treatment, our experts typically recommend autologous stem cell transplants for eligible patients, which involves collecting and storing a patient's own blood cells for transplant. The goal of stem cell transplant is to help patients achieve remission for as long as possible.
At MedStar Health, our Stem Cell Transplant and Cellular Immunotherapy program is the only adult program of its kind in Washington, D.C. Our full-time transplant specialists have decades of experience, making us one of the top stem cell transplant teams in the area. By providing the full spectrum of transplant care, you can trust us to guide you safely through treatment and recovery.
Looking for expert cancer care?
With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.
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Ravi Krishnan Anandakrishnan, MBBS
Kevin Y. Chen, MD
Medical Oncology & Hematology Oncology
Gurdeep Singh Chhabra, MD
Rumaisa Hameed, MD
Shweta Kurian, MD
Hematology Oncology & Medical Oncology
Ankit Madan, MD
Hematology & Medical Oncology
Mahsa Mohebtash, MD
Hematology, Breast Medical Oncology & Medical Oncology
Kamyar Nader, MD
Myeloma, Lymphoma, Leukemia, Hematology & Hematologic Malignancy
Charles A. Padgett, MD
Aarthi Ganesh Shenoy, MD
Hedy P. Smith, MD,PhD
Alaa Ali, MD,MSC
Cellular Therapy, Hematology & Medical Oncology
Kieron M Dunleavy, MD
Lymphoma, Hematology, Cellular Therapy & Medical Oncology
Anne Renteria, MD
Hematologic Malignancy & Hematology Oncology
Gustavo Adolfo Rivero, MD
David H. Vesole, MD,PhD
Myeloma, Hematology & Medical Oncology
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3800 Reservoir Rd. NW Washington, DC 20007
110 Irving Street, NW Washington, D.C., 20010
25500 Point Lookout Rd. First Fl. Leonardtown, MD 20650
18105 Prince Philip Dr. TG100 Olney, MD 20832
5601 Loch Raven Blvd. Russell Morgan Building First Floor Baltimore, MD 21239
12 MedStar Blvd. Ste. 180 Bel Air, MD 21015
9103 Franklin Square Dr. The Harry and Jeanette Weinberg Cancer Institute Suite 220 Baltimore, MD 21237
7501 Surratts Rd. Ste. 101 Clinton, MD 20735
We have a dedicated team of multiple myeloma experts who work closely with other specialists to treat you.
Your cancer team includes several doctors and a nurse practitioner who focus exclusively on diagnosing and treating multiple myeloma. Because these providers are highly-specialized, you can expect to build a close relationship that leads to personalized and compassionate care as you seek long-term treatment. In addition, our myeloma experts work closely with doctors in other fields, including pain management, orthopedics, and others to help manage the effects of your disease on your entire body.
We offer comprehensive care that consists of the latest myeloma treatments in combination with support services that treat all of you.
The Georgetown Lombardi Comprehensive Cancer Center is the only National Cancer Institute (NCI)-designated comprehensive cancer center in the Washington, D.C., region and the research engine behind the latest cancer treatment breakthroughs, including clinical trials. As an NCI-designated comprehensive cancer center, we offer a full range of services that help patients with myeloma feel supported throughout treatment, remission, and ongoing management of their condition.
You'll benefit from seamless coordination with our renowned bone marrow transplant center.
Home to the nation’s largest stem cell collection facility, our Stem Cell Transplant and Cellular Immunotherapy program is the region’s only adult, Foundation for the Accreditation of Cellular Therapy (FACT)-accredited program for autologous transplant, allogeneic transplant, and cellular immunotherapy. Our transplant specialists have exceptional experience caring for eligible patients before, during, and after their transplant procedure. In addition, we have innovative technology and unmatched experience in using CAR-T cell therapy to treat other blood cancers, which we hope to translate as a treatment option for myeloma patients in the future.
Awards and recognition
MedStar Georgetown University Hospital is the region’s only adult Foundation for the Accreditation of Cellular Therapy (FACT)-accredited program for autologous transplant, allogeneic transplant, and cellular immunotherapy.
Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons’ Commission on Cancer (CoC)
Magnet® designation from the American Nurses Credentialing Center (ANCC)
Clinical trials and research
Clinical trials allow us to test promising, novel treatments, such as bispecific therapies and new monoclonal antibodies that may help to slow down cancer progression. The doctors at our Myeloma Clinic actively participate in these research studies, offering a wide range of clinical trials to patients who are eligible.
Through our research engine and the only National Cancer Institute-designated comprehensive cancer center in the Washington, D.C., region, Georgetown Lombardi Comprehensive Cancer Center, our doctors and scientists continue exploring new targeted agents and drug combinations that may help better manage the disease.
Even after entering remission, cancer survivors benefit from physical, emotional, and psychological support services that help them return to good health. From a myeloma support group to personalized rehabilitation and follow-up care, we're here for you and your family.
Although myeloma is rarely related to hereditary conditions, our board-certified genetic counselors can help evaluate you and your family's risk for inherited cancers. This information can help you determine whether or not to pursue genetic testing and additional screening methods that may help you manage your cancer risk.
Multiple myeloma affects people in different ways, and physical or occupational therapy can help you to move and feel like yourself after treatment. Through a rehabilitation plan designed to meet your unique needs, our rehabilitation experts can help you rebuild strength, stamina, and flexibility.
After treatment, we help to guide you back to health with a personalized survivorship plan that involves management of any late effects, lab work and testing to monitor for recurrence, and specialty care for any unique health needs.