Bringing Myeloma Under Control
The initial treatment for multiple myeloma may be either:
- non-intensive for older or less fit patients
- intensive for younger or fitter patients
The decision about which treatment is appropriate for you is usually based on your biological age or fitness.
As a general rule, people younger than 65 are more likely to be candidates for intensive therapy. For those over 70, non-intensive treatment is more likely to be recommended.
Those aged in between will be given careful consideration as to what treatment group they fall into.
Both non-intensive and intensive treatments involve taking a combination of anti-myeloma medicines. Intensive treatment involves much higher doses and is followed by a stem cell transplant.
The medicines usually include a chemotherapy medicine, a steroid medicine, and either thalidomide or bortezomib.
Slowing Bone Loss With Bisphosphonates
Our doctors use a group of drugs called bisphosphonates to slow bone loss in people with myeloma. Bisphosphonates are commonly used to treat osteoporosis. Thats the thinning of bone tissue and loss of bone density associated with aging. At higher doses, bisphosphonates can halt the progression of bone destruction due to myeloma and other cancers. Preventing bone destruction also relieves pain.
Bisphosphonate therapy for myeloma is given intravenously on a monthly basis. Unlike pain relievers, which start working immediately, bisphosphonates take some time to strengthen the bones. Eventually, they provide protection against fractures.
Our doctors will review the side effects of bisphosphonates with you before prescribing them. In rare cases, bisphosphonate therapy can cause damage to kidneys or the jawbone. We will provide detailed information and guidance to help you and your dentist manage any side effects in the jaw. If you are undergoing extractions or other invasive dental procedures, you will need to wait until your mouth has completely healed before taking bisphosphonates.
What Does Bone Pain From Multiple Myeloma Feel Like
Multiple myeloma affects people in different ways, but most say that bone pain is a frequent and sometimes debilitating symptom. Members of MyMyelomaTeam describe bone pain in their own words:
- My leg pain was so bad I could not eat, sleep, or walk.
- I was miserably in pain.
- I used to not be able to wear shoes because I felt like my feet were on fire.
- For me, the pain is a very deep, dull pain.
- It was excruciating.
- This pain is just not going away, no matter what I do.
- Nothing can seem to kill the pain, so I get maybe one or two hours of sleep a night.
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How Is Multiple Myeloma Treated
Your treatment choices depend on the number of plasmacytomas you have, where they are, your symptoms, test results, and the stage of the cancer. The goal of treatment may be to control the cancer or help ease problems caused by cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be.
Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy and targeted therapy are systemic treatments. You may have 1 treatment or a combination of treatments.
Multiple myeloma may be treated with:
- Active surveillance
- Radiation therapy
- Stem cell transplant
Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.
Related Conditions Associated With Multiple Myeloma
As multiple myeloma progresses, other conditions develop. There are three significant conditions associated with multiple myeloma: amyloidosis, hypercalcemia and anemia.
A major co-occurring condition with multiple myeloma is amyloidosis, a buildup of proteins in the body that injures organs, stopping them from functioning normally. In addition to the primary symptoms of multiple myeloma, amyloidosis may cause:
- Purple spots on skin
- Swollen tongue or other issues with swelling
- Numb or tingly feeling in limbs, especially the feet and legs
- Painful joints
- Diarrhea, clay-colored stools or other digestive issues
Damage to the bones from multiple myeloma may release too much calcium into the blood. This causes hypercalcemia, a condition that may cause symptoms including:
- Nausea, vomiting or loss of appetite
- Constipation and other digestive issues
- Twitching of muscles or restless feeling
Hypercalcemia, amyloidosis and the excess of M protein and antibodies released by growing plasma cell tumors may damage organs, including the kidneys, nerves, heart, muscles and digestive tract. Multiple myeloma may lead to kidney failure and damaged peripheral nerves in the limbs. Symptoms of kidney failure include:
- High blood pressure
- Swelling of the legs, feet or ankles
- Muscle cramps
- Stiffness or fluid in joints
- Cognitive issues, such as trouble thinking or getting easily confused
- Feeling that limbs are weak or easily fatigued
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Symptoms Of Multiple Myeloma
Common pain is a common clinical complaint, which ultimately leads the doctor to the diagnosis of multiple myeloma. Seemingly small injury can cause abnormal compression of the vertebrae or fracture of the ribs. During physical examination, pain is often detected when moving in the affected bones, as well as tumor masses during palpation of the skull or other affected bones. Neurological signs of nerve compression due to a tumor or fracture and cerebrovascular complications are often present. Also, there may be positive signs of Trusso and Khvostek due to hypercalcemia. Anasarka due to renal failure is an unfavorable prognostic sign.
The presence of Ben Jones protein in the urine, anemia and an increase in the M protein of the tphi serum protein electrophoresis indicates a multiple myeloma. Classic “pierced” pockets in the bones of the skull and spine on radiocontrastless radiography are pathognomonic for this disease. Due to low osteoclast activity in patients with multiple myeloma, a gradionuclide study of bone with diffuse destruction can produce a negative result. MRI is indicated for all patients presumed to have multiple myeloma with signs of spinal cord compression. All patients with multiple myeloma showed serum creatinine determination, automated blood biochemistry, which includes determination (serum calcium.
What Is Multiple Myeloma Exactly
Multiple myeloma is a blood cancer that starts in the bone marrow. It happens when certain white blood cells known as plasma cells mutate and grow out of control. MM, also known as Kahler disease or plasma cell myeloma, is a pretty rare conditionthe average Americans risk of getting at some point in their lifetime is just one in 132.
About 30,000 cases of MM are diagnosed every year, and there are an estimated 130,000 people living with it in the U.S. today.
Like any cancer, multiple myeloma is a serious condition. But people with the disease have a much brighter future today than they did even 10 years ago. have been approved in the last decade, and survival rates keep going up. Today, the percentage of people who live at least five years after diagnosis is over 50%. For the 5% of people with multiple myeloma who are diagnosed at an early stage, the outlook is even bettertheir 5-year survival rate is over 70%.
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Differential Diagnosis Of Multiple Myeloma
Many other bone marrow pathologies, including heavy chain disease and Waldenstrom macroglobulinemia, can mimic the clinical picture of multiple myeloma. Amyloidosis also has many clinically similar symptoms. Metastatic disease due to a tumor of the prostate or breast cancer may provoke pathological fractures of the spine and ribs and metastasis in the cranial vault that can be taken for myeloma. The results of analyzes of patients with benign monoclonal gammapathy, most of which do not need special treatment, can simulate laboratory data observed with multiple myeloma.
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Symptoms Of Pressure On The Spine
Bone damage can cause pressure on your spine, which could lead to some of these symptoms:
- central back pain, made worse if you move, cough or strain
- a sudden change in a pain youve had for a long time
- crescendo pain
- pain that gets worse if you lie down or raise your legs
- pain in either one or both legs, especially if it starts in your back and spreads to your legs
- a tingling, electrical feeling in your arms or body when you bend your head forwards
- weeing or pooing uncontrollably, or having trouble going to the loo at all
- weakness or loss of feeling, usually in your legs, starting in the feet and moving upwards.
Its a good idea to share this information about new symptoms with your friends and family, so they can get medical help if you become unwell.
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When To Seek Medical Advice
You should speak to your GP if you have symptoms of multiple myeloma. While they’re unlikely to be caused by cancer, it’s best to be sure by getting a proper diagnosis.
You should seek immediate medical help if you have symptoms of spinal cord compression, hypercalcaemia or kidney failure, as these are medical emergencies that need to be investigated and treated as soon as possible.
What You Should Do
While neck or back pain is common, pain that suddenly develops, pain that is acute or progressively worsens warrants investigation, a diagnosis. According to the American Cancer Society , multiple myeloma is uncommon occurring in about 1 out of every 143 people in the United States. The ACA projects there will be about 30,330 new cases of multiple myeloma diagnosed during 2016.
American Cancer Society. What is multiple myeloma? http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-what-is-multiple-myeloma. Reviewed May 22, 2014. Updated January 19, 2016. Accessed September 20, 2016.
American Society of Clinical Oncology. Multiple Myeloma – Symptoms and Signs. http://www.cancer.net/cancer-types/multiple-myeloma/symptoms-and-signs. Published June 2015. Accessed September 23, 2016.
Multiple Myeloma. https://medlineplus.gov/multiplemyeloma.html. Last reviewed May 25, 2016. Updated August 18, 2016. Accessed September 20, 2016.
Multiple Myeloma Research Foundation. Bone Lesions and Damage. https://www.themmrf.org/multiple-myeloma/symptoms/bone-lesions/?gclid=CjwKEAjwmf6-BRDi9fSN7Ijt1wUSJAASawcjJ8BlrOs0b2F4NRA6tjR4rAHfVdiGVVHflgcWm-sQ2xoCmDDw_wcB. Accessed September 20, 2016.
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How Is Multiple Myeloma Diagnosed
Multiple myeloma may be diagnosed when you see your doctor because of symptoms. Sometimes its only found after abnormal blood or urine tests that were done for another reason, like a routine physical.
Your healthcare provider will ask you about your health history, symptoms, risk factors, and family history of disease. A physical exam will be done.
You may also have one or more of these tests:
- Blood tests
- Bone marrow aspiration and biopsy
After a diagnosis of multiple myeloma, youll likely need more tests. These help your healthcare providers learn more about the cancer. Imaging scans are used to see where and how much cancer there is in your body. Tests are also done to find out the stage of the cancer. The stage of multiple myeloma is a measure of certain proteins in your blood and gene changes in the cancer cells. It’s one of the most important things to know when deciding how to treat the cancer.
Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your healthcare provider to explain the details of your cancer to you in a way you can understand.
What Causes Bone Lesions In Multiple Myeloma
In a person who does not have myeloma, a normal bone has a process for bone remodeling. This keeps your bones strong and healthy. Inside the body, the bone remodeling process begins with certain specialized cells known as osteoclasts breaking down the old bones. Osteoblasts, another type of specialized cells, then lay down the foundation of a new bone in its place.
However, in people affected by multiple myeloma, the cancerous plasma cells, also known as myeloma cells, produce certain chemicals that are known as osteoclast activating factors . These osteoclast activating factors signal the osteoclasts to start breaking down the bones faster than usual. When this happens, the old bone gets broken down rapidly, but there is no new bone to take its place as the new bone is still manufactured by the osteoblasts at the same pace. This disruption of the natural process causes bone lesions and they are likely to weaken your bones and also make them more susceptible to break and fractures.
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When Should I Call My Healthcare Provider
Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:
- New symptoms or symptoms that get worse
- Signs of an infection, such as a fever
- Side effects of treatment that affect your daily function or dont get better with treatment
Ask your healthcare provider what signs to watch for, and when to call. Know how to get help after office hours and on weekends and holidays.
What Are The Causes Of Multiple Myeloma Bone Pain
Multiple myeloma causes bone lesions to develop as mentioned above. These bone lesions show up on an x-ray in the form of holes. Bone lesions are very painful and also increase the risk of having painful fractures or breaks.
Another reason for experiencing bone pain in multiple myeloma is that the cancer can also damage the nerves. You may also feel pain when a bone lesion presses up against a nerve. These bone lesions can also compress your spinal cord, causing muscle weakness and severe back pain.
You are likely to feel pain when you move, but not when you stay still. In multiple myeloma, you may feel bone pain in your- legs, hips, back, chest, pelvis, arms, skull, teeth, jaw and belly.
Statistics from the Multiple Myeloma Research Foundation shows that nearly 85% of all patients having multiple myeloma are going to experience some form of bone loss and bone pain associated with this.
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Early Symptoms Of Multiple Myeloma
Heres the tricky thing about the beginning stages of multiple myeloma: There are often no noticeable symptoms at all. Thats frustrating, because when its caught early, treatment can be more successful.
Often, early MM is discovered because the numbers are off on blood tests that are being done for other reasons. And importantly, a 2020 study by researchers at the Dana-Farber Cancer Center in Boston, MA, identified RNA changes in certain immune system cells during pre-cancer stages of multiple myeloma that may help doctors determine which patients are most likely to developing multiple myeloma.
Either way, as the disease progresses, there are some classic symptoms to keep an eye out for. Remember, having one or more of these symptoms doesnt necessarily mean you have multiple myeloma. But you should talk to your doctor to get a better understanding of whats going on.
Other Approaches To Improving Neuropathic Pain
- Transcutaneous electric nerve stimulation can be helpful.
- Regular exercise, such as walking, swimming, or gentle yoga or tai chi, can improve circulation and help reduce pain from neuropathy.
- Cigarette smoking and excessive alcohol consumption can worsen neuropathy. Avoid both.
- Good nutrition will ensure you are taking in the essential vitamins and minerals necessary for nerve protection and tissue repair. Discuss supplementing your diet with B vitamins amino acids such as acetyl-L-carnitine alpha lipoic acid and folic acid with a member of your health-care team.
- Gentle massage with cocoa butter can provide some pain relief.
- Acupuncture is safe when performed by a certified practitioner using sterile needles, and may provide some relief.
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Blood And Bone Marrow Problems
Myeloma can stop you from making enough healthy blood cells. This can cause symptoms like:
- Fatigue, weakness, shortness of breath, dizziness and feeling lightheaded
- Bruising and bleeding,
- Increased risk of blood clots
- Blood transfusion. This can help to reduce symptoms from low red blood cells . Blood will be given to you through a needle inserted into a vein like a drip.
- Erythropoietin. This drug can help severe anaemia. It causes the bone marrow to make red blood cells more quickly. It is normally given by an injection under the skin.
Abnormal bruising and bleeding
- Platelet transfusions. This is a fluid containing platelets which is given like a blood transfusion to prevent abnormal bruising and bleeding.
Multiple Myeloma Symptoms And Diagnosis
The most common symptom of multiple myeloma is severe pain, often occurring in the back, hips, or legs. In addition, patients may report fatigue due to anemia or high calcium levels. Less commonly, the disease may also cause unexplained weight loss.
In addition, proteins known as light chains secreted by dysfunctional plasma cells can damage the kidneys. And as myeloma attacks bone, calcium is released into the bloodstream, which can also affect kidney function.
Back or hip pain from myeloma may occasionally be mistaken for a sprain, slipped disc, or other spinal problem. However, routine blood and urine testing can give clues to the diagnosis of multiple myeloma, thus facilitating an earlier diagnosis even before bone damage can begin. This underscores why everyone should seek regular health checkups from a healthcare professional, and why we must work to increase access and affordability to routine care for all segments of the community.
To make a clear diagnosis, we of course begin with a comprehensive physical exam and patient history. In addition to blood and urine tests performed in-office or at the Emergency Department, we order lab tests that look for abnormal proteins. An X-ray can assess bone involvement and, where theres evidence of multiple lesions, an MRI or PET study can provide a better picture.
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Multiple Myeloma Plasma Cells
Plasma cells live in your bone marrow, the soft tissue that fills hollow bones. In addition to plasma cells, bone marrow is also responsible for producing other healthy blood cells.
Multiple myeloma leads to an accumulation of cancer cells in your bone marrow. Eventually, the cancer cells overtake healthy blood cells, and your body becomes unable to produce disease-fighting antibodies. Instead, it creates harmful proteins that damage your kidneys and cause other signs and symptoms.
Knowing the most common signs and symptoms of multiple myeloma may help you detect it before it becomes advanced. Make an appointment with your doctor if you notice any of the potential warning signs.
, the most common genetic mutations are in:
- oncogenes such as MYC and RAS
- tumor suppressor genes such as p53 genes
- deletion of chromosome number 17
Dendritic cells in bone marrow can also contribute to multiple myeloma. They release a hormone called interleukin-6 to stimulate cell growth in plasma cells. However, overproduction of IL-6 can promote abnormal cell growth and an increased risk for plasma cell tumors.
Signs and symptoms of multiple myeloma arent always easy to detect. You may not experience early symptoms of multiple myeloma. As the cancer advances, symptoms vary greatly.
The most common signs and symptoms of multiple myeloma include:
Other common signs and symptoms of multiple myeloma include: