What Is Multiple Myeloma? Understanding Symptoms, Diagnosis, and Treatment Options
Multiple myeloma is a type of blood cancer that originates in plasma cells—white blood cells responsible for producing antibodies to fight infections. In this condition, abnormal plasma cells multiply uncontrollably within the bone marrow, crowding out healthy blood cells and producing defective antibodies known as M proteins. These malfunctioning proteins can accumulate in the bloodstream and organs, leading to a range of systemic complications.
Understanding the Biology Behind Multiple Myeloma
Plasma cells are a vital part of the immune system, normally helping the body defend against pathogens. However, in multiple myeloma, genetic mutations cause these cells to become malignant. The overproduction of monoclonal immunoglobulins (M proteins) disrupts normal immune function and damages tissues throughout the body.
This uncontrolled cell growth often leads to the suppression of normal hematopoiesis—the process by which the body produces red blood cells, white blood cells, and platelets. As a result, patients may develop anemia, increased susceptibility to infections, and bleeding disorders.
Common Signs and Symptoms
The clinical presentation of multiple myeloma varies widely but typically includes several hallmark symptoms:
- Bone pain and fractures: Especially in the spine, ribs, and pelvis due to osteolytic lesions caused by tumor infiltration.
- Anemia: Resulting from reduced red blood cell production, causing fatigue, weakness, and shortness of breath.
- Kidney dysfunction: M proteins can damage renal tubules, potentially leading to chronic kidney disease or even renal failure.
- Frequent infections: Due to impaired antibody production and weakened immunity.
- Hypercalcemia: Caused by bone breakdown, which releases calcium into the bloodstream, leading to confusion, nausea, and dehydration.
Who Is at Risk? Age and Incidence Trends
Multiple myeloma predominantly affects older adults, with the majority of cases diagnosed in individuals over the age of 70. While it remains relatively rare compared to other cancers, its incidence has been steadily rising—a trend closely linked to global population aging.
Other risk factors include male gender, African ancestry, family history of plasma cell disorders, and pre-existing conditions such as monoclonal gammopathy of undetermined significance (MGUS), a precursor state that can progress to full-blown myeloma.
How Is Multiple Myeloma Diagnosed?
Accurate diagnosis involves a combination of laboratory tests, imaging studies, and clinical evaluation. Key diagnostic tools include:
Bone marrow aspiration and biopsy: This procedure examines the percentage of plasma cells in the marrow. A count exceeding 10% is considered abnormal and supports a diagnosis of multiple myeloma when correlated with symptoms.
Serum protein electrophoresis and immunofixation: These blood tests detect the presence and quantity of M proteins. A level above 30 g/L, combined with clinical findings, helps confirm the disease.
Imaging techniques: X-rays, MRI, or PET-CT scans are used to identify bone lesions and assess the extent of skeletal involvement.
Treatment Approaches and Long-Term Management
While multiple myeloma is currently incurable, it is treatable. Modern therapies aim to induce remission, manage symptoms, improve quality of life, and extend survival. Most patients respond well to treatment and can enjoy prolonged periods of stable health.
Standard Therapeutic Strategies
Chemotherapy and targeted agents: Combinations such as bortezomib, lenalidomide, and dexamethasone form the backbone of initial therapy. These drugs target myeloma cells through different mechanisms, enhancing efficacy.
Autologous stem cell transplantation (ASCT): Often recommended for eligible patients under 75, this procedure involves harvesting the patient's own stem cells, administering high-dose chemotherapy, and then reinfusing the cells to restore bone marrow function.
Supportive care: Includes bisphosphonates to strengthen bones, erythropoietin for anemia, dialysis for kidney issues, and antibiotics to prevent infections.
The Chronic Nature of the Disease
Multiple myeloma is classified as a chronic illness requiring ongoing monitoring and adaptive treatment strategies. Relapses are common, but new therapies—including monoclonal antibodies like daratumumab and CAR T-cell therapy—are improving outcomes even in recurrent cases.
With early detection and personalized treatment plans, many patients now live for years with good functional status and minimal symptoms. Clinical trials continue to explore novel approaches, offering hope for deeper remissions and improved long-term survival.