Who Mostly Gets Multiple Myeloma?

Reviewed on 3/25/2022
Multiple myeloma cancer cells
Risk factors for multiple myeloma include being a man, people over age 60, family history, obesity, certain ethnicities, and having a history of a solitary plasmacytoma of the bone or plasma cell disease.

Multiple myeloma is a relatively rare cancer that occurs when plasma cells in the blood grow abnormally and out of control. 

People who are more likely to develop multiple myeloma include: 

  • Men
    • Slightly more likely than women 
  • People over 60 years old
    • Average age at diagnosis is 70 years
  • People who have a family history of multiple myeloma
    • People who have first-degree relatives (parents, siblings, children) with multiple myeloma have a 2 to 3 times higher risk of developing the disease
  • People who have a personal history of a solitary plasmacytoma of the bone
  • People who are obese
  • Race/ethnicity
    • More than twice as common in African Americans than in white Americans
    • More common in the Middle East, North Africa, and the Mediterranean
  • People who have other plasma cell diseases such as monoclonal gammopathy of undetermined significance (MGUS)
    • Exposure to radiation or chemicals
    • Exposure to radiation 
    • Exposure to asbestos, benzene, pesticides, and other chemicals used in rubber manufacturing 
    • Frequent exposure to wood products in work such as such as carpentry, furniture making, and paper manufacturing
    • Professional firefighters 
    • Exposure to herbicides, including Agent Orange

What Are Symptoms of Multiple Myeloma?

Multiple myeloma does not always cause symptoms. When symptoms occur, they may include:

  • Bone problems
    • Fractures
    • Pain
    • Weakness
  • Low blood counts of red blood cells (anemia), white blood cells (leukopenia), or plasma cells (thrombocytopenia)
  • High blood levels of calcium (hypercalcemia)
  • Infections, including pneumonia
  • Nervous system symptoms if the bones in the spine weaken and cause spinal cord compression, a medical emergency. See a doctor right away if you have: 
    • Muscle weakness, usually in the legs
    • Numbness, usually in the legs
    • Sudden severe back pain
  • Nerve damage 
    • “Pins and needles” feeling
    • Weakness and numbness 
  • Kidney problems
    • Itching
    • Leg swelling
    • Shortness of breath
    • Weakness
  • Thickened blood (hyperviscosity) that slows blood flow to the brain
    • Confusion
    • Dizziness
    • Stroke symptoms, such as slurred speech and weakness on one side of the body 

How Is Multiple Myeloma Diagnosed?

Multiple myeloma is diagnosed with a patient history and physical examination, and a combination of blood, urine, and imaging tests. 

Lab tests used to diagnose multiple myeloma include: 

  • Blood tests
    • Complete blood count (CBC
    • Blood chemistry 
    • Levels of creatinine, albumin, calcium, and other electrolytes
    • Quantitative immunoglobulins
    • Lactic dehydrogenase (LDH) levels 
    • Electrophoresis
    • Beta-2 microglobulin
    • Serum free light chains
  • Urine tests 
  • Biopsies
  • Imaging tests
    • Bone X-rays
    • Computed tomography (CT) scan
    • Magnetic resonance imaging (MRI) scan
    • Positron emission tomography (PET) scan
    • Echocardiogram (“echo”) of the heart

A diagnosis of multiple myeloma requires:

  1. A plasma cell tumor (proven by biopsy) OR at least 10% plasma cells in the bone marrow, AND
  2. At least one of the following:
    • Low red blood cell counts (anemia)
    • High blood calcium level
    • Poor kidney function
    • Increase in one type of light chain in the blood so that one type is 100 times more common than the other
    • Holes in the bones from tumor found on imaging studies 
    • 60% or more plasma cells in the bone marrow

What Is the Treatment for Multiple Myeloma?

Treatments for multiple myeloma may be local (directed at the tumor without affecting the entire body) or systemic. 

Local treatments are usually used to treat earlier stage multiple myeloma, and may include: 

  • Surgery 
  • Radiation therapy

Systemic treatments reach cancer cells throughout the body and may include drug therapy. It is generally preferable to use at least 2 or 3 different kinds of drugs in combination because the cancer responds better. 

  • Chemotherapy
  • Corticosteroids  
  • Immunomodulating agents 
  • Proteasome inhibitors 
  • Histone deacetylase (HDAC) inhibitors 
  • Monoclonal antibodies 
  • Antibody-drug conjugates 
  • Nuclear export inhibitor 
  • Bisphosphonates for bone disease
  • Stem cell transplant 
  • CAR T-cell therapy (a type of immunotherapy)
  • Supportive treatments 
    • Intravenous immunoglobulin (IVIG) 
    • Treatment for low blood cell counts
    • Plasmapheresis
Reviewed on 3/25/2022
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