What Does Multiple Myeloma Mean?

What Does Multiple Myeloma Mean?

Multiple myeloma is a cancer that begins in a type of white blood cell called plasma cells. These cells are found in the bone marrow and are responsible for producing antibodies, which are also known as immunoglobulins, that help fight infections. When a person has multiple myeloma, these plasma cells become cancerous and multiply uncontrollably.

This leads to an overproduction of an abnormal antibody called the M protein, which doesn’t serve a useful function. The cancerous plasma cells can also crowd out healthy blood cells in the bone marrow and release substances that cause bone damage.

Multiple myeloma is not a solid tumor like breast or lung cancer. Instead, it’s a type of blood cancer that can affect how multiple parts of the body work, including the bones, kidneys, and immune system. The disease is considered chronic, which means that while it can’t typically be cured, it can be managed for many years with effective treatment.

How Is Multiple Myeloma Diagnosed?

Diagnosis often begins with a routine blood test showing high levels of protein or calcium, or with a patient experiencing symptoms like bone pain or fatigue. The diagnostic process involves several tests to confirm the presence of myeloma and determine its extent.

• Blood and urine tests: These tests check for the presence of the M protein and other substances or issues that indicate myeloma, such as high calcium levels or kidney problems.
• Bone marrow biopsy: This is a key diagnostic test. A small sample of bone marrow is taken, usually from the hip, to be examined for cancerous plasma cells.
• Imaging tests: X-rays, MRI, PET scans, or CT scans are used to look for bone damage, or lesions, caused by the myeloma cells.
• FISH analysis: This genetic test is performed on the bone marrow sample to identify specific chromosomal abnormalities in the myeloma cells, which helps determine prognosis and guide treatment decisions.

“The diagnosis of myeloma is very often delayed,” Dr. Joseph Mikhael, a professor in the Applied Cancer Research and Drug Discovery Division at the Translational Genomics Research Institute, an affiliate of City of Hope Cancer Center, and chief medical officer of the International Myeloma Foundation, said in an interview with CURE. “On average, people see their primary care provider three times with signs and symptoms consistent with multiple myeloma before the diagnosis is made.”

How Is Multiple Myeloma Treated?

The treatment for patients with multiple myeloma is highly personalized and depends on several factors, including the patient’s age, overall health, and the specific characteristics of their myeloma cells. The goal of treatment is to reduce the number of cancerous cells, control symptoms, and prolong remission.

• Induction therapy: This is the initial treatment phase. It’s often a combination of different drugs aimed at killing the myeloma cells and getting the disease under control. Common drug types include:
• Proteasome inhibitors: These drugs block the proteasome, a cellular complex that breaks down proteins, causing myeloma cells to die. Examples include Velcade (bortezomib) and Kyprolis (carfilzomib).
• Immunomodulatory drugs (IMiDs): These drugs work by enhancing the body’s immune response against myeloma cells. Examples include Thalomid (thalidomide), Revlimid (lenalidomide), and Pomalyst (pomalidomide).
• Steroids: Medications such as dexamethasone are often used in combination with other drugs to enhance their effectiveness.
• Stem cell transplant (SCT): An autologous stem cell transplant is often considered for eligible patients. It involves collecting a patient’s own healthy stem cells, giving high-dose chemotherapy to destroy the remaining cancerous cells, and then reinfusing the stored stem cells to help the bone marrow recover and produce new, healthy blood cells.
• Maintenance therapy: After induction therapy or a stem cell transplant, a patient may be placed on a lower dose of medication (often an IMiD) to maintain remission and prevent the disease from returning.
• Monoclonal antibodies (mAbs): These are lab-made proteins designed to mimic the natural antibodies in your body. Instead of targeting a wide range of invaders, they are specifically engineered to latch onto a single, precise target, known as an antigen, on the surface of myeloma cells. Once attached, they can work in a few different ways:
• Directly killing the cell: Some mAbs act like a poison dart, triggering the myeloma cell’s death.
• Flagging for destruction: Other mAbs act like a beacon, tagging the myeloma cell so the body’s own immune system can more easily find and destroy it.
• Blocking signals: Some mAbs can block signals the cancer cells use to grow and survive.

Examples include Darzalex (daratumumab) and Sarclisa (isatuximab), which both target the CD38 protein on myeloma cells, and Empliciti (elotuzumab), which targets the SLAMF7 protein.

Monoclonal antibodies are now a standard part of treatment for many newly diagnosed patients. Specifically, the anti-CD38 monoclonal antibody Darzalex has revolutionized the initial treatment of patients with multiple myeloma. Clinical trials have shown that adding Darzalex to standard-of-care regimens significantly improves outcomes. Specifically, its injection form, known as Darzalex Faspro (daratumumab and hyaluronidase-fihj), makes treatment time faster and has become more common than the original intravenous formulation.

• For transplant-eligible patients: Daratumumab is often used in combination with other drugs, such as Velcade, Thalomid, and dexamethasone, as an induction therapy before an autologous stem cell transplant.
• For transplant-ineligible patients: A combination of Darzalex, Revlimid, and dexamethasone is a standard regimen for newly diagnosed patients who are not candidates for a stem cell transplant. Similarly, Sarclisa is indicated for use in combination with Velcade, Revlimid, and dexamethasone in adult patients with newly diagnosed multiple myeloma who are ineligible for transplant.

“These are exciting times in cancer therapy in general and in particular in multiple myeloma, where, historically, we had to use the sorts of treatments that were tough on the patient, not just tough on their myeloma,” Mikhael said. “But now we have come to an era where we can be much more targeted.”

Other novel classes of agents, such as CAR T-cell therapy and bispecific antibodies, which are showing promising results for patients who have relapsed or are refractory to other treatments, are being explored in earlier disease settings.

Multiple Myeloma Treatment-Related Side Effects

Treatments for multiple myeloma can cause various side effects. It’s important to discuss these with your oncologist, as many can be managed with supportive care.

• Fatigue: Feeling tired is a very common side effect of both the disease and its treatments.
• Peripheral neuropathy: This is nerve damage that can cause tingling, numbness, or pain, most often in the hands and feet. It’s a common side effect of some proteasome inhibitors.
• Low blood counts: Myeloma and its treatments can suppress the bone marrow, leading to a low number of red blood cells (anemia), white blood cells (neutropenia), and platelets (thrombocytopenia). This can increase the risk of infections and bleeding.
• Gastrointestinal issues: Nausea, vomiting, diarrhea, or constipation can occur with many of the medications.

Embracing the Journey: Your Path Forward With Multiple Myeloma

A diagnosis of multiple myeloma can be overwhelming, but it’s important to remember that it’s a very treatable cancer. Your treatment plan will be carefully tailored to your specific needs, and with ongoing research, new and more effective therapies are becoming available. This overview is just the beginning of your journey.

“The year 2025, especially, has been a good one, and we have so many good immunotherapies now that we didn’t have in the past, that I give new patients optimism. I use myself as an example,” Dr. Jim Omel, a retired family practitioner from central Nebraska diagnosed with multiple myeloma in 1997, told CURE. “I’m an outlier when it comes to living that long, but new patients now can expect long, healthy lives. I use the analogy of diabetes. We cannot cure diabetes, but you can live with it, and we have good treatment for it. So I say that myeloma now is, for the majority — not all — but for the majority of patients, a chronic disease. You can live with it and enjoy your life.”

The most important step you can take is to partner with your healthcare team. Ask questions, share your concerns, and be open about any side effects you experience. This will help your oncologist and you make the best decisions for your care, ensuring you have the highest quality of life throughout your treatment.

Interested in learning more about your multiple myeloma diagnosis? Hear firsthand a multiple myeloma survivor share his story surrounding his 1997 cancer diagnosis and how his cancer journey has evolved.

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