Blood cancer: Myeloma

Myeloma

There are three main types of blood cancers – leukaemias, lymphomas and myeloma.

Myeloma is a type of blood cancer (1). Bone marrow cells called plasma cells grow out of control and collect in the bone marrow (1,2). These cells are also part of the immune system where their main role is to make antibodies, also known as immunoglobulins (3).

In myeloma, the cancerous plasma cells make abnormal antibodies; your doctor may call these proteins or paraproteins (2). They can be picked up in the urine or blood and doctors use them to diagnose or monitor myeloma (1).

We do not know what causes myeloma (4). It is usually diagnosed in older people and is very rare in people under 40. It is more common in men (5). You may have an increased risk if you have someone in the family who has had myeloma, lymphoma or leukaemia; but this is a rare disease so it is still a small risk (6).

Symptoms

Because the cancerous plasma cells collect in the bone marrow, they can damage the bones (7). This causes pain, most often in the back (7,8). It also increases risk of fractures (9). Sometimes, a fracture in the spine can cause numbness, tingling and difficulty moving the legs. If you have any of these symptoms, you should contact a doctor as soon as possible.

Other symptoms are caused by the plasma cells crowding out normal blood cells in the bone marrow. The abnormal paraprotein can also damage your kidneys (9). You may:

• feel very tired
• have infections that are difficult to get rid of
• feel sick or lose your appetite.

The damaged bones can leak calcium into the blood. This can make you very thirsty, pass lots of urine and, if untreated, cause confusion and drowsiness (9).

Treatment

The main treatments for myeloma include drugs that target the cancerous plasma cells - targeted treatments and chemotherapy. You may have either or both treatments. If your myeloma responds well to this treatment, you will have maintenance treatment with a drug that targets the plasma cells. You are also likely to have a bisphosphonate drug that helps to stop myeloma from damaging your bones (10). Your doctor may also suggest radiotherapy to treat pain.

In a small number of people, myeloma can grow very slowly. If this is the case, your doctor may just monitor you until you have troublesome symptoms, or tests show that the disease is growing (11).

If you are fit enough, your doctor may suggest a stem cell transplant using your own blood stem cells: an autologous transplant. If you have a relative who is a match, your doctor may suggest a donor transplant: an allogeneic transplant. But this is used less often because it is tougher to get through than a transplant with your own stem cells (11).

Outlook

The aim of treatment for myeloma is to control it (11,12). The outcome of treatment depends on how advanced your myeloma was when it was diagnosed, your age and fitness, the treatment you have and how well the myeloma responds to it (12,13). Overall, around five out of 10 people diagnosed (50%) live for more than five years (13). Around three out of 10 people live for more than 10 years after diagnosis (13).

These figures do not mean people only live for five or 10 years. Patients who take part in clinical trials usually have their health monitored for five or more years after treatment, so ‘five-year survival’ and ’10-year survival’ are commonly quoted statistics.