Multiple Myeloma (MM) is a type of blood cancer, less common than others (Leukemias and Lymphomas). It mostly affects people over 65 years-old, very rarely under 50. It’s a disease of Plasma Cells, a kind of white blood cell lymphocyte that makes antibody. The abnormal plasma cells multiply rapidly to invade various organs, especially bones and the kidneys.
Most of the time the disease evolves slowly, although occasionally it erupts rapidly as an emergency (the worst being Sepsis, or paralysis from an unstable spinal vertebra). The most common symptoms are fatigue (perhaps some shortness of breath with exertion), bone pain, and weight loss. We consider MM if a person has recurrent bacterial pneumonias or sinusitis (we consider HIV then as well). Sometimes we make come to suspect the diagnosis based on abnormal blood tests ordered for other reasons.
Diagnosis usually proceeds stepwise:
1. Common lab tests, the Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP):
- Low hemoglobin with normal-sized red blood cells (Anemia of Chronic Disease)
- Elevated creatinine (Kidney Injury)
- Elevated Calcium
- Elevated Globulin
- If ordered, the ESR and CRP may be extremely high
2. We then order both Serum and Urine Protein Electrophoresis (SPEP and UPEP), looking for any abnormal protein (a “monoclonal spike” among normal proteins).
3. If all of the above are positive, the traditional exam is a “Skeletal Survey,” meaning Plain X-Rays of many bones in the body (skull, entire spine, ribs, pelvis, long bones in arms & legs [humerus & femur]). We look for “lytic” spots: punched-out areas of bone loss. Nowadays, clinicians find it easier to order whole-body CT scans.
4. We then biopsy any abnormal findings. If the Skeletal Survey is normal, we may refer to a Hematologist for a bone marrow biopsy.
Treatment of MM is very complex. New chemotherapy is constantly being developed, new studies appear all the time. The only cure would be an “allogenic” stem cell (bone marrow) transplant from a genetically-matched compatible donor. Another option, not as curative but which can add years of life, is an “autologous” transplant of one’s own bone marrow. The problem with bone marrow transplants, however, is the procedure itself are risky. Any excellent website explaining differences is the American Cancer Society’s cancer.org, search for “Types of Stem Cell Transplants”.