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Multiple myeloma is a cancer of plasma cells.
Plasma cells are the cells responsible for making antibodies which protect us from bacteria and viruses. Because each plasma cell can only make one type of antibody and each antibody can fight only one type of bacteria or virus, under normal circumstances we have many different plasma cells making many different antibodies to fight the many bacteria and viruses that could attack us. In patients with myeloma, one plasma cell making only one antibody takes over. The super abundance of the one antibody accounts for the “M protein” or monoclonal spike that can be detected on a simple blood test called a serum protein electrophoresis (SPEP).
Multiple myeloma can have multiple symptoms and is difficult to diagnose early.
Multiple myeloma is often not diagnosed unless specific tests, like the SPEP are performed. Although some patients have minimal or no symptoms, other patients with more advanced disease, can have symptoms related to the presence of the high number of plasma cells making only one antibody. These include:
- Bone and back pain secondary to weakening of the bones
- Anemia
- Kidney injury
Increased number and severity of infections due to the loss of antibody diversity
Multiple myeloma treatment depends on stage and the presence or absence of symptoms
Patients without symptoms who may have been diagnosed by abnormal blood tests may not require therapy. These patients are often diagnosed with “smoldering” or “asymptomatic” myeloma. In the presence of significant symptoms or laboratory abnormalities, most patients are treated with newer agents followed by autologous stem cell transplant which has been shown to deepen and prolong the remission and delay the time until patients need more aggressive treatment again.
After transplant, patients generally receive well-tolerated maintenance therapy which has been shown to prolong remissions by an average of more than two years.
Radiation may be used to treat painful bone or back lesions. Patients with significant back pain may respond to relatively simple surgical spine procedures such as vertebroplasty and kyphoplasty. In patients whose disease comes back after initial treatment, there are a variety of newer drugs which have significantly improved patient outcome and survival.
Expertise from Rutgers Cancer Institute and RWJBarnabasHealth
Immunotherapy, treatments which harness the patient’s own immune system are just beginning to make a huge impact on treatment. These include treatments such as bispecific antibodies, CAR T-cells and antibody-drug conjugates. Some treatments for multiple myeloma are currently available only as part of a clinical trial but are expected to be approved in the next several months or in the next few years. These treatments as well as well as CAR T-cell therapy and blood and marrow transplantation are available at Rutgers Cancer Institute and RWJBarnabas Health.
Dennis Cooper, MD, is chief of Blood and Marrow Transplantation at Rutgers Cancer Institute of New Jersey, an attending physician at Robert Wood Johnson University Hospital, and a professor of medicine at Rutgers Robert Wood Johnson Medical School.
