Myeloma

At present myeloma is still considered an incurable disease. However recent advances in both the diagnosis, monitoring of myeloma as well as treatments have meant that for an increasing number of myeloma patients, they are able to attain very good responses to treatment and also remain in remission for increasingly longer periods.

There are constant advances and development of newer therapies for myeloma which means that we anticipate that the outcomes of myeloma patients will continue to improve over time.

Our doctors will review your condition and the symptoms, if any, before creating a treatment plan suited to your needs.

Myeloma is a blood cancer that originates from cells within the bone marrow, known as plasma cells. Changes in the plasma cells’ DNA produces abnormal cells, and when these abnormal cells begin to multiply uncontrollably, this results in myeloma. 

In some patients there will be a condition called monoclonal gammopathy of undetermined significance (MGUS) that precedes the development of myeloma. In MGUS, patients have no symptoms but they have plasma cells that produce an abnormal protein known as M-protein. Only 20% of patients with MGUS progress to myeloma.

Since myeloma can weaken a patient’s bone, it is not uncommon to experience pain in these affected bones – typically the neck, back, hips, or ribs. The pain experienced is often a dull, persistent ache that may be exacerbated by movement. 

Patients with myeloma can experience back pain due to infiltration of the back bones (vertebrae) by the myeloma. Sometimes the myeloma can present as a mass which presses on the nerves in the spine causing discomfort. Myeloma can also result in weakness of the bones in the back, causing partial or complete collapse or fractures of the bones resulting in severe back pain as well.

Myeloma is usually a liquid cancer involving plasma cells in the bone marrow and blood, a plasmacytoma. These tumours may present in the bone marrow, preventing the bone marrow from producing healthy cells. Sometimes these tumours may present in the spine, or in the chest wall (amongst other locations) and can cause symptoms due to the infiltration and pressure effects on surrounding nerves and organs.

Plasmacytomas can sometimes present as isolated tumours without myeloma involvement in the bone marrow. These tumours are known as solitary plasmacytomas and our doctors may recommend radiation therapy to treat and manage these tumours.

Patients who present with myeloma together with plasmacytomas will usually need targeted chemotherapy as well as possibly radiotherapy as treatment.

At an early stage some of the symptoms of myeloma are non-specific and can often be mistaken for other conditions. For example, fractures of the spine may be thought to be due to osteoporosis. Anaemia, bone pain and kidney issues could be mistaken for other medical conditions such as autoimmune diseases or kidney disorders. Sometimes myeloma can be mistaken for other blood disorders such as leukaemia or lymphoma.

Detailed blood tests, bone marrow and other specific investigations are often needed to ensure that the correct diagnosis of myeloma is made.

Since myeloma affects the bones, many patients experience weakness and pain. However, weight-bearing exercises, such as walking, can aid in strengthening the bones. Patients should always consult with our doctors before attempting a new workout routine and if they experience pain or notice a change in their symptoms.

While the exact cause of multiple myeloma is still unclear, doctors are able to understand that changes in the plasma cells can cause them to become cancerous. Myeloma, as with many other cancers, is caused by mutations in the DNA of cells.

Exercise is beneficial to one’s health in a multitude of ways. Patients diagnosed with multiple myeloma will find that weight-bearing activities such as walking and climbing stairs can aid in strengthening one’s bones. 

However, patients should always consult with our doctors before taking on a new exercise routine and if they experience pain or a change in their symptoms. Often our team will advise that patients with myeloma bone disease initiate a phased exercise programme with a recommended physiotherapist.

Myeloma is usually a liquid cancer involving plasma cells in the bone marrow and blood. a plasmacytoma. These tumours may present in the bone marrow, preventing the bone marrow from producing healthy cells. Sometimes these tumours may present in the spine, or in the chest wall (amongst other locations) and can cause symptoms due to the infiltration and pressure effects on surrounding nerves and organs.

Plasmacytomas can sometimes present as isolated tumours without myeloma involvement in the bone marrow. These tumours are known as solitary plasmacytomas and our doctors may recommend radiation therapy to treat and manage these tumours.

Patients who present with myeloma together with plasmacytomas will usually need targeted chemotherapy as well as possibly radiotherapy as treatment.

There is no specific diet recommended for patients diagnosed with myeloma. However, patients should follow a healthy diet. This includes recommended servings of carbohydrates, proteins, vegetables, and healthy fats. A well-rounded diet can aid patients with myeloma in keeping their energy and strength up.

Patients who have been diagnosed with multiple myeloma may experience pain related to the disease as myeloma can cause weakness in the bones or compression of nerves due to a tumour. Speak to our doctors if you experience any pain related to your condition.

Yes, to detect and diagnose myeloma, our doctors will conduct a series of tests, including blood and urine tests, to identify an abnormal protein. This protein is known as the monoclonal protein or M-protein.

A FISH test, or fluorescence in situ hybridisation test, is used to test for gene changes in cells. Our doctors may order a FISH test to look for specific changes in cells, indicating the presence of myeloma. This may include the production of a particular protein, an increased production of protein, or the lack of a specific protein.

Multiple myeloma can prove challenging to diagnose as it often presents with little to no symptoms in the early stages. However, blood tests, bone marrow assessment and imaging tests such as x-rays, MRI/PET-CT scans can be used to clarify the diagnosis of myeloma.

There are multiple tests used in the diagnosis of multiple myeloma. These include blood and urine tests to check for M-protein and immunoglobulin levels. Other tests such as an x-ray, MRI, PET-CT scans may also be recommended by our doctor.

Additionally, a bone marrow aspiration and biopsy may also be conducted to assess the amount of myeloma involvement in the bone marrow, as well as to analyse the genes in the myeloma through something known as fluorescence in situ hybridisation (FISH) test. 

These tests will allow our doctor to better understand your condition and determine the most suitable treatment plan for you. However, not all tests will be done for each patient. Our doctor will be able to explain which tests are recommended and why.

Multiple myeloma can be confirmed by a combination of blood tests, bone marrow assessment. Sometimes if the myeloma presents as a tissue mass (known as a plasmacytoma) then a tissue biopsy of the affected site may be required.

The most commonly used staging system for myeloma is the Revised International Staging System (R-ISS).

The R-ISS divides myeloma into three stages. Stage 1 is the earliest stage and stage 3 is more advanced.

The stages are based on the results of various blood tests that check:

• levels of beta-2 microglobulin (B2M) – a protein produced by myeloma cells that shows the extent of certain diseases
• levels of albumin – a protein produced by the liver that is a sign of overall health
• levels of lactate dehydrogenase (LDH) – an enzyme released into the blood when cells are damaged or destroyed
• genetic information – specific chromosomal abnormalities that identify people at risk of the disease progressing.

While both myeloma and leukaemia are types of blood cancer, they affect different types of cells in the bone marrow causing different symptoms, presentations and outcomes.

Myeloma is a cancer affecting a type of cells in the bone marrow known as plasma cells that usually produce proteins (immunoglobulins) that protect us from infections. Myeloma often presents with symptoms related to bone pain or fractures, kidney damage or other symptoms related to low immunity (infections etc) and also anaemia.

Acute leukaemia is a blood cancer affecting the white cells in the body. Refer to the link to acute leukaemia for more information.

Myeloma and lymphoma are classified as two separate forms of blood cancer. Myeloma is a form of blood cancer that affects the plasma cells in the bone marrow while lymphoma typically involves the lymph nodes and white cells known as lymphocytes.

There are some similarities in the biology of the cancer cells between myeloma and lymphoma, hence some of the drugs used for the treatment of myeloma are also sometimes used in the treatment of forms of lymphoma.

Chronic lymphocytic leukaemia and myeloma are both closely related forms of blood cancer as both affect a form of white cells known as B-cells. CLL involves abnormalities in mature B-cells known as lymphocytes, while myeloma affects plasma cells in the bone marrow.

CLL does not usually lead to myeloma, and likewise myeloma does not lead to CLL.