Multiple Myeloma

Multiple Myeloma

What Is Multiple Myeloma? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Pamela Kaufman
By Medically Reviewed by 
Reviewed:
Medically Reviewed
Multiple myeloma is a rare cancer that affects plasma cells, a type of white blood cell found primarily in bone marrow (the soft, inner tissue of bones). Plasma cells are an important part of the immune system. They produce proteins called antibodies that help the body fight infection by attacking and killing germs. In multiple myeloma, cancerous plasma cells grow out of control and begin to collect in the bone marrow and different areas of the body.

Common Questions & Answers

What are the first signs of multiple myeloma?
Multiple myeloma often causes no symptoms until it’s in the later stages. Among the common signs of the disease when symptoms do appear are bone pain, weakness, or fractures; low numbers of red blood cells, white blood cells, and platelets, which can lead to fatigue; shortness of breath; susceptibility to infection; bruising and bleeding; and high blood levels of calcium, which can lead to thirst, dehydration, constipation, and belly pain.
Is multiple myeloma fatal?
Not universally, no. Much depends on the stage at which the cancer is diagnosed. Currently, the five-year survival rate (the percent of people who are still alive five years after diagnosis) for people diagnosed with the disease at an early stage is 72 percent. For those diagnosed at later stages, the five-year survival rate is closer to 50 percent.
Is multiple myeloma difficult to diagnose?
The diagnosis of multiple myeloma is based on symptoms, a doctor’s examination, and an array of tests, which may include blood tests, urinalysis, biopsies, and scans that may include X-rays, CT scans, MRIs, and PET scans.
Are there risk factors for multiple myeloma?
Risk factors for multiple myeloma include age (most people diagnosed with the disease are over age 65), gender (it’s slightly more common in men than in women), race (it’s more common in Black Americans than in white Americans), obesity, and having another plasma cell disease such as monoclonal gammopathy of undetermined significance.
Does multiple myeloma run in families?
People with a parent or a sibling with the disease are more likely to develop multiple myeloma than someone with no family history. But in most cases of multiple myeloma, there is no known family history.

Symptoms of Multiple Myeloma

Symptoms of multiple myeloma vary by person and some may not have any symptoms at all, especially during the early stages of the cancer.

A couple reasons why this rare cancer of the plasma cells is difficult to diagnose: The symptoms can be vague and are easy to attribute to other health conditions, or simply to aging (the majority of patients are at least 65 years old).

When symptoms do occur, they may include the following:

  • Bone pain, most often in the spine, pelvis, or ribs

  • Thrombocytopenia, or low levels of platelets in the blood, which can cause increased bruising and bleeding

  • Bone fractures

  • Fatigue

  • Weakness

  • Frequent infections

  • Weakness or numbness in the legs

  • Excessive thirst

  • Constipation

  • Nausea

  • Loss of appetite

Learn About the Symptoms of Multiple Myeloma

Causes and Risk Factors of Multiple Myeloma

Scientists still don’t know what causes multiple myeloma or how to prevent it. For most people who develop the disease, there are no clear reasons why. Many cancers, such as lung cancer and skin cancer, have been tied to avoidable causes, like smoking and sun exposure. But in the case of multiple myeloma, few cases of the cancer have been tied to avoidable risk factors.

Known risk factors for multiple myeloma include the following considerations:

  • Age Multiple myeloma is most often diagnosed in adults over age 65.

  • Gender Men are at a slightly higher risk than women.

  • Race Black Americans are almost twice as likely to get multiple myeloma as white Americans.

  • Family History Having a close relative with multiple myeloma increases a person’s odds of developing it. Is multiple myeloma hereditary? Sometimes. But most people with multiple myeloma have no family history of the disease.

  • Obesity People who are overweight or obese are at a higher risk.

  • Other Plasma Cell Diseases Multiple myeloma may start as a relatively benign condition called monoclonal gammopathy of undetermined significance (MGUS).

How Is Multiple Myeloma Diagnosed?

To make a multiple myeloma diagnosis, a medical team has a lot to consider. The patient’s symptoms, the results of a physical exam, and the findings of a battery of tests all help pinpoint whether multiple myeloma is the cause of symptoms. Doctors use these key tests to diagnose myeloma:

  • Blood and Urine Analysis Your doctor will check if large amounts of certain kinds of proteins as well as calcium, which may indicate that calcium is being pulled from your bones, are present in the blood or urine.

  • Bone Marrow Biopsy Ten percent or more of malignant plasma cells in the bone marrow indicates that a patient has myeloma.

Learn More About Multiple Myeloma Diagnosis

Stages of Multiple Myeloma

Staging multiple myeloma is the method that doctors use to assess how much cancer is in the body, where it is, and whether it has spread. Doctors stage the disease to come up with a treatment plan and a prognosis.

In patients who are symptomatic, doctors use the Revised International Staging System, which considers four factors to determine what stage a person’s cancer is in:

  • The amount of albumin, a protein made by the liver, in the blood
  • The amount of beta-2-microglobulin, a type of protein that is a tumor marker, in the blood
  • The amount of lactate dehydrogenase in the blood
  • Gene abnormalities, or cytogenetics, detected in the cancer

Learn More About the Stages of Multiple Myeloma

Prognosis of Multiple Myeloma

The median five-year survival rate for multiple myeloma is around 58 percent, but that depends on many factors, including the stage the cancer is when first detected.

This number won’t be true for every patient. Factors such as age, the tumor’s genetic characteristics, your kidney function, and your overall health also play a role. (Note that this statistic is based on 2012 to 2018 data that doesn’t take into account many new drugs that have become available in recent years.)

The type of multiple myeloma also makes a difference. People with the early kind called smoldering multiple myeloma may remain symptom-free for many years before the disease begins to take a toll. Conversely, patients who have a form of myeloma with a high-risk genetic feature may have an especially poor prognosis.

Learn More About the Prognosis for Multiple Myeloma

Treatment and Medication Options for Multiple Myeloma

Multiple myeloma has long been considered an incurable disease. It’s extremely rare for a patient to be considered cured. But many patients keep their cancer at bay for long periods of time with treatment. It’s typical for patients to experience periods of symptomatic myeloma, which requires treatment, followed by periods of remission, in which a person may not need to be treated.

Current treatments aim to relieve symptoms, prolong periods of remission, and prolong survival. Oncologists have many ways to treat multiple myeloma and will typically use more than one at a time. Treatments include the following options:

  • Chemotherapy and Targeted Drugs This includes targeted drugs that home in on specific genes or proteins on cancer cells.
  • Stem Cell Transplantation Cancerous cells are replaced with healthy stem cells from the patient’s own system or a matched donor. Stem cell transplants are often followed by maintenance therapy with a drug such as lenalidomide (Revlimid).
  • Radiation Therapy This therapy uses high-energy rays to kill cancer cells. It’s often used to target areas of bone damaged by multiple myeloma.
  • Surgery Multiple myeloma can cause bone deterioration that results in weakened or fractured bones. Surgery may be used to fortify areas of bones to make them more stable.
  • Clinical Trials New drugs and drug combinations are constantly being investigated for treating multiple myeloma and other cancers.
The rapid pace of research means that more and more treatments are in the pipeline. Among the most promising under investigation are those involving a type of immunotherapy called CAR T cell therapy. CAR T cell treatments involve genetically engineering a patient’s own T cells (a type of white blood cell) to allow them to recognize and attack cancer cells.

For every approach, outcomes for people with multiple myeloma depend on a number of factors, including overall health and ability to tolerate treatment. Quality of care also makes a difference. It’s important to seek out a doctor with experience treating multiple myeloma or one who will work in concert with a specialist. These specialists are usually called hematologist oncologists.

Learn More About Treatment for Multiple Myeloma

Complications of Multiple Myeloma

Multiple myeloma can cause a number of complications, some of which may be very serious:

  • Low Blood Counts As myeloma cells multiply in bone marrow, they leave less space for red blood cells, white blood cells, and platelets. Low red blood cell levels, a condition known as anemia, can result in fatigue and weakness. A drop in your white blood cell count can decrease the body’s ability to fight. Lack of platelets can lead to significant bruising and bleeding, even from minor scrapes or cuts.
  • Bone and Calcium Issues Myeloma cells can accelerate the breakdown of old bone and slow the buildup of new bone. This can lead to osteoporosis, raising the risk of fractures. Bones may become so fragile that even normal activities, like coughing and walking, may be enough to lead to a broken bone.
  • Suppressed Immune System Myeloma cells interfere with both the quality and quantity of infection-fighting white blood cells, raising the risk of infection.
  • Kidney Damage An antibody produced by myeloma cells can harm the kidneys and lead to kidney failure.

Multiple Myeloma Research and Statistics

More than 34,000 Americans received a multiple myeloma diagnosis in 2022.

That makes multiple myeloma relatively rare, accounting for 1.8 percent of all new cancer cases.

Around 0.8 percent of men and women in the United States will be diagnosed with multiple myeloma at some point during their lives.

The number of people diagnosed with multiple myeloma has climbed an average of 0.9 percent each year over the course of a decade, according to the most recent data. But death rates from multiple myeloma have decreased 0.5 percent per year, reflecting improvements in treatment.

Black Americans and Multiple Myeloma

Multiple myeloma accounts for less than 2 percent of cancers nationwide, but it is the most common blood cancer among Black Americans. Black Americans are twice as likely to be diagnosed with multiple myeloma or MGUS compared with white Americans. Black Americans are also more likely to develop this cancer at a younger age. In addition, survivorship rates are lower among Black Americans.

This is likely due to disparities in access to treatments such as stem cell transplantation, a treatment that is becoming more common in the United States as a whole but not at the same rates among Black Americans.
Black Americans are also underrepresented in clinical trials for new and potentially promising treatments for multiple myeloma. Black Americans account for just 6 percent of patients enrolled in clinical trials for experimental treatments. This could be due to clinical trial availability by location, the cost, or inherent racism built into the system, such as a patient not being told about a clinical trial that they qualify for because a physician assumes they won’t be interested. The IMF provides resources, including patient support groups, that can help Black patients access information on treatments, including clinical trials, as well as other support.

Additional Resources for Multiple Myeloma

If you’ve been diagnosed with multiple myeloma, a number of excellent resources can help you understand and cope with your condition. Click on the link below for more information on organizations, blogs, and websites that provide a wealth of information as well as medical, emotional, and financial support for people with multiple myeloma.

Learn More About Resources for Multiple Myeloma

With additional reporting by Kaitlin Sullivan.

Editorial Sources and Fact-Checking

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