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10 Key Questions About Multiple Myeloma

Medically Reviewed by Ed Zimney, M.D.

What Is Multiple Myeloma?

Multiple myeloma is a type of cancer that develops in a subset of white blood cells called plasma cells. Plasma cells, like other white blood cells, are part of the immune system whose function is to defend the body against infection and disease.

In normally functioning bone marrow, the production of these cells is controlled, based on the body's needs. In myeloma, a single type of plasma cell is transformed and, as a result, no longer responds to these control mechanisms. These abnormal cells, called clones or myeloma cells, divide too rapidly, grow uncontrollably and live longer than normal plasma cells. As they proliferate, the myeloma cells crowd out healthy cells and interfere with their infection-fighting activities. The cancerous cells can spread throughout the body and collect in masses called tumors.

In multiple myeloma, the body produces large amounts of abnormal plasma cells. These myeloma cells tend to accumulate in bone marrow and in the hard, outer parts of bones. While in some cases, they collect in only one bone, most often they accumulate in many bones and form many tumors, thus the name multiple myeloma.

What Are the Risk Factors for Multiple Myeloma?

While scientists have worked diligently to find the cause of multiple myeloma, so far they don't know exactly why some plasma cells become cancerous. Research, however, has uncovered some factors that appear to make a person more likely to develop multiple myeloma:

  • Increasing age is the most significant risk factor. According to the American Cancer Society, people younger than 40 years old make up only 2 percent of multiple myeloma diagnoses. The average age of a patient at diagnosis is about 70.
  • African-Americans are diagnosed with multiple myeloma about twice as often as Caucasian Americans.
  • People who are exposed to herbicides, insecticides, petroleum products, heavy metals, plastics and asbestos have a higher-than-average chance of developing multiple myeloma.
  • People who have other medical conditions that affect the plasma cells are at increased risk of developing multiple myeloma.
  • Exposure to high doses of radiation may be a risk factor, but according to the American Cancer Society it accounts for a very small number of cases.
  • Family history of multiple myeloma may put a person at somewhat greater risk, but most myeloma patients do not have relatives with the disease.

What Are the Symptoms of Multiple Myeloma?

In the early stages of multiple myeloma, people usually have no symptoms. When symptoms do show up, they may be vague and mimic those of other medical conditions. As a result, doctors sometimes discover multiple myeloma after patients have routine blood tests to check for another condition.

When they do appear, symptoms include:

  • Pain in the lower back or in the ribs. Doctors and patients often describe this as "bone pain." As myeloma cells increase and collect in the bones, they damage and weaken them, which leads to pain and sometimes to fractures.
  • Weakness and fatigue. Myeloma cells can crowd out new red blood cells, which causes anemia. Symptoms of anemia include tiredness and weakness. Patients with anemia may appear pale.
  • Repeated infections, such as bacterial pneumonia, urinary-tract infections and shingles. Because myeloma cells prevent the bone marrow from making normal, infection-fighting white blood cells, people with multiple myeloma may not be able to ward off infection.

How Is Multiple Myeloma Diagnosed?

To diagnose multiple myeloma, doctors will ask patients about their personal and family medical history and will perform a physical examination. They may also order a number of tests:

  • Blood or urine tests called serum protein electrophoresis or urine protein electrophoresis check levels of antibodies called M-proteins, which occur in unusually high amounts in the blood and urine of people with multiple myeloma. Because myeloma cells are all the same (clones), they all make the same exact antibody - called M-proteins. A high amount of M-proteins in blood and urine is sometimes referred to as a monoclonal gammopathy.
  • Complete blood counts measure the number of red blood cells, platelets and white blood cells to see if any exceed normal ranges or if they are lower than normal because of crowding out by the myeloma cells.
  • Blood tests for creatinine evaluate a person's kidney function, which is often reduced.
  • X-rays are used if a person has bone pain to see whether bones are broken or damaged. If myeloma is diagnosed, the physician may also order a bone survey, also called skeletal survey, which is a series of X-rays to check for possible myeloma lesions in the bones that may not be causing any pain.
  • Magnetic resonance imaging, or MRI, produces close-up pictures of the bones using a powerful magnet linked to a computer. This test may not be necessary during the initial evaluation.
  • Biopsy of a sample of cells or tissue from the bone marrow to check for myeloma cells under a microscope.If other tests suggest multiple myeloma, the doctor will most likely order a bone marrow biopsy. In a bone marrow aspiration, a needle is inserted into bone marrow in the hip bone or breast bone to withdraw a sample of fluid and cells. In a bone marrow biopsy, a larger needle is used to remove a sample of tissue. In some patients, the bone marrow involvement is patchy, resulting in the need for multiple biopsies to confirm the diagnosis.

How Does Multiple Myeloma Progress?

Once cancer has been diagnosed, doctors use a process called staging to characterize the disease based on how far it has advanced. In multiple myeloma, doctors look at several factors to stage the cancer:

  • The presence of plasma cell tumors in the bones
  • The amount of abnormal M-proteins in the blood or urine
  • Signs of bone damage in X-rays
  • The amount of calcium in the blood. A high level of calcium may indicate bone damage due to multiple myeloma.

Multiple myeloma has three stages, and each stage is further divided into two categories, A and B. The kidneys of people in the A groups are working normally. People in the B groups have some kidney damage.

  • Stage I: There are few cancer cells spread throughout the body and no tumors in a patient's bones. The number of red blood cells and the amount of calcium in the blood are normal. The amount of M-proteins in the blood or urine is very low. People in this stage who have no symptoms usually don't receive treatment. Doctors monitor them carefully for signs of the disease, and chemotherapy or radiation therapy begins when symptoms are spotted.
  • Stage II: People whose cases fall somewhere between stage I and stage III have stage II multiple myeloma. For example, a patient who has one or two plasma cell bone tumors would be classified as stage II. People who have stages II and III multiple myeloma usually receive conventional chemotherapy. Radiation therapy and therapy with drugs now in clinical trials may be options. They may also receive treatment with high doses of chemotherapy followed by stem cell transplantation.
  • Stage III: Doctors find a relatively large number of cancer cells throughout the body. They also find one or more of the following:
    • Anemia caused by a decrease in the number of red blood cells
    • High amount of calcium in the blood
    • More than three bone tumors
    • High levels of M-proteins in the blood or urine

Treatment for stage III multiple myeloma is similar to treatment for stage II of the disease.

How Is Multiple Myeloma Treated?

Treatment for multiple myeloma depends on many factors, including the stage and symptoms of a patient's disease, and his or her age and overall health. In general, however, standard treatment for multiple myeloma is conventional chemotherapy, and, in some cases, radiation therapy. High-dose chemotherapy followed by stem cell transplantation, while not without serious risks, has been shown in clinical trials to increase survival and is becoming a common treatment for multiple myeloma patients.


In multiple myeloma, doctors often prescribe chemotherapy drugs called alkylating agents that slow or stop the growth of cancer cells. These drugs are sometimes used with corticosteroids, which also battle multiple myeloma. One common combination is the oral alkylating agent Alkeran (melphalan) with the corticosteroid prednisone. Doctors call this treatment MP for short. Other combinations abound but because drugs differ in how they are absorbed, doctors often work with patients to find the best combination.

High-dose chemotherapy followed by stem cell transplantation

Stem cell transplantation replaces the critical blood-forming cells that are destroyed by chemotherapy. First, patients receive high doses of chemotherapy in an effort to kill cancerous cells. Later, they get a transplant of healthy stem cells through a surgically placed catheter or tube placed in a large vein in the neck or chest. These transplanted cells develop new blood cells.

Doctors use one of two sources for stem cells. In bone marrow transplantation, stem cells come from the bone marrow. In peripheral stem cell transplantation, the cells come from circulating blood. In either case, the transplanted cells may come from a healthy donor whose cells match the patient's (allogeneic transplant), or from the patient (autologous transplant). In multiple myeloma, doctors prefer to use autologous stem cells from the patient. Using donor cells more often results in a complication called graft-versus-host disease in which the transplanted stem cells react against the patient's tissues.

In some cases, conventional chemotherapy is used to reduce the amount of cancer in the body before a patient undergoes high-dose chemotherapy and stem cell transplantation. This is called induction therapy.

Radiation therapy

Radiation therapy, also called radiotherapy, uses high-energy X-rays to kill cancer cells. In multiple myeloma, doctors use external radiation, or radiation that comes from a machine outside of the body. Often, they aim the rays at a specific section of bone or another region of the body, though some patients may have radiation therapy to their entire bodies in preparation for stem cell transplantation. Radiation therapy may be used if a patient has not responded to chemotherapy.

How Is Response to Myeloma Treatment Measured?

Throughout treatment for myeloma, tests are conducted to determine whether a patient is responding to treatment. Doctors often refer to a patient's response to treatment by the following terms:

  • Complete remission or response: No sign of M protein in blood and urine. Normal percent of plasma cells or no sign of myeloma cells in bone marrow.
  • Partial remission or response: More than a 50 percent decrease in M protein in the blood.
  • Complete molecular remission or response: No sign of myeloma cells in the bone marrow using very sensitive tests.
  • Minimal response: Less than a 50 percent decrease in M protein in the blood.
  • Progressive disease: More than a 25 percent increase in M protein in the blood, new areas of bone damage or a new clump of myeloma cells (plasmacytoma).

Do Multiple Myeloma Treatments Have Side Effects?

Side effects from multiple myeloma treatment are likely to occur with either chemotherapy or radiation therapy. Chemotherapy side effects vary depending on the type of drugs and the individual patient's response and level of tolerance. They include nausea, vomiting, hair loss and fatigue, all of which can be very uncomfortable but are usually temporary and disappear after the course of treatment is over. The typical side effects of radiation therapy are fatigue, nausea, eating problems, hair loss, and skin irritation and dryness. There are treatments available for most of the side effects from either radiation or chemotherapy, so it's important to report them to your doctor if they do occur.

Is There a Connection Between Myeloma and Bone Cancer?

Almost all people who have advanced stage multiple myeloma (an estimated 70 to 95 percent) develop bone disease, and the majority of them will experience bone pain. Sometimes doctors find these bone lesions when they discover the original cancer. At other times, they find them months or years later, often during follow-up tests. To find bone lesions, doctors use imaging tests, such as X-rays, bone scans, computed tomography (CT or CAT scans) and magnetic resonance imaging (MRI). They also use blood tests to look for high levels of substances that are released by cancer cells or by damaged bone. If they suspect a bone problem, doctors may request a biopsy to take a tiny amount of tissue for study under a microscope.

Symptoms of bone problems include:

  • Pain in a bone: Often the first symptom, the pain may come and go and feel worse at night.
  • Broken bones (fractures): Most often fractures related to bone problems occur in the arms, legs and spine.
  • Loss of appetite, nausea, thirst and extreme fatigue: When cancer moves to the bones, they begin to give off calcium, which causes the blood level of the mineral to rise. The condition, called hypercalcemia, can make people feel nauseated, thirsty and very tired.

Doctors commonly treat bone lesions by treating the underlying cancer. But there are also treatments that both target bone lesions specifically and combat their symptoms:

Where Can I Get Information About Multiple Myeloma?

Your doctor may be able to refer you to community resources and local cancer support groups. In addition, you'll find more information on the following pages at Everyday Health and on other Web sites:

Last Updated: 12/05/2007 | Last Reviewed: 01/12/2008