Understanding Multiple Myeloma

Understanding Multiple Myeloma

With the recent news about Tom Brokaw’s myeloma diagnosis, there has been more interest in what multiple myeloma is.

In myeloma, the cells in the bone marrow that are cancerous are plasma cells – these are white cells, and where 80 percent of their job is to make antibodies. The process of going from a normal plasma cell to a myeloma cell can take years or decades. Initially, one or a group of plasma cells mutates to not die. These plasma cells are abnormal, but they live within the patient without directly attacking the patient – similar to a colon polyp. This is called monoclonal gammopathy of undetermined significance (MGUS). Over time the immune system becomes weaker, letting the cage for these mutated plasma cells get bigger – a disease state called smoldering myeloma (SMM).

It is important to note that MGUS and SMM are not thought to be cancerous conditions, even though recent data suggest that patients with these precancerous conditions have an immune system that is not quite 100 percent.

The important transition is between these precancerous conditions and active multiple myeloma. The basis for this transition is when the mutated plasma cells mutate further, creating genetic instructions for these cells to grow further and cause the patient harm. Myeloma cells cause damage in some basic ways:

  • Calcium: Myeloma cells eat away at your bones and spit the calcium into your blood, causing high calcium levels that can damage your kidneys and make it hard for you to function;
  • Renal (kidney): Myeloma cells can make malformed antibodies that, when they are filtered through your kidney, can damage it. Some untreated myeloma patients are diagnosed in complete kidney failure for no clear cause and require dialysis immediately;
  • Anemia: Having too many myeloma cells in your bone marrow makes it difficult for you to make an adequate number of red cells, causing you to be anemic and feel more tired. Eventually you can be so anemic that you are predisposed to suffer a heart attack or stroke;
  • Bones: Myeloma cells eat away at your bones and put you at high risk of fracture – often times in weight-bearing areas such as your hips, pelvis, or back (in your back, these are called compression fractures).
These are the so-called CRAB criteria that clinch the diagnosis of myeloma.

Myeloma is not currently curable, and the average overall survival is often cited as four to 10 years with excellent treatment. But the rate of change in myeloma is quick – there has been a new drug approved for it in each of the last two years, and more than 50 different clinical trials are open to testing new drugs with novel mechanisms.

At the OSUCCC – James, we are developing ways to use the immune system to attack myeloma cells, to weaken myeloma cells by targeting them without harming the normal cells around them, and, most importantly, to get away from standard chemotherapy. We not only want to have treatments that are more successful, we want to do it better.

We have partnered with a local 501©3 called MMORE, Multiple Myeloma Opportunities for Research and Education. With MMORE, we have planned an ImagineMMORE Symposium on April 11 for researchers interested in novel treatment and clinical care concepts, and on April 12 we will have a morning symposium to bring myeloma clinicians around the country together to discuss controversial myeloma treatment topics in an easy-to-reach format for patients and caregivers.

Visit MMORE.org for additional information on MMORE and its upcoming events.

By Craig Hofmeister, MD Chief, Section of Plasma Cell Dyscrasias Assistant Professor of Internal Medicine