Multiple Myeloma
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Multiple myeloma is a malignant disease of the blood-forming system. It mainly occurs in older age. The disease causes uncontrolled growth of plasma cells. These cells are part of the immune system. Normally, they produce antibodies.
Multiple myeloma belongs to the group of monoclonal plasma cell neoplasms or plasma cell disorders. A single abnormal cell clone takes over antibody production. It then produces large amounts of identical but structurally changed antibodies or antibody fragments. These are called monoclonal immunoglobulins or light chains.
There are different forms of the disease. Multiple myeloma is a generalized disease of the bone marrow. Plasma cell clusters develop in several areas. Plasmacytoma, on the other hand, describes a localized tumor focus. It is a special form of multiple myeloma. Both forms can develop into each other.
In multiple myeloma, the main problems are abnormal antibody production, disturbed bone metabolism and displacement of normal blood formation in the bone marrow. The abnormal plasma cells often produce more IgG or IgA antibodies. These antibodies cannot support immune defense. Instead, they may build up in the blood or organs and damage tissue.
Myeloma cells can also affect bone metabolism. This can lead to osteolytic lesions, where bone tissue breaks down. In addition, the growing plasma cells increasingly displace normal blood formation in the bone marrow. As a result, the body has fewer healthy red blood cells, white blood cells and platelets.
Prof. Dr. med. Dipl.-Med. Holger Wehner
The treatment of multiple myeloma requires a long-term and individualized therapeutic strategy. Complementary approaches such as hyperthermia may help support the body and improve quality of life throughout treatment.
Multiple Myeloma Causes and Risk Factors
The causes of multiple myeloma cannot be clearly identified in most cases. The abnormal plasma cells develop over many years. During this time, genetic changes build up in one cell. These changes affect genes that control growth, cell division and repair.
When these control mechanisms become unbalanced, a monoclonal plasma cell clone can develop. This may appear as MGUS, smoldering multiple myeloma or active multiple myeloma. Smoldering multiple myeloma is an asymptomatic early stage of active disease. It is still unclear why this transition happens in some people. However, some risk factors may increase the likelihood.
Typical risk factors include:
- Older age
- Male sex
- Family history or genetic predisposition, such as trisomies or translocations
- Precursor stages such as MGUS
- Ethnic background, especially African American ancestry
- Chronic immune stimulation and previous illnesses
- Exposure to certain chemicals, such as pesticides and products from petroleum, natural gas and rubber processing
- High exposure to ionizing radiation
It is important to note that these risk factors do not necessarily lead to multiple myeloma. Many people with the disease have no clear risk factors. Multiple myeloma is therefore a multifactorial disease. Chance, aging processes, genetic susceptibility and external influences can all play a role.
Multiple Myeloma Symptoms
Multiple myeloma symptoms are not only caused by the tumor in the bone marrow. They are mainly linked to its effects on bones, blood formation, the immune system and organs such as the kidneys. Symptoms can vary widely. They may range from no symptoms to a highly acute course.
At first, the disease often develops slowly. Early signs may be mild or unspecific. They can include susceptibility to infections, fatigue or diffuse back pain. These symptoms often increase slowly over time. They may also become harder to explain by other causes.
The most common symptoms and signs of multiple myeloma include:
- Bone pain
- Frequent bone fractures
- Back pain
- Severe fatigue and reduced performance
- Pale skin, shortness of breath during exertion and palpitations
- Increased susceptibility to infections
- Weight loss, loss of appetite and a general feeling of illness
- Signs of kidney damage
- Neurological symptoms, such as numbness or polyneuropathy
- Increased or unusual bleeding tendency
Classic warning signs include new or increasing bone pain without a clear cause. Fractures after minor strain can also be a warning sign. Persistent fatigue, frequent or severe infections and unexplained weight loss should also be taken seriously.
If several of these signs occur together, persist or worsen over time, they should be checked by a doctor. The earlier multiple myeloma is detected, the better the options for relieving symptoms and treating the disease in a targeted way.
Multiple Myeloma Diagnosis
Multiple myeloma diagnosis is based on several steps. These include a clinical examination, laboratory tests such as a blood test, imaging and a biopsy.
At the beginning, abnormal laboratory findings are often seen. These may include newly developed anemia, unexplained bone pain, recurrent infections or changed kidney values. If a plasma cell disease is suspected, further testing focuses on monoclonal immunoglobulins, the bone marrow and possible organ damage.
An important first step is blood and urine testing. Doctors usually check a complete blood count, kidney values, calcium levels and inflammation markers. They also perform serum protein electrophoresis. This test can make monoclonal protein visible.
Free light chains in the serum may also be measured. This is important because myelomas often produce light chains. These specific proteins can also be detected in the urine. These tests show whether a monoclonal immunoglobulin is being produced. They also show how much is present and whether organ damage has already occurred. This may include anemia, kidney dysfunction or hypercalcemia.
A bone marrow examination is also performed to confirm the diagnosis. A biopsy can show an increased number of clonal plasma cells under the microscope. These cells are then examined in more detail. This is especially important for risk assessment and later treatment planning.
Because multiple myeloma often affects the bones, imaging can help assess bone changes. These may include osteolytic lesions, vertebral fractures and other skeletal changes. In certain cases, a PET-CT may also be useful. It can show active lesions in the skeleton and outside the bone marrow.
These diagnostic methods can confirm multiple myeloma. They can also help distinguish active disease from precursor stages.
Multiple Myeloma Treatment and Prognosis
Multiple myeloma treatment has developed greatly in recent years. It usually combines several treatment approaches. The aim is to reduce the disease as much as possible, relieve symptoms, limit organ damage and preserve quality of life. Despite multimodal treatment, multiple myeloma is usually a chronic disease that cannot be cured.
Today, treatment often includes proteasome inhibitors, immunomodulatory drugs, corticosteroids and classic chemotherapy. Antibody therapies and CAR T-cell therapies are also used more often. In younger and physically fit patients, high-dose chemotherapy is usually followed by an autologous stem cell transplant. Radiation therapy may also be used for painful bone lesions. Bone-protective medicines, such as bisphosphonates, can also be part of treatment.
Alongside conventional medical treatment, complementary approaches may also be used. They can support treatment and strengthen well-being. One approach is hyperthermia.
Hyperthermia uses targeted heating of tissue or the whole body. This may make tumor cells more sensitive to chemotherapy or radiation therapy. Hyperthermia can therefore be used to help relieve symptoms and support standard treatment. Preclinical studies are also examining the apoptotic effect of hyperthermia on multiple myeloma.
Because multiple myeloma mainly affects the bones, vitamin D and calcium also play an important role. Many medicines used in treatment can also influence bone metabolism. Vitamin D and calcium support bone stability, especially when bone-protective medicines such as bisphosphonates or denosumab are used.
There is also evidence that a balanced vitamin D level may support patients with peripheral nerve pain during treatment. This can include therapy-related polyneuropathy.
Acupuncture is also often used as a complementary approach in oncology. It may help reduce pain, nausea, sleep disorders and inner restlessness. This can make it easier to cope with the disease and the effects of treatment.
In multiple myeloma, acupuncture may especially support quality of life in patients with chronic pain or neuropathic symptoms.
Dr. med. Karsten Ostermann M.A.
In multiple myeloma, bone health, immune function, and individual patient needs should be considered alongside the disease itself. An integrative approach can help support treatment comprehensively and promote long-term well-being.
Further information
The information listed contains relevant topics and serves to improve understanding.