Myeloma / Plasma Cell Disorder

A myeloma is a malignant tumor that originates in the bone marrow. More precisely, it is a disease of the plasma cells – specialized cells of the immune system that normally produce antibodies. When plasma cells become abnormal and multiply uncontrollably, they displace healthy blood-forming cells and produce non-functional proteins, known as paraproteins or M-proteins.

The term bone marrow cancer is frequently used in everyday life, but it is not a precise medical specialist term. In colloquial language, it describes various diseases that originate in the bone marrow – including myeloma, but also leukemia or lymphomas. Myeloma is a specific, clearly defined disease with its own characteristics, clinical courses, and therapeutic approaches.

Myelomas are among the more common hematological cancers and account for around ten percent of all blood-related cancer diagnoses. They primarily affect people aged 60 and over, but can generally occur at any adult age.

Fundamentally, a myeloma disorder (or plasma cell disorder) generally describes the presence of malignantly altered plasma cells.
The term plasmacytoma is specifically used in medicine when this disease is strictly confined to a single, isolated location – meaning there is only a single tumor focus in the bone or tissue.

However, if the abnormal cells spread in the bone marrow and form foci in various parts of the body, it is referred to as multiple myeloma. A plasmacytoma can remain stable for years, but in some cases, it can develop into such an extensive myeloma disorder over time.

For choosing the appropriate therapy, this precise distinction through imaging techniques – whether it is a purely isolated focus or an extensive involvement – is of crucial importance.

The exact causes of myeloma remain not fully understood to this day. It is a multifactorial disease in which various influences interact.

Age is a confirmed risk factor: the vast majority of those affected are older than 60 at the time of diagnosis. Men are affected slightly more frequently than women. Genetic predisposition also plays a role – anyone who has first-degree relatives with a myeloma carries a slightly increased risk.

An important precursor state is the so-called MGUS (monoclonal gammopathy of undetermined significance). In this condition, plasma cells already produce abnormal proteins without the disease being clinically active. In a small proportion of those affected, myeloma develops from an MGUS over the years. Regular monitoring is important in this case.

Influences such as chronic inflammation, exposure to heavy metals or pesticides, as well as a permanently weakened immune system are also under discussion. These factors have not yet been conclusively proven scientifically, but they are taken seriously in integrative medicine as relevant accompanying factors and are included in the overall assessment.

The symptoms of myeloma are diverse and often non-specific, which complicates diagnosis in the early stages. Many affected individuals are initially examined for other complaints before the actual finding comes to light.

In medicine, the classic key symptoms are summarized under the acronym CRAB: elevated calcium in the blood (C), renal insufficiency (R), anemia (A), and bone damage (B). These four areas reflect how myeloma can simultaneously impair different organ systems.

In the early stages, the complaints are often uncharacteristic. Affected individuals frequently report persistent fatigue and exhaustion, which can be attributed to anemia. Back pain or bone pain without an apparent cause is also a common first sign, as the myeloma attacks the bone substance and can lead to ostelysis – meaning local bone loss. An increased susceptibility to infection can also occur early, as healthy immune cells are displaced by the abnormal plasma cells.

With an increasing disease burden, further complaints may arise. Kidney function disorders develop because the paraproteins produced by the myeloma strain the kidneys. An elevated calcium level in the blood can lead to nausea, confusion, constipation, and increased thirst. Bone pain increases, and in advanced cases, vertebral bodies can collapse, resulting in acute back pain or neurological deficits.
Some affected individuals also notice changes to the skin and fingernails, as well as visual disturbances or tingling in the extremities, which can indicate nerve involvement or a deposition of paraproteins.

The diagnosis of myeloma requires several coordinated examination steps. Initial indications are often provided by the blood test: altered blood values such as an increased erythrocyte sedimentation rate, anemia, or abnormal protein levels can point toward a myeloma. Serum electrophoresis is a central diagnostic tool – it visualizes the abnormal M-protein produced by the abnormal plasma cells.

For further clarification, a bone marrow biopsy is performed, during which a tissue sample is taken from the bone marrow and examined histologically. Imaging techniques such as MRI, CT, or PET-CT help to assess bone damage and the extent of the disease. An ultrasound can also be used as an adjunct.

The diagnosis is considered confirmed when certain criteria are met – including a plasma cell proportion of at least ten percent in the bone marrow, as well as evidence of organ damage or specific biomarkers.

The treatment of myeloma has evolved significantly in recent years. Although the disease is not fully curable in most cases, it can be controlled over long periods of time in many affected individuals today. The goal of therapy is to bring the disease into remission, alleviate symptoms, and maintain the quality of life.

Drug therapy for myeloma includes a variety of active substances today. Classic chemotherapeutic agents are frequently combined with corticosteroids and newer substance classes, including proteasome inhibitors and immunomodulatory drugs. In eligible patients, an autologous stem cell transplantation is pursued, in which the patient’s own stem cells are first harvested, a high-dose chemotherapy is then performed, and the stem cells are subsequently returned.

Newer therapeutic approaches such as CAR-T cell therapy and bispecific antibodies show promising results, particularly in patients for whom previous therapies no longer work. Targeted immunotherapies are also increasingly being used and are expanding treatment options significantly.

The prognosis for myeloma has improved significantly over the last two decades thanks to modern therapies. While the median survival time used to be around three years, many affected individuals today reach survival times of ten years or more with optimal treatment. In modern oncology, a functional cure is occasionally mentioned for patients who respond extraordinarily well to new therapies – meaning that the disease remains permanently controlled without significantly shortening life. However, this remains the exception and depends heavily on individual factors.

In most cases, myeloma remains a chronic disease that cannot be completely cured, but is often controllable over long periods of time. The prognosis depends on several factors: the stage at diagnosis, the subtype of the myeloma, the response to the initial therapy, as well as the general health condition and age of the patient. Certain genetic alterations in the tumor genome can make the clinical course less favorable and are routinely captured in diagnostics today.

In the terminal stage of myeloma, vital organs increasingly fail. The kidneys are often heavily strained, blood formation in the bone marrow is significantly restricted, and severe infections become the greatest danger since the immune system is barely functional. In addition, complications from bone damage or pronounced anemia can occur. In this phase, palliative support is paramount, with the goal of alleviating symptoms and preserving the remaining quality of life.

Myeloma is a complex disease that raises many questions for affected individuals and their relatives – from its development and symptoms to its prognosis and therapy. The answers to the most common questions are summarized here in a compact format.

The information listed contains relevant topics and serves to improve understanding.