What Is Multiple Myeloma?

Multiple myeloma is a type of blood cancer. It starts in your bone marrow, the spongy tissue inside bones. This is where your body makes blood cells, including a certain type called plasma cells. These cells can grow out of control and crowd out the normal, healthy ones in your bone marrow. When they build up, they form a tumor. The name “multiple myeloma” means there is more than one tumor.
Scientists aren’t sure what causes multiple myeloma. It might be linked to changes in DNA. But they do know that some people have a higher chance of getting the disease than others. Things that make your risk go up include:

Age. Most people with multiple myeloma are 45 or older. More than half are 65 or older.
Race. The disease is nearly twice as common in African-Americans.
Being male. It’s slightly more common in men.
Being overweight.
Other people in your family have had multiple myeloma.
You’ve had another plasma cell disease.

Symptoms
In the early stages of multiple myeloma, you might not have any symptoms, or they might be very mild. Everyone who has the disease will feel different effects. In general, it can cause:
Pain in your bones, especially in your back, ribs, and skull
Weakness
Fatigue
Feeling very thirsty
Getting infections and fevers often
Changes in how often you need to pee
Restlessness
Confusion
Nausea and vomiting
Loss of appetite
Weight loss
Numbness, especially in your legs
Multiple myeloma can affect your body in different ways.
Bones. The disease can make your bones weak and easy to break.
Blood. Because your bone marrow makes blood, multiple myeloma can affect how many healthy blood cells you have.
Too few red blood cells (called anemia) can make you feel weak, short of breath, or dizzy.
Too few white blood cells (called leukopenia) can make it easy to get infections like pneumonia. It can take longer to recover from them, too.
Too few platelets (called thrombocytopenia) makes it harder for wounds to heal. Even minor cuts can bleed too much.
Multiple myeloma can lead to too much calcium in your blood. This can give you belly pain and make you:
Thirsty
Pee a lot
Dehydrated
Constipated
Not feel like eating
Weak
Sleepy
Confused
Go into a coma (if your problem is severe)
Kidneys. Multiple myeloma and high levels of calcium can hurt your kidneys and make it harder for them to filter your blood. Your body might not be able to get rid of extra salt, fluid, and waste. This can make you feel:
Weak
Short of breath
Itchy
Swelling in your legs

Stages of Multiple Myeloma
When your doctor diagnoses multiple myeloma, she’ll try to give you an idea of how much the cancer has grown or spread in your body. This is called the stage of your disease.
Doctors can tell what stage the multiple myeloma is in by looking at X-rays of your bones and testing your blood, pee, and bone marrow.
Your stage might be:
Smoldering myeloma. This is very early in the disease, when there are no symptoms or problems. The blood and kidneys are normal, and there is no bone damage. People who have smoldering myeloma often do not need treatment right away.
Stage I. There aren’t that many myeloma cells in the body. Doctors can’t see any bone damage on X-rays, or the cancer has damaged only one area of bone. The amount of calcium in the blood is normal. Other blood tests may be only slightly off-balance.
Stage II. This is the middle ground between stage I and stage III. There are more myeloma cells in the body than in stage I.
Stage III. There are many myeloma cells and the cancer has destroyed three or more areas of bone. Blood calcium is high and other blood tests are abnormal.

Multiple Myeloma Treatments

If you have multiple myeloma, remember that you often have a lot of choices in how to treat it. You and your doctor will work together to create a cancer treatment plan that’s right for you.
The goal of multiple myeloma treatment is to shrink your tumors, stop the cancer from spreading, keep your bones strong, and help you feel better and live longer. To do this, you might get medication, a stem-cell transplant, radiation, a type of blood filtering called plasmapheresis, and surgery.
The treatment plan you and your doctor choose will depend on:
Your age
How much your cancer has spread in your body, called the stage of your disease
Lab test results
Symptoms you have, like fatigue or pain
Your lifestyle and general health
Which Drugs Treat Multiple Myeloma?
Using medication to treat cancer is called chemotherapy. You might take just one medicine or a mix of them. Some come in pills, while others are shots into your vein or muscle.
Chemotherapy drugs for multiple myeloma kill cancer cells or keep them from spreading. They include:
Bendamustine (Treanda)
Cyclophosphamide (Cytoxan)
Doxorubicin (Adriamycin)
Etoposide (VP-16)
Liposomal doxorubicin (Doxil)
Melphalan (Alkeran)
Vincristine (Oncovin)
Your doctor may suggest that you take other drugs to fight your multiple myeloma along with your chemotherapy.
Some drugs help your immune system fight cancer cells in your blood.  They include daratumumab (Darzalex), elotuzumab (Empliciti), lenalidomide (Revlimid), pomalidomide (Pomalyst), and thalidomide (Thalomid). These drugs may cause birth defects if you take them while you’re pregnant, so talk to your doctor about using birth control.
Newer drugs keep cancer cells from growing out of control. They include bortezomib (Velcade), carfilzomib (Kyprolis), ixazomib (Ninlaro), and panobinostat (Farydak).
Your doctor may also prescribe steroid drugs like dexamethasone or prednisone. Sometimes you’ll get them along with your chemotherapy so you have less nausea and vomiting during treatment.
Multiple myeloma can make your bones weaker and more likely to break. Your doctor may give you drugs to help strengthen your bones, including pamidronate (Aredia) and zoledronic acid (Zometa). These drugs are called bisphosphonates.
Stem Cell Transplant
Myeloma damages your bone marrow where cells, called stem cells, make new blood. A stem cell transplant can help your body make new, healthy blood cells. You can get new stem cells from a healthy donor, or your doctor can collect some of your own from your blood and give them back to you. The latter is the standard treatment for multiple myeloma.
Before a transplant, you’ll get high-dose chemotherapy to kill any cancer in your bone marrow. It could last for several days. Then the doctor will put stem cells back into your blood through an IV. (If you’re using your own stem cells, the doctor will collect them from you before you start chemo.) You won’t feel any pain, and you’ll be awake while it’s happening.
It can take up to 2 weeks after the transplant for your bone marrow to start making new blood cells. You may need to stay in the hospital during this time. You’ll also have a higher risk of infection, so your doctor might give you antibiotics to keep you from getting sick.
Using your own stem cells for a transplant can make myeloma go away for a while, sometimes several years, but it won’t cure the disease.
Other Treatments
Your doctor may try other treatments to fight your multiple myeloma.
Radiation, along with drugs, can kill cancer cells or treat bones that the disease has damaged.
You might have surgery to remove tumors or treat bones or muscles damaged by multiple myeloma.
Plasmapheresis is a way to remove myeloma from the liquid part of your blood, called plasma. It won’t get rid of your disease, but it may relieve your symptoms for a short time. You’ll probably also get chemotherapy or treatment with another drug at the same time.
Will I Have Side Effects?
Side effects are possible, though not everyone has the same ones. The treatments may not affect you as much as another person. Some, like blood clots, may be serious but are rare.

The side effects you might have from multiple myeloma treatment include:
Too few red blood cells (called anemia)
Bleeding problems
Blood clots
Bruising
Constipation
Diarrhea
Fatigue
Infections
Nausea
Nerve pain, tingling, or numbness
Vomiting
Talk to your doctor about how your treatment makes you feel. There may be ways to reduce your side effects, including lowering your drug dosage, changing medications, taking aspirin to fight blood clots, changing your diet to help with constipation or diarrhea, or giving you other medicines to ease nausea or fatigue.

What Else Can I Do?

Stick with your multiple myeloma treatment plan. Your medications will work better against your cancer if you take them as prescribed. If you take pills at home, follow the instructions carefully.
Don’t be afraid to talk to your doctor or nurse if you don’t understand how to take your medicine. Don’t stop taking it if you have side effects. Instead, call your doctor’s office and talk about your options.