Multiple myeloma is a type of cancer that originates in plasma cells, which are a type of white blood cell responsible for producing antibodies to help the body fight infections. In multiple myeloma, these plasma cells become abnormal and multiply uncontrollably, crowding out healthy blood cells in the bone marrow.
As the cancerous plasma cells accumulate and spread, they can cause several complications, including:
Multiple myeloma is considered a complex and heterogeneous disease, meaning it can vary significantly from one individual to another in terms of symptoms, progression, and response to treatment.
In Singapore, multiple myeloma is among the top ten most common cancers, most found in elderly individuals. The exact reasons why multiple myeloma is more prevalent in the elderly are not entirely clear, but it may be associated with age-related changes in the immune system and the accumulation of genetic mutations over time. Globally, multiple myeloma accounts for approximately 1% of all cancers and around 10% of haematological (blood-related) malignancies.
The most common symptoms of multiple myeloma can vary from person to person, and some individuals may not experience any symptoms in the early stages of the disease. When symptoms do occur, they can be vague and similar to other conditions, making diagnosis challenging.
The most common symptoms of multiple myeloma include:
Persistent bone pain, particularly in the back, ribs, hips, and skull, is a common symptom of multiple myeloma. The pain may be dull, aching, or sharp and can worsen with movement.
Feeling tired, weak, or exhausted, even after resting, is a common symptom.
Multiple myeloma can weaken the immune system, leading to an increased susceptibility to infections, such as pneumonia, urinary tract infections, or skin infections.
Abnormal plasma cells can crowd out healthy blood cells in the bone marrow, leading to a decrease in red blood cells, resulting in anaemia. Anaemia may cause fatigue, weakness, and shortness of breath.
Some individuals with multiple myeloma may experience unintended weight loss.
Multiple myeloma can sometimes affect the nerves, leading to weakness, numbness, or tingling in the hands or feet.
In advanced cases, multiple myeloma can cause high levels of calcium in the blood, leading to symptoms such as increased thirst, frequent urination, and constipation.
Multiple myeloma proteins can damage the kidneys, leading to kidney dysfunction, which may manifest as decreased urine output or swelling in the legs and ankles.
It is important to note that these symptoms can be caused by various other conditions as well, and having one or more of these symptoms does not necessarily mean you have multiple myeloma. If you are experiencing persistent or concerning symptoms, it is essential to consult a healthcare professional for a proper evaluation and diagnosis. Early detection and diagnosis of multiple myeloma can lead to better outcomes and improved management of the disease.
Multiple Multiple Myeloma is a complex disease with different subtypes and variations based on various factors. The main types of Multiple Myelomas include:
In some cases, multiple myeloma may be present but does not cause any symptoms or organ damage. This is known as asymptomatic or smouldering multiple myeloma. The patient is monitored closely without immediate treatment until the disease progresses and becomes symptomatic.
In most multiple Multiple Myeloma cases, cancerous plasma cells produce abnormal proteins (immunoglobulins or antibodies) that can be detected in blood and urine tests. However, in some cases, the Multiple Myeloma cells do not produce these proteins, making it challenging to diagnose. This is known as non-secretory multiple Multiple Myeloma.
Multiple myeloma is further categorised based on the type of abnormal immunoglobulins (antibodies) produced by the cancerous plasma cells. The most common types are IgG and IgA Multiple Myeloma. IgD and IgE Multiple Myeloma are rarer subtypes.
In some cases, Multiple Myeloma cells produce only the light chains of immunoglobulins without the heavy chains. This is known as light chain multiple Multiple Myeloma or Bence Jones Multiple Myeloma.
In this subtype, Multiple Myeloma cells produce only a small number of abnormal proteins, making them challenging to detect through standard tests.
Each subtype of multiple myeloma can have unique characteristics, clinical features, and treatment considerations. Accurate classification is crucial for determining the most appropriate treatment approach for an individual with multiple multiple myeloma. Proper diagnosis and staging are essential for developing a personalised treatment plan and providing the best possible care for patients with Multiple Myeloma.
Multiple Multiple Myeloma is staged to assess the extent and severity of the disease, which helps guide treatment decisions and predict outcomes. The staging system commonly used for multiple Multiple Myeloma is the Revised International Staging System (R-ISS). The R-ISS considers three main factors:
This is a protein found on the surface of many cells in the body. High levels of beta-2 microglobulin in the blood indicate more extensive disease.
Albumin is a protein made by the liver. Low levels of albumin in the blood can indicate poorer overall health and may be associated with more advanced Multiple Myeloma.
Genetic changes in Multiple Myeloma cells can affect disease behaviour and response to treatment. The presence of specific chromosomal abnormalities is considered in the staging.
Based on these factors, multiple myeloma is categorised into three stages:
This stage includes patients with low beta-2 microglobulin levels and normal albumin levels. There are no high-risk cytogenetic abnormalities.
This stage encompasses patients characterised by elevated beta-2 microglobulin levels and reduced albumin levels, indicative of a more advanced disease state and diminished overall health. Additionally, it may comprise patients with high-risk cytogenetic abnormalities, which include chromosome 1 abnormalities, TP53 mutations, chromosome 17p deletions, as well as aberrations involving translocation t(4;14) and translocation t(14;16). These high-risk cytogenetic abnormalities are genetic variations associated with a poorer prognosis in multiple myeloma.
The R-ISS staging system helps oncologists assess the prognosis and tailor treatment plans for patients with multiple Multiple Myeloma. Additionally, other factors, such as the patient’s age, overall health, and response to treatment, are also considered in determining the best approach for managing the disease.
The exact causes of multiple myeloma are not fully understood, but it is believed to result from a combination of genetic and environmental factors. The disease develops when plasma cells, a type of white blood cell responsible for producing antibodies, become cancerous and grow uncontrollably.
Some of the known risk factors for multiple myeloma include:
Multiple myeloma is more commonly diagnosed in older adults, with many cases occurring in individuals over the age of 65. The risk of developing multiple myeloma increases with age.
Men have a slightly higher risk of developing multiple myeloma than women.
Having a first-degree relative (parent, sibling, or child) with multiple myeloma or a related condition called monoclonal gammopathy of undetermined significance (MGUS) may increase the risk of developing multiple myeloma.
MGUS is a condition characterised by the presence of abnormal proteins in the blood but without cancerous plasma cells. People with MGUS have a higher risk of progressing to multiple myeloma or related disorders.
Exposure to high levels of radiation, such as radiation therapy for other cancers, may increase the risk of developing multiple myeloma.
Some studies have suggested a link between obesity and an increased risk of multiple multiple myeloma.
Prolonged exposure to certain chemicals, such as benzene and other solvents, may be associated with an increased risk of multiple myeloma.
Individuals with other plasma cell disorders may have a higher risk of developing multiple myeloma.
It is essential to note that having one or more risk factors does not guarantee that an individual will develop multiple myeloma. Many people with multiple myeloma have no known risk factors, and not everyone with risk factors will develop the disease.
Since the exact cause of multiple myeloma cancer remains unclear, it is challenging to prevent the disease. However, leading a healthy lifestyle, maintaining a balanced diet, avoiding exposure to harmful chemicals, and seeking regular medical check-ups can help promote overall well-being and may reduce the risk of certain cancers, including multiple myeloma.
It is important to remember that Multiple Myeloma can be treated successfully if caught early. If you have any concerns about Multiple Myeloma or notice any changes, do not hesitate to see a healthcare professional for evaluation.
If you suspect that you or your loved one have Multiple Myeloma, it is advisable to get the support you need. Early detection and diagnosis of Multiple Myeloma is key to treating the disease.
Regardless of what stage your Multiple Myeloma may be at, you should schedule an appointment to see an oncologist specialising in Multiple Myeloma as soon as possible. With the speed of developments in Multiple Myeloma diagnosis and treatment, novel emerging treatment options could be explored by your medical oncologist.
Our cancer specialists at OncoCare specialise in treating late stage and advanced stages of Multiple Myeloma, as well as earlier stages of the disease.
As the cancerous plasma cells accumulate and spread, they can cause several complications, including:
Common symptoms of Multiple Myeloma may include bone pain, fatigue, recurrent infections, weakness, unexplained weight loss, and kidney problems.
Multiple Multiple Myeloma is considered a complex and heterogeneous disease, meaning it can vary significantly from one individual to another in terms of symptoms, progression, and response to treatment.
In Singapore, Multiple Myeloma is among the top ten most common cancers, most found in elderly individuals. The exact reasons why multiple Multiple Myeloma is more prevalent in the elderly are not entirely clear, but it may be associated with age-related changes in the immune system and the accumulation of genetic mutations over time. Globally, Multiple Myeloma accounts for approximately 1% of all cancers and around 10% of haematological (blood-related) malignancies.
Unlike other cancers like lymphoma and breast cancer, there are no widely recommended screening tests for the general population to detect multiple myeloma early, particularly in individuals who do not have symptoms or known risk factors.
The reason for the lack of routine screening is that multiple myeloma is considered a relatively rare cancer, and most cases are diagnosed in older adults with symptoms that prompt medical evaluation. Additionally, the early symptoms of multiple myeloma can be vague and similar to other more common conditions, making it challenging to identify the disease through routine screening alone.
It is essential to recognise that if you are experiencing symptoms, such as persistent bone pain, unexplained weight loss, recurrent infections, or fatigue, you should seek medical attention promptly. Early diagnosis and treatment can lead to better outcomes for individuals with multiple myeloma.
If you have specific risk factors for multiple myeloma or a family history of the disease, it is essential to discuss your concerns with a healthcare professional. They can evaluate your individual risk and determine if any additional screening or monitoring is necessary based on your medical history and other factors. Regular check-ups and age-appropriate health screenings are still essential to monitor overall health and identify any potential health issues early on.
Diagnosing multiple Multiple Myeloma involves a series of tests and evaluations.
The doctor will begin by taking a detailed medical history, asking about your symptoms, any family history of cancer, and any other relevant information. They will also perform a physical examination to assess your general health and look for any signs of Multiple Myeloma, such as bone pain or swelling.
Blood tests are essential in diagnosing multiple Multiple Myeloma. Specific blood tests will be conducted to check for abnormal levels of certain proteins, such as monoclonal proteins (M-proteins) and light chains. Blood tests can also evaluate kidney function, complete blood counts (CBC) to assess the number of different blood cells, and other parameters related to Multiple Myeloma.
In multiple Multiple Myeloma, abnormal proteins produced by cancerous plasma cells may be excreted in the urine. Urine tests may be conducted to detect these proteins and assess kidney function.
A bone marrow biopsy and aspiration are crucial in confirming the diagnosis of multiple Multiple Myeloma. During this procedure, a small sample of bone marrow and bone marrow fluid is taken from the hipbone or other large bones. The samples are examined under a microscope to check for the presence of cancerous plasma cells and determine their characteristics.
Imaging tests, such as X-rays, MRI (Magnetic Resonance Imaging), or CT (Computed Tomography) scans, may be performed to visualise bones and other organs for signs of multiple myeloma-related changes. These tests can help identify bone lesions, fractures, or other abnormalities.
Depending on the specific case, additional tests may be performed to assess the extent of the disease and determine any complications. These tests may include PET (Positron Emission Tomography) scans, genetic tests, or cytogenetic studies to identify specific genetic abnormalities associated with Multiple Myeloma.
Once all the diagnostic tests are completed and the results are analysed, the healthcare team will evaluate the findings to make a definitive diagnosis of multiple myeloma. If the diagnosis is confirmed, further staging and evaluation will be conducted to determine the disease’s extent and develop an appropriate treatment plan tailored to the individual’s needs and condition.
Multiple myeloma is a type of blood cancer that affects plasma cells in the bone marrow. Cancer treatment options for multiple myeloma can vary based on the stage of the disease, the patient’s overall health, and other individual factors.
Targeted therapy is a type of cancer treatment that focuses on specific molecules or pathways involved
in the growth and spread of cancer cells.
In multiple Multiple Myeloma, targeted therapies have become an essential part of treatment. Some of
the common targeted therapies used for Multiple Myeloma include:
Targeted therapies are often used in combination with other treatments, such as chemotherapy or corticosteroids, to enhance their effectiveness. They may be used as part of induction therapy (initial treatment), consolidation therapy (after initial treatment), or maintenance therapy (to prevent relapse).
The choice of targeted therapy and the treatment plan is based on various factors, including the patient’s specific Multiple Myeloma subtype, overall health, previous treatments, and individual response to therapy.
Immunotherapy is a type of cancer treatment that aims to stimulate the body’s immune system to recognise and attack cancer cells more effectively.
Some of the key immunotherapy approaches used or under investigation for multiple Multiple Myeloma include:
As with any cancer treatment, the decision to use immunotherapy in multiple Multiple Myeloma depends on various factors, including the patient’s disease stage, overall health, and response to other treatments.
Chemotherapy is administered to multiple myeloma patients only in two situations. One instance is when they undergo autologous stem cell transplantation, for which all patients will first receive standard chemotherapy, such as Melphalan, before the transplant.
Chemotherapy drugs like Melphalan are occasionally employed, but they are less common for newly diagnosed multiple myeloma patients. Melphalan is typically used in conjunction with bone marrow transplantation to effectively control multiple myeloma, with the patient’s own bone marrow cells aiding recovery. In some cases, combining chemotherapy with other treatment approaches, including targeted therapies, may be recommended.
Radiation therapy employs powerful rays or particles to eliminate cancer cells, and it is often employed for bone regions affected by multiple myeloma that have not improved with targeted or immunotherapy, or other medications, potentially alleviating pain or preventing fractures. Additionally, it is the primary approach for addressing solitary plasmacytomas.
The primary radiation therapy for multiple myeloma or solitary plasmacytoma is external beam radiation therapy, where a machine outside the body directs radiation at the cancer. Radiation sessions are similar to diagnostic X-rays but longer, typically spanning several weeks.
Surgery is generally not considered a primary treatment for multiple myeloma. Multiple myeloma is a systemic cancer that affects the bone marrow and multiple bones throughout the body. As a result, surgical removal of the affected bone or tumour is not a standard treatment option for this disease.
However, there are certain situations where surgery may play a role in the overall management of multiple myeloma:
Targeted therapy for multiple myeloma is designed to specifically target certain molecules or pathways involved in cancer cell growth and survival. Some common side effects of targeted therapy for multiple myeloma may include:
Since immunotherapy works by stimulating the body’s immune system, the side effects are generally different from those of traditional chemotherapy.
Common side effects of immunotherapy for multiple myeloma may include:
Chemotherapy for multiple myeloma can have side effects as it affects both cancerous and healthy rapidly dividing cells in the body. The specific side effects experienced can vary depending on the type of chemotherapy drugs used, the dosage, the individual’s overall health, and how their body reacts to the treatment. Common side effects of chemotherapy for multiple myeloma may include:
Radiation therapy for multiple myeloma can cause side effects, which vary depending on the location and dose of radiation, as well as individual factors. Common side effects of radiation therapy for multiple myeloma may include:
While surgery is not the primary treatment for multiple myeloma, it may be utilised in certain situations, such as bone stabilisation or the removal of localised plasmacytomas. The side effects of surgery for multiple myeloma can vary depending on the type of surgery performed and the individual’s overall health. Some potential side effects may include:
Senior Consultant, Medical Oncologist
MBBS (Singapore) – ABIM Int. Med (USA) – ABIM Med Onc(USA) – FAMS (Medical Oncology)
Dr Tay has been recognised as one of the top cancer doctors doing research. He was awarded the prestigious centre grant by the National Medical Research Council of Singapore. He actively collaborates with other leading Asian researchers based in Korea, Taiwan, Hong Kong and the USA. Dr Tay has published his findings in numerous journals, including Nature Genetics, the Journal of Clinical Oncology, The Lancet Hematology, American Journal of Medicine, Leukemia & Lymphoma and Seminars in Hematology.
Dr Tay’s subspecialty interest is in women-related cancers, such as breast cancers and gynaecological cancers, melanoma, brain cancers, soft tissue and bone sarcomas and also haematological malignancies such as lymphoma, multiple myeloma and leukaemia.
Senior Consultant, Medical Oncologist
MBBS (Delhi) – American Board Certified (Int Med) – American Board Certified (Hematology)
American Board Certified (Med Oncology)
Before joining OncoCare Cancer Centre at Mount Elizabeth Hospital, Singapore, Dr Akhil Chopra was a Senior Consultant in Medical Oncology at Johns Hopkins Singapore, Tan Tock Seng Hospital and Adjunct Associate Professor at Lee Kong Chian School of Medicine.
Dr Chopra has experience treating multiple cancer types including breast cancer, lung cancer, cancers of the stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers; as well as Sarcomas and chronic leukaemia’s/multiple Multiple Myeloma. Besides his clinical and research work, he has been involved in teaching medical students from the Lee Kong Chian School of Medicine as well as medical residents and students from Johns Hopkins University, Baltimore, USA.
Cancer Specialities: breast cancer, lung cancer, cancers of the stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers, such as ovarian and uterine/cervical cancers.
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