Myeloma is a cancer that starts in plasma cells in your bone marrow
Myeloma is a type of blood cancer that begins in plasma cells, which are white blood cells that live in your bone marrow. Plasma cells normally make antibodies that help your immune system fight infection. In myeloma, these cells become cancerous and multiply out of control, crowding out healthy blood cells and damaging bone.
The cancer usually affects multiple bones at once, which is why it is often called multiple myeloma. As myeloma cells build up, they can cause bone pain, weaken your bones, damage your kidneys, and lower the number of healthy blood cells your body makes. This happens gradually, so many people have no symptoms when the disease is first found.
Myeloma is not the same as leukemia or lymphoma, which are other blood cancers. Myeloma specifically targets plasma cells in the bone marrow, whereas leukemia affects other types of white blood cells and lymphoma affects lymph nodes and the lymphatic system.
Key Takeaways
- Myeloma starts in plasma cells in your bone marrow and usually affects multiple bones, which is why it is called multiple myeloma.
- Early myeloma often causes no symptoms and is sometimes found by accident during blood tests for other reasons.
- Doctors diagnose myeloma using blood tests, urine tests, bone marrow biopsy, and imaging scans to see where the cancer is.
- Treatment options include chemotherapy, targeted drugs, immunotherapy, and stem cell transplant, chosen based on your age and overall health.
- Myeloma is treatable but not typically curable, though many people live for years with the disease under control.
What happens in your body when myeloma develops
In healthy bone marrow, plasma cells make up only a small part of the cells present. In myeloma, plasma cells become abnormal and start dividing rapidly. These cancer cells produce large amounts of a protein called monoclonal protein or M-protein, which builds up in your blood and urine.
As myeloma cells crowd the bone marrow, they push out red blood cells, which carry oxygen, and white blood cells, which fight infection. This crowding causes anemia (too few red blood cells), infections, and bleeding problems. The cancer cells also release substances that break down bone faster than your body can rebuild it, leading to bone pain and fractures.
The excess protein in your blood can also damage your kidneys by clogging the tiny filters that clean your blood. Over time, kidney damage can become serious if the cancer is not treated. Some people develop high calcium levels in their blood because the bone breakdown releases calcium, which can cause confusion, weakness, and kidney problems.
Early signs and symptoms you might notice
Many people with early myeloma have no symptoms at all. The disease is sometimes found by chance when a doctor orders blood work for another reason and sees unusual results. When symptoms do appear, they develop slowly over weeks or months.
Bone pain is the most common symptom, usually in the back, ribs, or pelvis. The pain may feel worse with movement and better with rest. Some people break bones easily or have fractures from minor falls or injuries. Others feel tired and weak because of anemia, or they get infections more often than usual because their immune system is weakened.
Less common early signs include nausea, constipation, confusion, or excessive thirst. If you have any of these symptoms, especially bone pain that lasts more than a few weeks, tell your doctor. Many conditions cause these symptoms, so your doctor will run tests to find out what is happening.
How doctors test for myeloma
If your doctor suspects myeloma, they will order several tests. A complete blood count measures the number of red blood cells, white blood cells, and platelets in your blood. A blood chemistry panel checks kidney function, calcium levels, and other markers. A serum protein electrophoresis test separates proteins in your blood and can show the abnormal M-protein that myeloma cells produce.
Your doctor will also order a 24-hour urine test to check for protein in your urine, which often appears in myeloma. If blood and urine tests suggest myeloma, your doctor will perform a bone marrow biopsy. In this procedure, a needle is inserted into the back of your hip bone to remove a small sample of bone marrow. A pathologist looks at the sample under a microscope to count plasma cells and check whether they are cancerous.
Imaging tests show whether bones have been damaged. Your doctor may order X-rays, a CT scan, or an MRI to look for bone lesions. Sometimes a PET scan is used to see which areas of bone are most affected. These tests together help your doctor confirm the diagnosis and understand how advanced the cancer is.
Stages and how doctors measure disease progression
Myeloma is staged based on the amount of cancer in your body and how well your kidneys are working. Doctors use a system called the Revised International Staging System, which divides myeloma into three stages. Stage 1 means the cancer burden is low, stage 2 is intermediate, and stage 3 means the cancer burden is high.
Doctors also look at specific genetic changes in the myeloma cells, because some changes carry a better or worse outlook than others. Your doctor will explain your stage and what it means for your treatment plan. The stage helps predict how quickly the disease may progress and guides decisions about which treatments to use.
Even within the same stage, myeloma behaves differently in different people. Some people's disease progresses slowly and may not need treatment right away, while others need treatment sooner. Your doctor will monitor you with regular blood tests and imaging to watch for changes.
Treatment options and what to expect
Treatment for myeloma depends on your age, overall health, and how advanced the cancer is. Many people receive chemotherapy, which uses drugs to kill cancer cells throughout your body. Others receive targeted therapy drugs that attack specific features of myeloma cells, such as proteasome inhibitors or immunomodulatory drugs.
Immunotherapy is a newer approach that helps your own immune system recognize and attack myeloma cells. CAR-T cell therapy is a type of immunotherapy in which your T cells (immune cells) are removed, modified in a lab to target myeloma, and then returned to your body. A stem cell transplant is sometimes used, especially in younger patients, to allow doctors to give higher doses of chemotherapy.
Treatment is usually given in cycles, with periods of therapy followed by rest periods. Your doctor will check your blood regularly to see how well the treatment is working. If one treatment stops working, your doctor can switch to a different one. Most people with myeloma need ongoing treatment to keep the disease under control, though the goal is to reach a state where the cancer is no longer growing.
Living with myeloma and what happens next
Myeloma is a chronic disease, meaning it is long-lasting. Most people cannot be cured, but many live for years with the disease controlled by treatment. Some people go into remission, which means the cancer is no longer detectable in blood tests, though it may return later.
During treatment, you will have regular appointments with your oncologist (cancer doctor) for blood tests and scans. You may also see other specialists, such as a nephrologist if your kidneys are affected or an orthopedic surgeon if you have bone damage. Many cancer centers offer support services including counseling, nutrition advice, and support groups.
Side effects from treatment vary depending on which drugs you receive. Common side effects include fatigue, nausea, low blood cell counts, and nerve damage. Your doctor can prescribe medications to manage most side effects. It is important to tell your doctor about any new symptoms or changes in how you feel, because they may signal that your treatment needs to be adjusted.
Frequently Asked Questions
Is myeloma the same as bone cancer?
No. Myeloma is a blood cancer that starts in plasma cells in bone marrow and damages bone as a side effect. Bone cancer (osteosarcoma) starts in the bone cells themselves. They are different diseases with different causes and treatments.
Can you get myeloma at a young age?
Myeloma is most common in people over 65, but it can occur at any age. A rare form called light chain myeloma sometimes appears in younger people. If you have symptoms like bone pain or unexplained fatigue, your doctor can run tests regardless of your age.
What is the difference between myeloma and smoldering myeloma?
Smoldering myeloma is an early stage where blood tests show signs of myeloma but you have no symptoms and organs are not damaged yet. Some people with smoldering myeloma need treatment right away, while others are monitored closely without treatment until symptoms appear.
Does myeloma run in families?
Most myeloma is not inherited. Having a family member with myeloma may slightly increase your risk, but the disease is not passed down like genetic conditions. Your doctor can discuss your personal risk factors if you are concerned.
Can myeloma come back after treatment?
Yes. Even when treatment works well and the cancer goes into remission, myeloma can return months or years later. This is called relapse or recurrence. When it happens, your doctor can try different treatments, and many people respond well to new therapy options.