At Boston Medical Center (BMC), the care of patients with multiple myeloma is a collaborative, multidisciplinary process. BMC’s Cancer Care Center organizes its services around each patient, bringing together the expertise of diverse specialists to manage care from the first consultation through treatment and follow-up visits. The Cancer Care Center is dedicated to providing treatment that is effective and innovative in curing and controlling cancer, while managing its impact on quality of life.
As the primary teaching affiliate of the Boston University Chobanian & Avedisian School of Medicine, BMC combines personal, patient-focused care with the state-of-the-art-expertise and technological advances of a major teaching hospital. BMC is at the forefront of clinical practice, surgical expertise, and research in oncology.
To schedule an appointment or refer a patient, call 617.638.6428. Patients with a diagnosis or strong suspicion of cancer are given appointments within 72 hours.
What Is Multiple Myeloma?
Multiple myeloma is a cancer of the bone marrow arising from plasma cells, which are part of the immune system.
There are red blood cells, white blood cells, and platelets. White blood cells help the immune system fight infection. Plasma cells are white blood cells that produce antibodies: proteins that help the immune system protect the body from infection. Plasma cells produce antibodies in response to foreign substances (called antigens) entering the body. Different antibodies bind to different antigens to help destroy them. Some antibodies are able to destroy antigens on their own, whereas others assist other white blood cells in destroying them.
Myeloma begins when a plasma cell becomes abnormal and begins to divide uncontrollably, producing large numbers of these abnormal cells. These abnormal plasma cells are myeloma cells, and they divide out of control and do not die when they should. The cancer cells then accumulate and form a tumor.
A single tumor is called an isolated (or solitary) plasmacytoma. When there are several tumors present, the disease is referred to as multiple myeloma.
A shortage of red blood cells, white blood cells, and/or platelets may result when too many myeloma cells are present in the bone marrow. This can lead to a number of health issues, such as anemia (a shortage of red blood cells, which can cause pallor and fatigue), leukopenia (a shortage of white blood cells, which makes it difficult for the body to fight infection), and bruising or bleeding (caused by a shortage of platelets, which control bleeding).
Myeloma cells also interfere with bone maintenance. Normally, groups of cells work together to maintain proper bone shape and health. Certain groups of cells build bones up, while others break them down. Myeloma cells cause too much bone to break down and not enough replacement bone to be made. Bones then become weak and break easily. Because myeloma causes so much bone to be broken down, it often causes calcium levels in the blood to rise, causing tiredness and weakness.
Symptoms of Multiple Myeloma
The most common symptoms of multiple myeloma include
- Bone pain, usually in the back or spine
- Broken bones, usually in the spine
- Feeling weak and very tired (also called fatigue)
- Frequent infections and fevers
- Frequent urination
- High levels of calcium in the blood
- Low blood counts
- Nausea or constipation
- Weight loss
These symptoms can occur from health issues other than cancer, so it’s important that anyone experiencing these symptoms be seen by a physician.
Causes of Multiple Myeloma
Although the exact causes of multiple myeloma remain unknown, certain risk factors—things that increase an individual's chances of developing cancer—have been identified. While risk factors may be useful in identifying high-risk individuals, they do not determine whether a person develops a disease. Some risk factors, such as diet, are within a person’s control, whereas others, such as age, are not.
Some possible risk factors for multiple myeloma include
- Age: A person’s chances of developing multiple myeloma increase with age. Few people develop the disease before age 65.
- Gender: Men have a higher risk of developing multiple myeloma than women. The reason why is unknown.
- Race: African Americans have the highest risk of developing the disease.
- Personal history of monoclonal gammopathy of undetermined significance (MGUS): MGUS is a benign (noncancerous) condition. For people who have it, it means abnormal plasma cells are present and producing M proteins. There are generally no symptoms associated with MGUS, and it is usually found with a blood test, the results of which indicate a high level of M protein in the blood. People with MGUS may develop certain cancers, including multiple myeloma. MGUS is not a treatable condition. For those with MGUS, physicians recommend regular lab testing (every 6 to 12 months) to monitor the level of M protein in the blood and regular exams to check for symptom development.
- Family history: A person’s risk of developing multiple myeloma is higher if that person has a close relative with the disease. Not having a family history of the disease in no way guarantees a person will not get it.
- Obesity: According to a study by the American Cancer Society, people who are overweight or obese have an increased risk of developing multiple myeloma (American Cancer Society 2015a).
- Radiation: Exposure to lower levels of radiation can also increase a person’s risk of developing the disease, but very few cases of the disease result from this kind of exposure.
Other possible risk factors currently under study include gene mutations (changes in the DNA sequence of a gene), eating certain foods, and exposure to certain chemicals or germs (viruses in particular).
Staging
Staging is the process of determining how extensive the cancer is. It is an important part of diagnosis because it is used to determine the most appropriate treatment options for patients.
To determine the stage of the disease, physicians may perform a number of tests, including blood tests, CT scans, and MRI scans.
Multiple myeloma ranges from Stage I to Stage III. The stage of the disease takes into account whether it is causing problems in the bones or kidneys or abnormalities in the blood counts or calcium levels.
Some patients have what physicians describe as “smoldering” myeloma. This means the disease is in its early stages, but no symptoms are present.
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Treatments & Services
Bisphosphonates
Bisphosphonates are used to help bones stay strong by slowing down the rate at which they are being dissolved by myeloma cells.
CAR T-cell Therapy Program
Chimeric antigen receptor (CAR) T-cell therapy is an innovative and powerful new cancer treatment now available at BMC. This cell-based gene therapy uses your own T cells (a type of white blood cell) to find and destroy cancer cells in your body. The program currently treats non-Hodgkin Lymphoma and in the future will be available to treat Multiple Myeloma as well.
Chemotherapy
Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV).
Multiple Myeloma Related Surgery
Surgery is not commonly used to treat multiple myeloma. However, surgery may become necessary if the spinal cord is pinched. It can also be used to attach metal rods or plates to support weight-bearing bones and to treat existing fractures and prevent future ones.
Radiation Therapy
Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT).
Stem Cell Transplant
A stem cell transplant is a procedure that uses stem cells to replace blood cells in the bone marrow that have been damaged or destroyed by chemotherapy, radiation or disease. For patients receiving a stem cell transplant, the first step is to lower the amount of cancer present in the patient’s body by induction treatment. After induction treatment, stem cells are harvested from the patient’s blood or bone marrow. Once harvested, the cells are frozen. After the stem cells have been removed, the patient receives high-dose chemotherapy to kill any leftover myeloma cells. The treatment also kills all of the remaining normal bone marrow cells. The frozen stem cells are then thawed and given back to the patient through an intravenous line in a process similar to a blood transfusion. The stem cells travel to the bone marrow where they begin to make new blood cells.
Watchful Waiting
Patients with early-stage myeloma (either smoldering or Stage I) who choose watchful waiting will be closely monitored but won't receive treatment until symptoms of the disease either appear or change.
Diagnostics and Tests
Personal and family medical history
Your doctor will likely ask you a series of questions relating to your personal medical history and your family's medical history.
Physical Exam
Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will including examining any specific areas of concern, especially as they relate to the reason for your visit to the office.
Multiple Myeloma Blood Tests
Doctors use several blood tests to check for multiple myeloma including blood count, quantitative immunoglobulins, SPEP, Beta-2 microglobulin, and blood chemistry tests.
Urine tests multiple myeloma
Doctors test the urine for a type of M protein called Bence Jones protein. Urine collected over a 24 hour period is sent to the lab to be examined. If the lab finds a high level of Bence Jones protein, doctors will monitor your kidneys, as too much Bence Jones protein can clog or damage the kidneys.
Bone x-rays
Bone x-rays are used to see damage to the bones caused by myeloma. Doctors will often take a series of x-rays that include most of the bones. This is called a bone survey or skeletal survey.
Computed Tomography (CT) Scan
CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut.
Magnetic Resonance Imaging (MRI)
This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be asked to drink a contrast solution for better imaging, and you will most likely lie on a moving table as pictures are taken.
Positron Emission Tomography (PET) scan
A PET scan is used to detect cellular reactions to sugar. Abnormal cells tend to react and "light up" on the scan, thus helping physicians diagnose a variety of conditions. For the PET scan, a harmless chemical, called a radiotracer, is injected into your blood stream.
Bone marrow aspiration and biopsy
For a bone marrow aspiration (also called a bone marrow biopsy), the doctor uses a thick, hollow needle to remove a sample of bone marrow and bone marrow fluid.
Our Team
BMC’s comprehensive multiple myeloma team includes physicians who work in hematology and medical oncology, surgical oncology, radiation oncology, and pathology, as well as staff from the Transfusion Medicine Service/Blood Bank. The team’s patient-centered, multidisciplinary approach assures each patient benefits from the collaborative expertise of physicians uniquely focused on their individual needs.
Hematologists
Adam Lerner, MD
Vaishali Sanchorawala, MD
J Mark Sloan, MD
Radiation Oncologists
Minh T Truong, MD
Gregory Russo, MD
Attending Physician, Department of Radiation Oncology, Boston Medical Center
Clinical Assistant Professor of Radiation Oncology, Boston University Chobanian & Avedisian School of Medicine
Patient Resources
References
American Cancer Society. 2015a. Detailed Guide: Multiple Myeloma. PDF.-----. 2015b.
Overview Guide: Multiple Myeloma Overview. PDF.
Millennium Pharmaceuticals, Inc. 2011.Understanding Multiple Myeloma. Houston: Phyllis Pittman Communications, LTD.
National Cancer Institute. 2008. What You Need To Know About™ Multiple Myeloma. PDF. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services.http://www.cancer.gov/
