What Is Multiple Myeloma?

If you or someone you love has been told you have multiple myeloma, it can be incredibly overwhelming. Multiple myeloma is an incurable blood cancer, but one that is very treatable. And in fact, has a much better prognosis than it ever did before, as most of our patients will live well over 10 years, if not their full life expectancy. To understand this complicated disease and make sense of it, we're going to talk about what multiple myeloma is.

Hi, everyone. Dr. Joseph Mikhael here, Chief Medical Officer of the International Myeloma Foundation, a not for-profit organization committed to the quality of life of patients as we seek prevention and a cure for multiple myeloma. What is multiple myeloma? Chances are most people have actually not heard the phrase multiple myeloma. Sometimes they confuse it with melanoma, which is a skin cancer. But multiple myeloma is a blood cancer. And let's break that down a little bit. It's blood cancer because it starts in the factory of our blood, which is called the bone marrow. So our bone marrow functions to make our blood. When we look at the blood, which is itself, believe it or not, an organ, it's made up of two major things. We've got the liquid part of the blood and the solid part of the blood. The liquid part we call plasma. The solid part, we call cells. We have three kinds of cells in the blood. I sometimes call them white, red, and rose, or white cells, red cells, and platelets. And these are the cells that circulate in our body that do really important things for our body.

Red cells carry oxygen so all the organs of our body can get oxygen. White cells are like our soldiers that help fight off infection, and platelets are little cells that help us clot so that we don't bleed. All three of these cells are made in the factory of our blood called the bone marrow. In the bone marrow, we see all of the complexity of a factory that make these three cells. Part of that factory is another group of cells called plasma cells. These are the cells I want us to understand a little bit more today because multiple myeloma is a cancer of the plasma cell. Let's start by trying to understand, well, what is cancer? I describe cancer simply as three things, identical, uncontrolled growth. Identical, uncontrolled growth. It's easier to conceive of it when we think of a lump of tissue, like a lung cancer or a breast cancer or a colon cancer, because we can think of a lump of tissue growing. It's the same principle, but this is a liquid, if you will, cancer, that inside the bone marrow, these plasma cells are starting to grow.

But what are plasma cells? Plasma cells are the cells that help us fight off infections because they are the cells that make antibodies. Antibodies are those things that we need to fight off infections. When you get a flu shot, when you get a tetanus shot, when you get a COVID shot, what happens? That message gets sent to the plasma cells and they make an antibody. Of course, in medicine, we like complicated terms. We call it an immunoglobulin, but it's the same concept as an antibody that will fight off infections. So plasma cells are good. They're important. We use them every day to fight off our infections. But in multiple myeloma, these plasma cells now become cancerous. They grow, they grow out of control. And now unfortunately, instead of making good antibodies to fight off infections, they make bad antibodies.

What do those antibodies do to the body? Historically, we talk about the so called CRAB criteria, C-R-A-B, to describe what happens when someone has multiple myeloma. As these plasma cells grow, as they release these antibodies into the bloodstream and into the body, they can do these four things. The C stands for a calcium elevation or an increased level of calcium in the blood, and this is typically because these antibodies actually attack the bone and calcium gets released in the blood. The second is R, which means renal or kidney damage. These antibodies like to go to the kidney and damage the kidney. So very often when people have multiple myeloma, they have kidney damage.

The third is anemia or a low red blood cell count. We talked about the three cells that circulate in our blood, white cells, red cells, and platelets. It's a low red blood cell count. And that's why when that level is low, people can feel fatigued. They can be tired. They can even be short of breath because they're not getting enough oxygen in the body. And lastly, the B stands for bone disease. And this is perhaps the most tragic part of multiple myeloma is that as it attacks the bone, it thins the bones and it can even break the bones. And very often, patients present with a lot of pain. This CRAB criteria, C-R-A-B, is how we define how multiple myeloma affects the body.

Before I continue, let me remind you that the IMF is here for you, and we want to be here for you in the best way for you. Some people want to speak to a person, so we have an info line where you can call in and ask questions about multiple myeloma, help find navigation through this complicated journey of multiple myeloma. Others want to use an AI chatbot. So we developed a reliable, trusted chatbot right on our website called Myelo that you can ask questions of. Some patients want to come to an in-person seminar and talk to the providers and talk to people there. Others want to attend virtual workshops. All of those resources and more are available to you at myeloma.org.
It's also really important to know how we measure multiple myeloma. When we measure solid tumors like lung cancer or breast cancer, often we're just using an x-ray to see the size of a particular tumor. In liquid tumors, it's a little bit more complicated. So in multiple myeloma, we have lots of things to measure. We measure the amount of plasma cells in the bone marrow. We measure the level of the antibody in the blood or that immunoglobulin. Sometimes we call that antibody or that bad protein in the blood an M spike. Why do we call it that? We call it that because it's a monoclonal spike. Remember how I said cancer is identical growth? This protein, this antibody are not all the different kinds of antibodies that you make to fight off infections.

It's one exact antibody it keeps making more of. So it's called monoclonal compared to our usual antibodies, which we call polyclonal. And so it's important to measure that M spike when we measure it in someone's blood. But there are even some patients where we can't measure the M spike because this protein or this antibody is made of a big bit and a small bit, what we call the heavy chain and the light chain. And there are some patients, about 20% of patients who only have a light chain. So when we measure myeloma, we not only look for the M spike, which looks at the whole thing, we look for those light chains. And so we do what's called the serum free light chain assay.
Lastly, it's really important that we look at other measures of myeloma as well, all those things in the blood that we talked about, the white count, the red blood cell count, the platelet count, all the chemistry of our blood like our kidney function. And then lastly, we may have to do specialized x-rays because of the way multiple myeloma affects the bones. Sometimes I say to my patients, myeloma's kind of like a crime scene, there isn't one piece of evidence that tells you the whole story. You need a full picture. We need these different measures in the blood, sometimes even a measure from the urine, and we need the x-rays to understand multiple myeloma. All this is important because we want to make sure as we treat our patients, we can see that the disease is going down and staying down.

That brings me to treatment. How do we treat multiple myeloma? Like with most cancers, we want to give people a treatment that damages the cancer, but not the patient. And this is the exciting part of multiple myeloma. When I started in multiple myeloma over 20 years ago, we had very few choices, and frankly, the treatments were very harsh on patients. But now with the tremendous research that's been done in multiple myeloma, we often can use treatments that really allow patients to maintain their quality of life and even continue to work if they're working and do the things that they enjoy. Typically, we will treat people at the start with what we call induction treatment. That's just a big word that is meant to induce or result in a remission, meaning that we bring that level of the disease down and then we keep it down. Remission doesn't mean cure. It doesn't mean it's gone for good, but we want to get it down and we keep it down.

We typically do that with a combination of different medications and then sometimes even what's called a stem cell transplant or a bone marrow transplant to really try and keep the disease down. The reality is, unfortunately, with most patients with multiple myeloma, even though we can get the disease down, at some point, it will come back again. What we call progression or relapse. But thankfully now, we have over 20 different drugs approved in multiple myeloma to be able to treat the disease when it comes back. And I want to end on a positive note because the prognosis or the outlook of our patients with multiple myeloma has radically changed over the last several years and even just in the last two years. As we've been introducing new treatments and new ways of conquering multiple myeloma, and a lot of times, we actually use a patient's own immune system to take down their multiple myeloma. Patients are living longer, patients are living better with multiple myeloma.

Indeed, the average survival with myeloma now is over 10 years, and we think it's going to continue to improve in the years to come. I hope this has helped you try to understand myeloma a little bit better, to demystify some of the complicated terms and concepts in multiple myeloma. But please come and visit us at myeloma.org, where you have a host of resources available to you, where you can search all of the different things that we have on the website. You can call in to our info line and speak to someone. You can use the AI chatbot that we have and ask questions 24/7. You can attend an in-person seminar, a virtual seminar. We're here for you. So if you have questions for us, bring them to us. Use the hashtag, #AskTheIMF, on any of our social media channels and we'll be there for you to help you through this.