Multiple Myeloma, a Cancer of the Bone Marrow Plasma Cells 

This week's Ask Dr. Durie comes from a recently diagnosed patient who wants to know what is myeloma. Well, it is a malignant cancer which affects the plasma cell. 

Plasma cells when they turn cancerous are called myeloma cells. Typically, those myeloma cells build up in the bone marrow. In this sense, myeloma is bone marrow cancer. Occasionally these myeloma cells can occur and grow outside of the bone marrow. And these are called soft tissue plasma. So tumors. And so this is the basic aspect of the disease, a cancer of the plasma cell, which is actually part of the body's immune system. 

And so in terms of what are the effects of myeloma, well, it can definitely affect the immune system because the cancerous plasma cells are really embedded within the immune system. So there are decreases in the production of normal antibodies, which could increase the susceptibility to infection, which is one of the common features of multiple myeloma. One of the other common features is an impact on the other bone marrow cells. 

As myeloma cells build up in the bone marrow, then the production of red cells, white cells and platelets is decreased because of the impact on other bone marrow cell growth. And so these effects contribute to the development of anemia, which can sometimes be severe and can also increase the likelihood of infection. But perhaps the most characteristic feature of myeloma is the effect on the surrounding bone of the bone marrow sits within bones, particularly in the spinal area, but also in the pelvic area and around the hips and shoulders. 

These areas can be impacted such that as the myeloma cells grow, they can damage the bone, make it fragile, and one can get fractures of the bones. And this causes obviously, pain in the bones. And so, for example, pain in the lower back is one of the common presenting features of active multiple myeloma. And so a myeloma patient can have back pain, some anemia, some recurrent infections, and also impact of the myeloma cells on other tissue areas, including nerves and the effects of the myeloma protein on kidneys. 

So the BOTTOM LINE is that myeloma is a cancer of the plasma cell, but is a bit unusual because it has a variety of presenting features. It is a cancer which has been transformed in recent years because of the introduction of many new therapies. 20 years ago, we had very little to treat myeloma patients with no with what we call next-generation therapies. 

Patients can achieve remissions in a majority of cases, and the average patient will have an expectation of remission and survival, at least in the 5 to 10-year range. And so myeloma is a treatable cancer on one where there are a lot of new therapies that are being introduced. For this reason, we strongly recommend that at the time of diagnosis, patients reach out for a second opinion, get full consultation early on so that you can get on a good path, get the best therapy and be pointed in a direction to achieve the very best outcomes.