Multiple myeloma:
signs, life expectancy and treatment

Multiple myeloma (also known as plasma cell myeloma) is a type of blood cancer associated with a malignant alteration of plasma cells in the bone marrow. For that reason, this form of cancer is often referred to as bone marrow cancer. The term “multiple” indicates that the cancer usually starts with several, i.e. multiple, tumours. If only one tumour site is present, this is referred to as a solitary plasmacytoma. Myeloma is a disease of the lymphatic system, which is part of the immune system.

Plasma cells are formed from white blood cells. They are responsible for defending the body against infectious pathogens by forming antibodies to eliminate them. In the case of myeloma, these plasma cells are degenerated or altered in such a way that they multiply and produce a multitude of unnecessary antibodies. As a result, the body’s immune system is weakened and becomes less effective at fighting off disease.

In addition, these malignant plasma cells form proliferations in the bone marrow, increasingly displacing normal and healthy cells. This results in various symptoms.

Multiple myeloma is a rare type of cancer. In Switzerland, around 620 people develop multiple myeloma each year, the majority of whom are over 70 years of age.

The manifestation of multiple myeloma varies from person to person. There are often very few signs at first. However, there are also acute cases with severe symptoms.

The first symptoms are generally vague:

• Fatigue
• Weight loss
• Susceptibility to infection

At advanced stages of the disease, other symptoms usually occur:

• Bone pain
• Anaemia
• Impaired kidney function
• Changes in the urine
• Increased calcium levels in the blood

Other vague symptoms such as fever and night sweats may also occur.

A doctor should be consulted for symptoms such as bone pain, increased susceptibility to infections, discoloured or foaming urine and weight loss.

Doctors can use various methods to make a diagnosis:

• Blood and urine tests: can elevated calcium levels be detected in the blood? What is the protein content (abnormal antibodies can be detected this way)? Does the patient have anaemia?
• Bone marrow biopsy: in this procedure, bone marrow is removed from a bone and examined for chromosomal changes in the cells
• Imaging procedures: computed tomography (CT), magnetic resonance imaging (MRI)

It is not always necessary to initiate treatment immediately for multiple myeloma. As long as no symptoms have occurred, it is sufficient to have the disease monitored by a doctor.
The doctor will recommend appropriate treatment as soon as he or she deems it necessary, e.g. if the proportion of plasma cells in the bone marrow has already reached ten percent or if several tumours have reached the size of five millimetres.

Potential treatments then include:

• Administration of proteasome inhibitors, immunomodulating agents (e.g. thalidomide, melphalan, bendamustine), glucocorticoids (dexamethasone, prednisolone)
• Chemotherapy, or a combination of chemotherapy and drug therapy, is also possible. The aim is to destroy the tumour cells.
• Immunotherapy with antibodies that target the surfaces of the myeloma cells
• Autologous blood stem cell transplantation (using the patient’s own stem cells)
• Allogeneic blood stem cell transplantation (using donated stem cells)

Radiotherapy is an option for single tumours (plasmocytoma). If the bones are affected, this can result in severe pain. In such cases, the use of painkillers is necessary. Bisphosphonates strengthen the bones and can counteract fractures.