Myeloma, also known as multiple myeloma, is a type of bone marrow cancer arising from plasma cells, which are normally found in the bone marrow. Plasma cells form part of your immune system.

Normal plasma cells produce antibodies (also called immunoglobulins) to help fight infection. In myeloma, the abnormal plasma cells release only one type of antibody known as paraprotein, which has no useful function. It is often through the measurement of this paraprotein that myeloma is diagnosed and monitored.

Bone marrow is the 'spongy' material found in the centre of larger bones in the body (see Figure 1). As well as being home to plasma cells, the bone marrow is the centre of blood cell production (red blood cells, white blood cells and platelets).

Myeloma affects multiple (hence multiple myeloma) places in the body where bone marrow is normally active in an adult, i.e. within the bones of the spine, skull, pelvis, the rib cage, and the areas around the shoulders and hips.

The areas usually not affected are the extremities: that is the hands, feet, and lower arm / leg regions. This is very important since the function of these critical areas is usually fully retained.

People Affected By Multiple Myeloma

Of the approximately 1,200 Australians who are diagnosed with multiple myeloma each year, almost all are older than 40 years. Multiple myeloma is most common in people aged 60 years and older, and men are affected more often than women.

Symptoms Of Multiple Myeloma

Most of the medical problems related to myeloma are caused by the build up of myeloma cells in the bone marrow and the presence of the paraprotein in the blood or in the urine.

Common problems are bone pain, bone fractures, tiredness (due to anaemia), frequent or recurrent infections (such as bacterial pneumonia, urinary tract infections and shingles), kidney damage and a high level of calcium in the blood (hypercalcaemia).

Some people go on to develop myeloma after having been diagnosed with a benign (non-malignant) condition called MGUS which stands for Monoclonal Gammopathy of Undetermined Significance. This term describes the condition of the raised abnormal protein seen in myeloma (the paraprotein), but where there are no other features of the disease (less than 10% plasma cells in bone marrow and no evidence of bone disease).

The risk of transition from MGUS to active myeloma is very low; only a 1% chance each year of follow-up. Even if the myeloma cells are at a higher level of 10-30% of the total bone marrow, the growth rate can be very slow and represent indolent / smouldering or asymptomatic myeloma.

Both these conditions can change very slowly over a period of years and do not require active treatment. It is very important to establish the correct diagnosis distinguishing MGUS and indolent myeloma from active or symptomatic myeloma, which does require treatment.

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Causes Of Multiple Myeloma

Although a large amount of research has been done to investigate the potential causes of myeloma, nothing has been proven to date.

Exposure to certain chemicals, radiation, viruses and a weakened immune system are thought to be potential causal or trigger factors. It is likely that myeloma develops when a susceptible individual has been exposed to one or more of these factors. It is thought that susceptibility may increase with ageing and the consequent reduction in immune function.

How Multiple Myeloma Is Diagnosed

People suspected of having multiple myeloma will usually need to have blood and urine tests, looking for evidence of paraproteins. X-rays or scans of the bones are also performed to determine if there are any areas of bone that have been weakened or eroded by the myeloma cells. A bone marrow biopsy — a test that involves taking a small sample of bone marrow, which is examined under a microscope to look for myeloma cells — is often required.

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Treatment For Multiple Myeloma

There have been many new developments in the treatment and management of myeloma over the last few years that have had a significant impact on the way myeloma is treated. Research is on-going to develop new treatments and to use existing treatments in a better, more effective way. Many of the current and new developments are discussed in this guide.

Treatments for myeloma can be very effective at halting its progress, controlling the symptoms, and improving quality of life, but they are not able to cure it. Even after successful treatment, regular monitoring is needed in case the myeloma comes back.

In addition to the treatment you receive from your doctor, there are several things that you can do to make living with myeloma easier.

Basic Facts

• There are in the region of 1,200 new cases per year in Australia
   
• About 5,000 people are living with myeloma at any one time in Australia
   
• Myeloma accounts for 15% of blood cancers and 1% of cancers generally
   
• Median age of onset is 71 and only 5-10% of patients are under 40.