Myeloma & Bone Cancer

Myeloma and Bone Cancer FAQs

Below is a list of questions frequently asked by our patients. Dr. Berenson has also recorded a video series covering myeloma and bone cancer concerns. There have been several recent breakthroughs for the treatment of multiple myeloma patients that have led to new therapeutic options.

What is multiple myeloma?

Multiple myeloma is a unique cancer of plasma cells that attacks and destroys bone. Due to its complexity, the disease can be difficult to diagnose and often results in varying treatment recommendations from doctors. The term “multiple myeloma” is derived from the multiple areas of bone marrow that are usually affected by the disease (which itself is the result of increased numbers of malignant plasma cells in the bone marrow). Since plasma cells are antibody-producing cells, patients have high levels of a single type of antibody called M-proteins in their blood and/or urine. These patients often have reduced blood cell counts and decreased amounts of normal antibodies, which often compromise the body’s immune system.

Collections of these plasma cells or patches in the bone can cause tumors leading to a reduction in bone strength. Bone fractures as well as significant bone pain commonly occur in multiple myeloma patients as a direct result of a loss in bone strength.

How is multiple myeloma treated?

The disease progresses at different rates depending on the patient and at this time there is no known cure. In spite of those facts, multiple myeloma is very treatable and outcomes are constantly improving. Current treatments aim to control the disease and its symptoms helping to allow the patient the best quality of life possible. Depending on the individual circumstances, treatment can include stabilization of body chemistry and the immune system, radiation and/or surgery to relieve discomfort and increase functionality and finally, chemotherapy and radiation to help slow or arrest the course of the disease or induce remission. Because multiple myeloma is a complex disease it can often be resistant to chemotherapy.

Who is at risk?

Approximately 1,000 people worldwide are diagnosed with multiple myeloma every day. The disease is found more commonly in middle-aged or elderly persons and is more prevalent in men than women, African Americans more than Caucasians. Although the causes of multiple myeloma are uncertain, exposures to pesticides, atomic radiation and petroleum products are considered to be important trigger factors. The average survival rate is approximately 5-6 years, depending on the level of the disease state.

What are the disease states?

There are 4 levels of myeloma-like states (starting from the lowest risk):

MGUS
Diagnosed when the M (myeloma) protein is found in the body but neither myeloma or disease symptoms exist. Usually no treatment is required or recommended at this level. There is a 1% chance per year that this condition will progress to a related disease requiring treatment. An analogy would be how HIV infection may transform to AIDS. You can have the HIV virus, but not develop AIDS.

Asymptomatic myeloma
This is a slow progression of the disease, causing mild anemia, early bone damage and predisposition to infection. Patient requires close monitoring and minimal treatment.

Plasmacytoma
This is usually diagnosed when a single group of abnormal plasma cells grows in a local area of bone or soft tissue. This can lead to the development of multiple growths or tumors (i.e., multiple myeloma). Radiation treatment is a common therapy. Rarely is tumor removal by surgery possible.

Symptomatic or Active myeloma (Stage II or III myeloma)
The typical symptoms of myeloma are present. These include:

  • Bone damage—Patient experiences bone pain or fracture or collapse of bone
  • Anemia—(decrease in the production of red blood cells) Patient feels fatigue and weakness
  • High protein levels in blood or urine—Patient experiences sluggish circulation
  • Kidney damage, High blood calcium (resulting from damaged bone)—Patient feels mental confusion, dehydration, constipation, fatigue and weakness
  • Compromised immune system—Patient becomes more susceptible to infection

How does myeloma affect the bones?

Myeloma most commonly affects the spine, ribs, pelvis and long bones with the main symptoms being pain or fractures. The debilitating effects of the bone weakness can occur from the inner bone marrow to the outer bone surface. Soft spots, or osteolytic lesions, are like “holes” in the bone, and appear as such when x-rayed. These lesions cause pain and can often lead to fractures and the collapse of bones. Bone destruction in myeloma is caused by the presence of these osteolytic lesions. The lesions are formed when the rapid growth of myeloma cells produce substances that activate bone-resorbing, or bone-eating cells called osteoclasts. Normally these cells break down old or worn out bone and work with bone-forming cells to repair bone. Unfortunately, the increased activity of osteoclasts causes bone loss at a rate greater than the rate at which new bone is formed.

What connection do breast, prostate and lung cancer have with bone cancer?

It is common for breast, prostate and lung cancers to metastasize into bone. Bone marrow provides an effective “soil” for the “seed” of the cancer to spread and grow. There appears to be a symbiotic relationship between the cancer and the bone marrow “soil” much like plants taking nourishment from the soil and giving back nutrients to the soil through decomposition. Most previous research for metastatic bone disease has ignored this potentially important link in targeting both the ”soil” as well as the ”seed” for patients with this form of cancer in the bone.

Since the bone does not serve as a “vital organ”, people with metastasis in the bone can live for a longer period of time, but with a very reduced quality of life. In particular, most of the problems related to the bone cancer tend to result from involvement in the pelvis or spine. This involvement causes great pain as well as a debilitating lifestyle due to the collapse and thinning of the bone in these important areas of the body. Patients who suffer from these catastrophic symptoms can often be at greater risk of developing the symptoms of depression.