Treating bone marrow cancer

Myeloma, which is also known as multiple myeloma, is a type of cancer that affects your bone marrow.

Myeloma is a rare form of cancer that mostly affects older people. Worldwide, an estimated 103,000 people are diagnosed with myeloma every year. Myeloma is twice as common in African-Caribbean people compared to Caucasian people.

Myeloma develops from plasma cells in your bone marrow. Plasma cells are a type of white blood cell that produce antibodies – proteins that fight against bacteria and viruses.

Bone marrow is the spongy centre of the large bones in your body that include your spine, skull, ribcage, shoulders and hips. Your bone marrow produces stem cells that mature into red blood cells, white blood cells and platelets.

If you have myeloma, your bone marrow starts to make abnormal plasma cells. These cells are known as myeloma cells, which produce an abnormal type of antibody known as paraprotein or M protein. Unlike a normal antibody, paraprotein doesn’t have any useful functions and can’t fight infection.

Myeloma cells are cancerous, meaning they grow in an uncontrolled way. They can spread though your bone marrow and bone, causing the symptoms of myeloma.

Symptoms of myeloma

Symptoms of myeloma may include:

• pain in your bones, often your lower back or ribs

• tiredness and weakness caused by anaemia (a condition in which the blood can’t carry enough oxygen to meet the needs of your body)

• nausea and vomiting

• repeated infections

• unexplained bruising or bleeding

• fractures of your bones

These symptoms aren't always caused by myeloma, but if you have them see a doctor.

Sometimes, myeloma doesn’t have any symptoms. This is known as asymptomatic or ‘smouldering’ myeloma.

Complications of myeloma

If myeloma is left untreated it can lead to kidney damage. The paraprotein produced by myeloma cells damages your kidneys as it passes through your blood and into your urine. If you have myeloma, you can help prevent kidney damage by drinking at least three litres of water each day. Ask your doctor for more advice.

Causes of myeloma

The exact reasons why you may develop myeloma aren't fully understood at present. However there are several factors that may make you more likely to develop it. These are listed below.

• A weakened immune system, such as if you have HIV/AIDS, or are taking medicines that suppress your immune system.

• A rare condition called monoclonal gammopathy of undetermined significance (MGUS), which means you have a low level of paraprotein in your blood, but don’t have bone disease.

• A close relative who has been diagnosed with myeloma or MGUS.

Diagnosis of myeloma

Your doctor will ask about your symptoms and examine you. He or she will also take a blood sample. If the results show that you may have myeloma, your doctor will refer you to hospital for further tests. For example, you may be asked to give the following.

• A blood sample. This is to check for paraproteins, your red blood cells, white blood cells and platelets, and to assess your calcium levels and kidney function.

• A urine sample. This is to check for specific paraproteins called Bence Jones proteins.

• You will also need to have a full body X-ray (also known as a skeletal survey) to check for any damage to your bones.

If paraproteins are found in your blood or urine, you will need to have a bone marrow biopsy. Your doctor will put a needle into one of your bones (usually your hip bone) and remove a sample of your bone marrow.

This test is usually done under local anaesthesia. This completely blocks pain from the area and you will stay awake during the procedure. The biopsy is sent to a laboratory to check for myeloma cells.

You may need to have further scans or blood tests to determine the severity of the disease – this is called staging of myeloma. Knowing how advanced the myeloma is can help doctors decide the most appropriate type of treatment for you.

Please note that availability and use of specific tests may vary from country to country.

Treatment of myeloma

There isn't a cure for myeloma, but there are treatments available to control the disease and help improve your quality of life. This can help get you into remission, which is when there are no longer any myeloma cells in your blood or bone marrow.

Treatment for myeloma will depend on whether or not you have symptoms. If you don’t have any symptoms, you won’t usually need treatment, but will be monitored by a haematologist (a doctor who specialises in conditions of the blood).

If you do have symptoms, you will usually be treated with a combination of medicines.

Medicines

The main treatments for myeloma are:

• chemotherapy – to destroy myeloma cells

• steroids – to help enhance the effects of chemotherapy treatment

• biological therapies – to help stimulate your body into attacking or controlling the growth of cancer cells

Other medicines you may have include:

• bisphosphonates – to help prevent damage to your bones and relieve pain

• erythropoietin injections – to help your bone marrow produce more red blood cells

• granulocyte-colony stimulating factor (G-CSF) injections – to help your bone marrow to make white blood cells

• antibiotics – to treat infections

If you’re under 65 and generally healthy, your doctor may suggest that you have high-dose chemotherapy with a stem cell transplant. Very high doses of chemotherapy can be used to destroy more myeloma cells than standard doses of chemotherapy, but this can severely damage your bone marrow. A stem cell transplant is usually needed afterwards to help your bone marrow recover.

Stem cells are blood cells at their earliest stage of development before they become red blood cells, white blood cells or platelets. In a stem cell transplant, stem cells are collected from your blood, or sometimes your bone marrow, before you have high-dose chemotherapy. They are then put back into your blood, through a drip into your vein, after the treatment.

Radiotherapy

This is a treatment that uses radiation to destroy myeloma cells. It’s usually used if you have signs of bone damage or bone pain in a specific area, but can be used if you have many affected areas of bone.
Surgery

If your bones fracture, or are at risk of fracturing, you may need to have an operation to repair them. Speak to your surgeon for more information.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.