A National Cancer Institute-designated Comprehensive Cancer Center

Make an appointment: 800-826-HOPE

Myeloma

Myeloma and Multiple Myeloma
Myeloma is a cancer of the plasma cells, which normally produces anitibodies to help fight infections. Left untreated, myeloma can interfere with production of normal blood cells and cause serious complications in bones and kidneys. When these cancerous cells form tumors throughout the body, it is classified as multiple myeloma.
 
As one of a handful of institutes to attain the elite designation of Comprehensive Cancer Center by the National Cancer Institute, City of Hope is acknowledged as a leader in the research and treatment of myeloma and related diseases.  With our decades of experience, specialized therapy protocols and extensive program of clinical trials, newly diagnosed or relapsed myeloma patients can find a treatment regimen that is tailored to their disease and gives them the best chance for survival.
 
 
City of Hope is the only southern California member of the Multiple Myeloma Research Consortium, a collaboration of research organizations focused on rapidly bringing the most promising multiple myeloma treatments to patients.

Our physicians treat myeloma and related plasma cell diseases, including:
 
  • Plasmacytomaa single tumor comprised of cancerous plasma cells
  • Waldenstrom macroglobulinemia: a disease with features of myeloma and non-Hodgkin lymphoma, characterized by high levels and buildup of monoclonal protein (M protein)
  • Monoclonal gammopathy of undetermined significance (MGUS): a slight overgrowth of plasma cells that can lead to myeloma or lymphoma
 
City of Hope has long been a leader in developing promising new combinations of chemotherapy drugs, stem cell transplant procedures, radiation treatments and therapeutic options.
 
  • City of Hope pioneered innovative transplant regimens that have improved the cure rate for patients with myeloma and other hematologic disorders.
  • City of Hope performs both autologous (using cells from the patient) and allogeneic (using cells from a matched donor) stem cell transplants.
  • Our transplant program is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT), the standard of excellence for blood and bone marrow transplant programs in the United States.
  • In addition to our world-renowned transplant program, City of Hope also offers the broadest range of therapeutic options available for treating myeloma, including adoptive T-cell therapy, helical tomotherapy and monoclonal antibody therapy.
 
Myeloma patients at City of Hope may also qualify to receive their transplant in an outpatient setting, giving them the option to go home after their treatments instead of staying in the hospital overnight.
 
 
In collaboration with other departments and cancer centers, City of Hope’s myeloma program has an active portfolio of myeloma clinical trials studying novel treatments against the cancer, including trials of new chemotherapy, immunotherapy and radiation therapy that are more effective against the disease and/or less toxic to the patient. Many of these promising therapies are only available to patients being treated at the City of Hope.
 
City of Hope physicians and researchers are particularly involved in new cancer drugs and drug combinations that can target and attack relapsed myeloma, which are or have become resistant to first-line treatment.
 
We are also actively involved in survivorship research to ensure that our myeloma patients have a minimal chance of developing long-term effects from their disease or treatment.
 

If you have been diagnosed with myeloma or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.
 

Myeloma Team

About Myeloma & Multiple Myeloma

Myeloma, the second most common type of blood cancer, affects the plasma cells. Normally, plasma cells produce antibodies that defend the body against bacteria, viruses and other pathogens. In the case of myeloma, these cells become abnormal and malignant, dividing uncontrollably and crowding out other types of blood cells, compromising the body’s ability to deliver oxygen and nutrients to tissues and organs, fight off infections and clot properly.

In the case of multiple myeloma, which makes up over 90 percent of myeloma diagnoses, the cancerous plasma cells will also form multiple tumors (called plasmacytomas) in bones and soft tissues. This can raise the risk of bone fractures, elevate blood-calcium levels (hypercalcemia) and cause neurological and kidney problems.

Signs and Symptoms of Myeloma
 
Myeloma symptoms may be caused by the cancer itself, or by anemia or hypercalcemia, both of which are linked to the disease. These include:
 
  • Abnormal bowel movement patterns
  • Bone fractures
  • Bone pain, particularly in the back or ribs
  • Confusion or trouble thinking
  • Easy bruising or bleeding
  • Enlarged tongue
  • Fatigue
  • Fever
  • Frequent infections
  • Frequent thirst
  • Frequent urination
  • Muscle weakness, particularly in arms or legs
  • Nausea
  • Purple spots on the skin
  • Restlessness
  • Swelling caused by fluid accumulation
  • Trouble breathing
 
If your or a loved one are experiencing these symptoms, please contact your doctor for further evaluation, which may include a biopsy for a myeloma diagnosis.
 
Myeloma Risk Factors
 
Risk factors associated with myeloma include the following:
 
  • Age: Myeloma is more common in people who are middle-aged or older.
  • African-American heritage
  • Family history of myeloma: People who have a sibling or parent diagnosed with myeloma are four times more likely to develop the cancer themselves.
  • Gender: Men are likely to develop myeloma
  • Radiation exposure
  • Obesity: Being overweight or obese increases myeloma risk
  • Other plasma cells diseases: People diagnosed with other plasma cell diseases, such as monoclonal gammopathy of undetermined significance (MGUS), Waldenstrom macroglobulinemia or solitary plasmacytoma, are at greater risk of developing myeloma
 
Note that having one or more risk factors does not mean that a person will develop myeloma. Most people who have risk factors never develop cancer. Likewise, some people who develop myeloma may not have any risk factors present.

If you suspect that you or a loved one may have myeloma, please contact your doctor for a medical examination.
 
 
If you have been diagnosed with myeloma or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.

Sources: American Cancer Society and National Cancer Institute
 

How We Diagnose and Stage Myeloma

To accurately diagnose myeloma, the City of Hope care team may need to perform several tests to determine how advanced the disease is. In addition to a routine physical exam and taking a patient’s medical and family history information, City of Hope staff may also perform biopsies and imaging tests.
 
  • Complete blood count - This basic test obtains an accurate count of all the different types of blood cells, which can help detect myeloma because it can cause a decrease in red blood cells, white blood cells and platelets.
  • Blood chemistry test - The blood sample is also checked for certain substances, such as calcium, indicated presence of multiple myeloma, as well as bone or organ damage associated with this cancer.
  • Bone marrow aspirate and biopsy - Bone marrow tissue is extracted and examined by a pathologist under a microscope to determine if the suspected tissue is cancerous. Generally, if a biopsy reveals that more than 10 percent of the marrow is made up of plasma cells, it is indicative of bone marrow plasmacytosis—a determining diagnostic factor of myeloma.
  • 24-hour urine test - Urine is collected for 24 consecutive hours and evaluated for substances that can be indicative of multiple myeloma and associated bone or organ damage.
  • X-ray - A skeletal X-ray is done to determine and locate bone lesions and tumors due to multiple myeloma.
 
Stages of Myeloma
 
To properly plan for treatment, multiple myeloma is staged in accordance to how advanced the cancer is. This is primarily done by measuring beta-2 microglobulin and albumin levels in the bloodstream.
 
The stages of multiple myeloma are:
 
  • Stage I: beta-2-microglobulin level is lower than 3.5 mg/L and albumin level is 3.5 g/dL or higher.
  • Stage II: beta-2-microglobulin level is lower than 3.5 mg/L and the albumin level is lower than 3.5 g/dL OR beta-2-microglobulin level is between 3.5 mg/L and 5.4 mg/L
  • Stage III: beta-2-microglobulin level is 5.5 mg/L or higher.
 

If you have been diagnosed with myeloma or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.
 

Our Treatment Approach

Just as every patient is different, we recognize that every multiple myeloma case is different. What distinguishes City of Hope in the treatment of patients with myeloma is seamless continuity of care. From a new diagnosis to treatment with the newest drugs within our extensive program of myeloma clinical trials to transplantation, patients are treated by the same team of doctors who see them through every phase of treatment and recovery. City of Hope also offers the expertise of geriatric oncologists who specialize in the treatment of older patients.

Our patients are provided treatments based on the latest evidence available and up-to-date clinical guidelines. Factors that determine the therapy regimen include:

  • Stage of myeloma
  • If there are related conditions—such as kidney damage, brittle/fractured bones or infection—present
  • Prior therapies, if any
  • Patient’s characteristics, such as age and overall health
  • Choice of the patient and care provider, if multiple treatment options are available

Based on these factors, the myeloma treatment regimen may include one or more of the following:

Chemotherapy

Chemotherapy, or the use of cancer-fighting drugs, is often an essential component of myeloma treatment because a systemic approach is necessary to kill cancerous cells in the bone marrow and throughout the bloodstream. Chemotherapy is usually given in cycles, with breaks in between to allow patients to recover from side effects.

Standard chemotherapy drugs used for myeloma may include one or more of the following:
 
  • Bartezomib (Velcade®)
  • Carfilzomib (Kyprolis®)
  • Dexamethasone
  • Fludarabine (Fludara®)
  • Lenalidomide (Revlimid®)
  • Melphalan (Alkeran®)
  • Pomalidomide (Pomalyst®)
 
Additionally, City of Hope researchers and clinicians are constantly developing new regimens to improve the effectiveness of existing drugs or building new drugs that are more powerful against myeloma. In particular, City of Hope researchers are studying cancer drugs (and drug combinations) that are more effective against relapsed myeloma.
 

Immunotherapy

By modifying the immune system, the patient’s own disease-fighting cells can be used to track and attack myeloma cells throughout the body. This can dramatically enhance other myeloma therapies and lead to better outcomes.
 
Immunotherapy approaches being used or studied at City of Hope include:
 
Monoclonal Antibodies
 
Unlike standard chemotherapy that typically affects both cancerous and normal cells, monoclonal therapies are highly targeted drugs that can hone in on cancer cells. After attaching to the cell, the antibody can interfere with the myeloma’s growth, be used as a delivery or targeting mechanism for other cancer therapies and/or trigger an immune response against the myeloma.

Adoptive T-Cell Therapy
 
T-cells are a powerful part of the immune system, and new approach being studied at City of Hope involves redirecting T-cells to recognize cancer cells specific to myeloma. T-cells are extracted then genetically modified so they can recognize, target and destroy the cancer cells. Studies are ongoing for this novel approach to treat recurrent, relapsed or refractory myelomas.
 

Stem Cell Transplantation

City of Hope is a leader in the use of stem cell transplantation to treat myeloma and other blood cancers. Since the program began in 1976, more than 12,000 transplants have been performed and it has been recognized for superior survival outcomes for nine consecutive years—the only transplant center in the United States with such an achievement.
 
Transplants are sometimes performed early in the course of treatment to improve long-term results or it may be utilized when other treatments are not working. Studies have shown that high-dose chemotherapy with stem cell transplant increases response and survival rates compared to standard chemotherapy alone for myeloma patients.
 
In this procedure, a patient undergoes intensive chemotherapy, and sometimes radiation therapy, to destroy the cancer-causing cells followed by an infusion of healthy new stem cells. The stem cell transplant may be either autologous (extracted from the patient’s own body) or allogeneic (using stem cells taken from another person.)

One known complication of allogeneic transplants is graft versus host disease (GvHD), in which the newly transplanted cells does not recognize the recipient’s body as their own and forms an immune response against it. City of Hope is on the forefront of tackling this condition and is constantly improving allogeneic transplant protocols to minimize GvHD risk and severity.
 
Nonmyeloablative (Mini) Transplants
 
City of Hope physicians also specialize in “mini” stem cell transplants for patients who cannot tolerate the side effects associated with a standard stem cell transplantation, such as older patients or patients with other medical conditions. These transplants rely less on the heavy doses of chemotherapy and radiation and more on the antitumor effects of the graft itself. This novel approach has patients who otherwise ineligible, including patients in their 70s, to be treated with this lifesaving procedure. Thus, this is particularly beneficial for CLL patients, who are usually in this age range upon diagnosis.
 
 
Some myeloma patients may be treated in an outpatient setting with City of Hope’s day hospital, which allows them to receive their stem cell transplant without staying at the hospital overnight. Studies have shown that the day hospital model meets clinical standards for stem cell transplant without compromising quality of care. Further, this can improve patient satisfaction by giving them the option to spend their evenings at home with loved ones.
 
Learn more about the day hospital for myeloma patients.
 

Radiation Therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. City of Hope is the first in the western United States to treat myeloma using the Helical TomoTherapy System® , which reduces the unwanted exposure of normal tissues and reduces potential complications. The system combines radiation delivery with real-time imaging, allowing doctors to deliver a higher dose of radiation with greater precision. This significantly improves outcomes and reduces side effects compared to traditional whole-body irradiation, which unnecessarily exposes healthy tissues.

Surgery

Because myeloma spreads throughout the bone marrow and bloodstream, surgery plays a limited role in treatment.  However, surgery may be performed to treat localized myeloma-related conditions.

How to Become a Patient

If you have been diagnosed with myeloma or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.

Myeloma Research/Clinical Trials

City of Hope is a recognized leader in myeloma research with more than three decades of experience. Our research projects have been funded by the National Cancer Institute (NCI) and many other research-based organizations, and our scientists collaborate with other leading research institutions to develop tomorrow’s breakthroughs today.
 
  • City of Hope is also the only southern California center in the Multiple Myeloma Research Consortium (MMRC), a collaboration of multiple medical institutions across the nation with the goal of finding and advancing the most promising therapies against myeloma. Since its founding in 2004, MMRC have conducted over 30 clinical trials of more than 20 novel compounds and drug combinations. Patients treated at City of Hope may be able to access MMRC-facilitated trials of novel, potential drugs that can become tomorrow’s standard of care for myeloma.
  • In addition to MMRC-facilitated studies, City of Hope has its own extensive program of myeloma clinical trials, providing our patients access to novel therapies, including many that are not available elsewhere. We are a national leader in transplant trials and are heavily involved in new drug trials, including a recently approved novel agent (carfilzomib) for myeloma.
  • Our Developmental Therapeutics Program has an active portfolio of trials for patients with recurrent myeloma, including trials of new chemotherapy and immunotherapy drugs, and we are one of the few institutions to begin T cell trials.
  • We are also actively involved in survivorship research to ensure that our patients lead full, productive lives following their myeloma diagnosis and treatments.

If you have been diagnosed with myeloma or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.
 

Living with Myeloma

In addition to curative treatments, City of Hope myeloma patients can also access the broad range of services offered by our Department of Supportive Care Medicine. The department’s staff of professionals can give expert assistance in navigating a complex hospital system as well as helping patients and loved ones with a variety of wellness issues including:
 
  • Managing side effects
  • Pain management
  • Coping and maintaining emotional/social/spiritual well-being
  • Staying healthy during/after treatment
  • Guidance on eating well and cooking smart
  • Healing arts
  • Being active
  • Building caregivers’ skills
  • Sexual health and fertility
  • Body image
 
 
The Sheri & Les Biller Patient and Family Resource Center is the heart of the Department of Supportive Care Medicine, integrating City of Hope's support services under one umbrella. The Biller Resource Center provides a warm and welcoming space where patients, families and caregivers can access the resources, education and support they need to strengthen and empower themselves, before, during and after treatment.
 
Our team of supportive care experts includes clinical social workers; pain and palliative care physicians and nurses; psychologists, psychiatrists; patient navigators; health educators; spiritual care chaplains; child life specialists and more.The Biller Resource Center staff may be reached at 626-256-4673 ext. 32273 (3CARE).
 
Additional Myeloma Resources
 

If you have been diagnosed with myeloma or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.
 

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.


For more information on supporting this specific program, please contact us below.

Tina Pakfar, Ph.D.
Vice President
Direct: 213-241-7216
Email: tpakfar@coh.org

 
 
Hematologic Cancers Support Groups
Refer a Patient
Physicians can choose a number of options to refer a patient:

  • Call 800-826-HOPE (4673) to speak with a patient referral specialist.
  • Fax the patient face sheet to 626-301-8432
  • Complete an online callback request form
 
Situated just northeast of Los Angeles, City of Hope combines the best science and the most innovative and highly compassionate patient care. Stretched across more than 100 acres in the City of Duarte, lushly landscaped gardens surround state-of-the-art facilities.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
 
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