Myeloma is not a common cancer, accounting for less than 1 percent of new cancer cases and 10 percent of all blood and bone marrow cancers. Myeloma develops when plasma cells - infection-fighting blood cells in the immune system - become abnormal and grow and divide uncontrollably to become tumors.
The Judy and Bernard Briskin Center for Multiple Myeloma Research at City of Hope is known internationally for its research breakthroughs and clinical treatments. We treat the full spectrum of the disease - whether you are in the early precursor stage, are newly diagnosed, have cancer that has returned or have failed other therapies.
- What is myeloma?
- What are the types of myeloma?
- What are the risk factors for myeloma?
- What are the signs and symptoms of myeloma?
- How is myeloma diagnosed?
- What are the treatments for myeloma?
- Meet our myeloma team.
- What clinical trials are being offered for myeloma?
- Living with myeloma.
Request a consultation
City of Hope’s world-renowned myeloma cancer care team uses the latest technology and innovation to treat cancer while providing compassionate care. Call 800-826-4673 or request an appointment online. Visit Making Your First Appointment for more information.
City of Hope is internationally recognized for its research and breakthrough treatments, has been named one of America’s top cancer hospitals by U.S. News & World Report for over a decade running and is a National Cancer Institute-designated comprehensive cancer center.
Highlights of our myeloma program include:
- Promising new therapies as part of our clinical trials program, including innovations in gene, CAR T cell and antibody therapy — to boost the immune system response to cancer
- Collaboration with the Multiple Myeloma Research Consortium, providing quick access to the best therapies, including the newest, most innovative clinical trials
- A pioneering blood and bone marrow program, one of the largest transplant centers in the U.S., which consistently produces some of the best outcomes — and whose innovative approaches include combining transplantation with new therapies
- Virtually unrivaled expertise with immunotherapy — including involvement in pivotal early trials for drugs now a part of myeloma therapy worldwide such as daratumumab, the first monoclonal antibody approved for the treatment of myeloma
- Understanding of unique issues facing older myeloma patients, including tailoring treatments to make them more effective and reducing side effects using computer models to predict toxicity
- Outpatient bone marrow transplantation, provided by highly trained, experienced transplant nurses
- Genetic testing and customized drug therapy tailored to the molecular profile of specific myeloma types
- Survivorship clinics that provide support and monitoring to patients throughout the course of the disease
City of Hope is one of only a few dozen centers in the country that treat myeloma using a comprehensive approach — by a multidisciplinary team whose sole focus is treating this type of cancer. Your care includes regular interaction and input from a team that includes hematologists, oncologists, radiologists and pathologists, along with nurses, social workers and specially trained support staff. This team brings together deep experience and diverse perspectives — shaped by seeing and treating myeloma every day — to arrive at the ideal treatment for every patient.
NEWS & BREAKTHROUGHS
April 10, 2018
What is myeloma?
Myeloma is a relatively rare cancer — accounting for around 10 percent of blood cancer cases. It develops in plasma cells, white blood cells that grow in bone marrow. Myeloma most often affects the aged — most cases are diagnosed in people age 65 and older. Although myeloma grows within bone, it is not considered bone cancer.
This year more than 30,000 people in the United States will be diagnosed with myeloma, according to the American Cancer Society.
Parts of the body involved in myeloma include:
- Bone marrow, spongy blood-producing tissue inside the bones, where all of the blood in the body is produced and where malignant (abnormal) plasma cells grow.
- Plasma cells, produced in the bone marrow and a part of the immune system, are a type of white blood cell that plays an important role in creating antibodies that fight infection. In myeloma plasma cells are abnormal.
- Immunoglobulins, another word for antibodies — proteins produced by plasma cells that are a crucial part of the immune response. They bind to infectious agents, like bacteria or viruses, which identifies them for destruction by other immune system cells.
- Bone cells, specifically osteoblasts that make bone and osteoclasts that dissolve bone. Myeloma cells produce a substance that stimulates breakdown of bone by osteoclasts — and inhibits the activity of osteoblasts — producing holes in the bone called “lytic lesions.”
- The nervous system may also be involved with myeloma. Nerve damage may be caused by toxic, abnormal proteins produced by myeloma cells.
How myeloma develops
- Myeloma develops when plasma cells — infection-fighting blood cells in the immune system — become abnormal and grow and divide uncontrollably to become tumors.
- During a normal immune response, B cells mature and change into healthy plasma cells. Those plasma cells then create antibodies that help the immune system recognize and fight the infection.
- Myeloma occurs when a damaged B cell develops into an abnormal plasma cell. Instead of helping the immune system fight disease, myeloma cells, which have no real purpose in the body, grow quickly and crowd out healthy blood cells. Over time, this process can lead to conditions such as anemia (low hemoglobin) and thrombocytopenia (low platelets or blood clotting cells) — and because the immune system is impaired, patients with myeloma are at increased risk of infection.
- Myeloma cells produce abnormal antibodies called monoclonal proteins, or M proteins. These proteins build up in the body, leading to the health problems associated with myeloma.
There are several types of myeloma — all related yet appearing and acting differently in the body. While myeloma is a rare disease overall, the most commonly diagnosed is multiple myeloma:
- Multiple myeloma is a cancer of plasma cells that affects several areas of the body, and is found in 90 percent of diagnosed cases. A tumor that grows from cancerous plasma cells is called a plasmacytoma. Isolated plasmacytoma is diagnosed when a single tumor grows, while multiple myeloma is diagnosed when more than one plasmacytoma develops. Plasmacytomas most often begin developing in the bone marrow, eventually spreading through the cavity containing the marrow and later the bone itself.
Other, rarer forms of myeloma include:
- Plasmacytoma, a solitary tumor, made up of cancerous plasma cells, most often beginning in bone but which can develop in other organs such as the skin and lungs. Over time plasmacytomas may become multiple myeloma.
- Multiple solitary plasmacytoma, involving multiple tumors but without other features of multiple myeloma such as bone disease; and the bone marrow appears normal.
- Extramedullary myeloma is disease involving organs besides the bone such as the skin, throat, lungs and muscle.
- Light chain myeloma, diagnosed when myeloma cells produce damaged, incomplete antibodies called immunoglobins. These proteins build up and cause damage in the kidneys.
- Nonsecretory myeloma, when tested, shows multiple myeloma cells that do not release the abnormal proteins characteristic of myeloma into the blood or urine. This requires more frequent bone marrow biopsies to monitor the disease.
- Rarer types of multiple myeloma include immunoglobulin D (IgD) myeloma and immunoglobin E (IgE) myeloma.
Myeloma is categorized based on whether it has symptoms and how quickly it develops:
- Asymptomatic myeloma, also called smoldering myeloma, develops slowly and has none of the characteristic symptoms such as bone pain or anemia or kidney damage. Those diagnosed with smoldering disease have fewer plasma cells and abnormal proteins in the bone marrow when compared with symptomatic disease.
- Symptomatic myeloma, also called active myeloma, has observable symptoms such as bone disease, kidney damage and anemia.
Similar to myeloma, amyloidosis is a disease caused by defective plasma cells producing too much protein, but the protein affects areas of the body that are different from myeloma — such as the heart, kidneys and digestive system. Because what is underlying the two diseases is similar, this condition is sometimes treated with some of the same therapies as myeloma, including certain drug therapies and stem cell transplantation.
Things that put you at higher risk for getting myeloma are called risk factors. Doctors do not fully understand what causes most cases of myeloma, and even defined risk factors do not have strong associations with developing myeloma. Some of those risk factors include:
- Age increases the risk of most cancers, including myeloma which is most often diagnosed after age 65.
- Sex is a risk factor: Males are more likely than females to be diagnosed.
- Race increases risk: African-Americans are about twice as likely as other groups to develop myeloma.
- Radiation exposure may increase risk of myeloma.
- Chemicals, pesticides and exposure to other toxins like Agent Orange, asbestos and benzene may be linked to myeloma.
- Certain conditions, such as chronic inflammation, may be involved with myeloma. And a small subset of patients (around 1 percent) diagnosed with a condition called MGUS, monoclonal gammopathy of undetermined significance, will develop myeloma.
- Obesity and being overweight are associated with developing several cancers and, in early studies, has shown an association with myeloma.
- Certain genetic factors, including abnormally developing genes, may increase risk of myeloma.
There are few early warning signs of myeloma — and some people have none at all. Symptoms of myeloma that appear at diagnosis are sometimes referred to by the acronym CRAB, which stands for:
- Calcium build-up, also called hypercalcemia
- Renal (kidney) problems
- Anemia, or lowered production of red blood cells
- Bone lesions and/or fractures
As a result of these problems, some of the most common symptoms of myeloma include:
- Bone pain, unexpected fractures
- Kidney damage or failure
- Weakness and numbness
- Increased thirst
- Frequent infections
- Increase or decrease in urination
- Weight, appetite loss
Symptoms of other medical conditions may mirror some of those involved with myeloma. If you are treated for those conditions, or if your symptoms last for several weeks despite medical treatment, you may need further consultation to rule out myeloma.
What inspires and excites me about the field is knowing there are even more new therapies in development that will have a huge impact on treating this disease. It is rare in the hematology field to see a disease that has made such advances in such a short time." Amrita Krishnan, M.D. Director, Judy and Bernard Briskin Center for Multiple Myeloma Research
Myeloma is group of cancers with overlapping features — identifying its different forms is challenging —and since every patient’s disease looks different, getting an accurate diagnosis is important.
For these reasons treatment at City of Hope begins with leading-edge diagnostics, performed by world-renowned hematopathologists who are well versed about the entire spectrum of this disease. This powerful combination of experience, next generation technology and talent is why City of Hope is known for improving survival among myeloma patients, especially those with advanced or misdiagnosed disease.
How myeloma is diagnosed
Myeloma is diagnosed using various tests, including:
- Blood and urine tests, usually the first tests performed that look for myeloma
- Bone marrow aspiration and biopsy, taking a small sample of marrow cells from inside the bone and looking at them under a microscope
Once a diagnosis is determined, other tests may be performed to figure out how much myeloma is in the body, how aggressive it is and where it is located. Those tests include:
- Imaging tests: PET, MRI and CT scanning
- Genetic testing
At City of Hope, diagnosis involves performing an extra layer of assessment among older patients to determine how well they can tolerate treatments such as chemotherapy.
There is no one treatment for myeloma. In other words, one size does not fit all. And here at City of Hope, we tailor treatments for each individual. This personalized medicine always offers the best options and outcomes for our patients." Amrita Krishnan, M.D., Director, Multiple Myeloma Program
City of Hope’s approach to treating myeloma starts with a coordinated, multidisciplinary care team, composed of myeloma specialists, whose main goals are controlling your disease so that you can live longer and maintain an active life.
Treatment advances are happening rapidly in myeloma and new agents approved recently mean survival has risen dramatically. We are among the centers at the forefront of that progress. City of Hope was involved in pivotal early trials on two drugs that are now part of myeloma therapy worldwide: daratumumab and ixazomib.
Each patient’s disease is distinct, so treatment plans are individualized and incorporate the newest combination therapies — for example, promising new immunotherapies often are combined with chemotherapy to increase the chances treatment will be effective.
While we treat the entire spectrum of disease, City of Hope is exceptionally experienced with treating patients who have high-risk disease, relapsed disease and those who have failed previous therapies.
All of our treatments are designed with quality of life in mind. We keep drug toxicity to a minimum so that you can continue to work and live normally, and we tailor therapy to include medications, called bisphosphonates, to deal with common disease-related bone problems. The goals of myeloma treatment at City of Hope include:
- Slowing down the disease progression
- Extending remission time
- Reducing symptoms
- Researching and developing curative therapies that may play a role in treatment
Types of myeloma therapy
- Single or combination drug therapy
High-dose chemotherapy with bone marrow transplant
- Autologous: using a patient’s own stem cells
- Allogeneic: using donor stem cells
- Radiation therapy for local disease
- New and emerging therapies
- Supportive care
Bone marrow and stem cell transplantation
The most effective treatment for myeloma is high-dose chemotherapy combined with stem cell transplant, and City of Hope is a true innovator in this area — with one of the largest and most successful transplantation programs in the world.
We have set standards for stem cell transplantation and improving long-term outcomes. Using innovative approaches for blood and bone marrow transplantation to treat myeloma has led our Hematologic Malignancies and Stem Cell Transplantation Institute to be considered an industry leader with unrivaled survival rates.
To address the growing need for high quality transplantation, City of Hope recently expanded its bone marrow transplantation program to include outpatient procedures, allowing patients to return home after treatment. The program allows greater autonomy for multiple myeloma patients undergoing autologous (using their own cells) transplants and consistently receives high satisfaction ratings.
Chemotherapy, a common treatment for myeloma, uses drugs to either kill cancer cells or stop them from growing. This approach usually is necessary to kill cancer cells circulating throughout the body.
Exciting advances in chemotherapy at City of Hope are allowing patients with advanced disease to get drug combinations —including combining targeted therapies, radiotherapies and immunotherapies with chemotherapy — designed to slow down disease progression and improve quality of life.
Immunotherapy is a way of awakening the immune system to action against cancer cells. Immune cells patrol the body in search of disease, but cancer cells often devise ways to get around or suppress them. City of Hope is developing and testing drugs that can unleash dramatic and specific immune responses to cancer cells — or make them visible to the immune system.
City of Hope has virtually unrivaled expertise with immunotherapy — and was involved in pivotal early trials on drugs that are now a big part of myeloma therapy worldwide, including daratumumab. We are on the leading-edge of drug treatment for myeloma, and we have ongoing clinical trials aimed at identifying even more effective immunotherapy treatments, including exciting advances in CAR T cell therapy, check point inhibitors, bispecific antibodies and novel antibody-drug conjugates.
City of Hope uses the latest technology to spot genetic vulnerabilities in cancer cells and use medications to stop them from growing. Knowing how a tumor behaves and how it would respond to different therapies allows us to created targeted therapies: drugs or drug combinations that would work best to treat specific cancers.
Radiation therapy uses high-energy radiation to kill plasma cells and shrink tumors. It is an effective treatment for myeloma and often is paired with other treatments. City of Hope offers advanced radiation treatments that are highly targeted to cancer cells while protecting the surrounding normal tissue.
One technique, TomoTherapy, includes delivering focused radiation to the entire bone marrow compartment. The technique, called total marrow irradiation, is an effective way to target cancer cells while reducing side effects.
City of Hope’s renowned physicians and researchers use the latest in technology and innovation to treat multiple myeloma, coupled with an enduring belief in providing unparalleled compassionate care.
- Cancer biology
- Molecular and cellular biology
- Basic and translational research in multiple myeloma
- Natural therapies: Compound derived from the chamomile flower that fights multiple myeloma
- Molecular epidemiology
- Genetic susceptibility
- Hematopoietic malignancies
- Gynecologic tumors
- Stroke and related cardiovascular endpoints
- Childhood cancers and conditions
- Immune biomarkers
- Infectious and viral causes of cancer
- CI, Myeloma
There are a number of things happening in clinical trials right now that are very promising. And we are in the process of launching an exciting study looking at CAR T cell therapy for myeloma." Maung Myo Htut, M.D., Hematologist/Oncologist
Getting treated for myeloma at City of Hope means you are steps away from labs where new treatments for cancer are being developed every day. That proximity means you benefit from something unique in cancer care — “bench to bedside” treatment. Bench to bedside means innovative research we are conducting at our on-campus research laboratories is moved quickly to the bedside to treat patients.
Our program is known internationally for its research breakthroughs and clinical treatments — we are at the forefront of new therapies and have the technology to identify new potential targets for new drugs.
Myeloma clinical trials
The Kenneth Goldman and Briskin Family Clinical Trials Program manages and coordinates all trials related to the treatment of multiple myeloma. We offer access to dozens of clinical trials and new therapies not always available elsewhere.
Our latest research is focused on new drugs and drug combinations that target and attack relapsed myeloma which has become resistant to first-line treatment.
Browse through some of our clinical trials and research projects.
Living with myeloma
When things get difficult, you can’t let yourself stop. You have to keep moving forward." Bob Dickey, survivor
When you come to City of Hope, you have access to a strong network of support services and staff to help you and your family along your cancer journey. That support is an integral part of your care and includes everything from financial counseling to talk therapy to meditation to being paired up with a patient navigator.
We can help with all of the following concerns, and more:
- Managing side effects
- Pain management
- Navigating the health care system
- Your emotional, social and spiritual health
- Staying healthy and active
- Healthy cooking and eating
- Healing arts
- Caregiver skills
- Dealing with family, school or work stress
Join a community of people who understand what you are going through
Hopeful is an online space where anyone touched by cancer can connect and learn to thrive. It features new stories weekly on everything from recipes to news about immunotherapy and other groundbreaking treatments. No one should have to go through cancer alone, and Hopeful ensures that every person will have a supportive community to lean on.
Diagnosed at age 44 with advanced multiple myeloma, a disease usually occurring in people 70 and older, Bob Dickey doesn't let his disease stop him from living life to the fullest.
A mother fights despair after a myeloma diagnosis