Multiple Myeloma

Multiple Myeloma - What it is

blood cells with multiple myeloma

What is multiple myeloma?

Multiple myeloma is a type of blood cancer affecting the bone marrow predominantly and is characterised by excessive multiplication of a type of white blood cells called plasma cells.

The consequence of unrestrained multiplication of plasma cells is two-fold. The cancer cells may overwhelm the normal bone marrow functions and prevent it from making enough healthy blood cells. As the number of myeloma cells increases, fewer red blood cells, white blood cells, and platelets are made.

Secondly, the myeloma cells may also damage and weaken the bone, making it friable such that it may fracture with even trivial injury or release calcium from the bones into the blood causing dangerously high blood levels of this element. This can cause excessive thirst, constipation, confusion or even loss of consciousness.

How common is multiple myeloma?

Multiple myeloma is the second most common type of blood cancer with approximately 100 to 120 new patients diagnosed with this disease in Singapore a year.

What are the different types of multiple myeloma?

There are different types of multiple myeloma, typically classified based on the proteins produced by the cancerous plasma cells. The main types include:

IgG myeloma: This is the most common type where the cancerous plasma cells produce abnormal IgG antibodies.
IgA myeloma: In this type, the plasma cells produce abnormal IgA antibodies.
IgD myeloma: A rarer form where IgD antibodies are produced.
IgE myeloma: Extremely rare with the production of IgE antibodies.
Light chain myeloma: Only light chains (parts of antibodies such as kappa or lambda) are produced rather than complete antibodies.
Non-secretory myeloma: In this rare type, the myeloma cells do not produce measurable antibodies or light chains.

Each type may vary in its progression and treatment approach.

Multiple Myeloma - Symptoms

What are the symptoms of multiple myeloma?

Some of the common signs and symptoms of multiple myeloma include:

Bony pain, particularly the backbone and ribs
Anaemia can cause tiredness, shortness of breath especially on exertion
Bone fractures with minimal to no trauma
Recurrent or frequent infections
Kidney damage
Unexplained weight loss
Increased thirst, constipation, mental confusion due to high calcium levels

When should you see a doctor?

You should consult a doctor if you notice any ongoing or unusual changes in your health, particularly if you feel unwell without an obvious reason. It is also important to seek medical advice if your symptoms worsen or new concerns develop, such as constant tiredness or unexplained changes in your well-being. Early intervention can help manage the condition more effectively.

Multiple Myeloma - How to prevent?

How is multiple myeloma prevented?

Regular screening for multiple myeloma is generally not recommended.

Individuals should seek medical attention if they have any of the above symptoms.

Currently there are also no proven preventive strategies for multiple myeloma. However, adopting a healthy lifestyle may help to prevent disease.

This includes:

Eating a diet rich in fruits and vegetables
Quitting or not starting smoking
Limiting alcohol consumption
Regular exercise

Multiple Myeloma - Causes and Risk Factors

What are the risk factors for multiple myeloma?

There is no specific cause for myeloma, but some factors that can increase the risk of myeloma include:

Age – Myeloma is more common in people over the age of 55 and increases with age such that over the age of 80 years up to 5% of patients may have myeloma.
Gender – Males are slightly more likely to develop myeloma compared to females.
Repeated exposure to toxic elements such as agricultural chemicals or pesticides, and petrochemicals are thought to increase the risk of Myeloma.
Exposure to DNA damaging ionising radiation or chemotherapeutic agents
Obesity is a common risk factor for several forms of cancers, including Myeloma

People with a first degree relative (a parent, sibling, or child) with Myeloma are nearly two times more likely to develop it compared to the general population

Multiple Myeloma - Diagnosis

How is multiple myeloma diagnosed?

Several tests and procedures might be needed to diagnose myeloma and develop an effective treatment plan.

These may include:

Clinical examination: Your doctor will check for any myeloma related complications and assess baseline functional capacity of different organ systems.
Blood tests: To test blood cell, kidney and liver function assessments. Blood tests required for measurement of M protein, subtyping and quantification as well as investigations required for staging like beta-2 microglobulin, to assess the extent of complications or organ function effects like kidney, calcium level etc will be performed.
Bone marrow aspiration and biopsy: Bone marrow samples are usually taken by inserting a needle into the flat part of the hip bone to extract the samples. These are then examined in the laboratory for the presence of cancer cells. It will also help quantify the percentage of the cancer cells in the marrow and help with prognostication by seeking the genetic change that the cancer cells harbour.
Imaging tests: Imaging tests including X-Rays or CT scan, MRI scans of the back bones and PET scans may be used to look for extent of the bone destruction caused by myeloma in the body.

Multiple Myeloma - Treatments

How is multiple myeloma treated?

SGH is a comprehensive myeloma care centre. At SGH, you'll receive care from a team of doctors and nurses who work together to understand and offer you personalised care.

Treatment for myeloma depends on age, patient’s fitness or frailty at the time of diagnosis, presence, or absence of other medical issues like kidney failure, nerve damage symptoms etc.

Treatment of Myeloma:

All patients diagnosed with myeloma benefit from treatment as it can help relieve pain, control and minimise complications of the disease, stabilise your condition and slow the progress of multiple myeloma.

While myeloma is not a curable condition, there are many treatment options which are effective in controlling the disease for years.

The goal of treatment is to bring myeloma in to a good remission and to keep it there for as long as possible while preventing and minimising its complications and ultimately improve the quality of life.

Treatment of myeloma can be divided into different phases:

Induction Phase: with the aim to reduce the amount of cancer cells in the bone marrow
Consolidation Phase: with the aim of further deepen the response after induction therapy using treatments like an autologous haematopoietic stem cell transplant
Maintenance Phase

There are different treatment modalities used in treatment of myeloma. They are often used in combination and is tailored based on the patient’s disease characteristics and overall function.

Corticosteroids: Steroids can regulate the immune system and can control inflammation in the body. They are also very active against myeloma cells.
Chemotherapy: There are many chemotherapy drugs that are used to eradicate myeloma cancer cells and prevent their growth. There are different group of chemotherapy drugs used to treat myeloma: proteasome inhibitors, alkylators, immunomodulatory drugs etc.
Immunotherapy: Immunotherapy harnesses the power of your immune system to control myeloma. For example, monoclonal antibodies like daratumumab target a specific protein on the surface of cancerous plasma cells and make it easier for the immune cells to identify and kill them.
Haematopoietic Stem Cell Transplantation: Stem cell Transplantation involves the substitution of diseased bone marrow with healthy bone marrow stem cells. In most cases, the patient’s healthy stem cells are transplanted. Healthy blood-forming stem cells are collected from the patient by a process called apheresis and is stored in advance of the transplantation. During transplantation, high doses of chemotherapy drugs are then given to destroy the diseased bone marrow. This isfollowed by reinfusion of previously collected stem cells back into the blood which then home in on the bone marrow and start producing all blood and immune cells
Radiation therapy: Radiation therapy or radiotherapy uses high-energy radiation (rays or particles) to kill or damage cancer cells. It is usually used to shrink localised collection of cancerous plasma cells that form a tumor and is commonly used in combination with chemoimmunotherapy.

The management of multiple myeloma requires a multi-disciplinary team to support patients in various aspects of their care. We have a dedicated pharmacist-led education and medication reconciliation service, transplant and cell therapy co-ordinators and robust patient education supported by our advanced practice nurses. Our dedicated medical social workers also facilitate the provision of financial and psychosocial support to patients.

SGH also has many clinical trials that are specifically designed for and beneficial to myeloma patients. By collaborating with other institutions and industry partners in Singapore, South Asia and globally, we aim to continue bringing novel treatment options to Singapore myeloma patients via clinical trials.

Multiple Myeloma - Other Information

How does multiple myeloma affect the body?

Multiple myeloma primarily affects the bone marrow by causing an overproduction of plasma cells. This leads to issues such as bone damage, reduced red and white blood cells and an increased risk of fractures, infections and organ dysfunction like kidney damage.

What methods are used to confirm a multiple myeloma diagnosis?

Diagnosing multiple myeloma involves blood tests to measure abnormal proteins, bone marrow biopsies to check for cancer cells and imaging scans like MRIs or CT scans to detect bone damage. These tests help doctors determine the stage and extent of the disease.

What are the typical warning signs of multiple myeloma?

Common warning signs include persistent bone pain, fatigue, frequent infections, unexplained weight loss and elevated calcium levels, which may cause excessive thirst and confusion. Fractures with minimal injury and kidney issues are also indicators.