OVERVIEW

What is multiple myeloma?

Multiple myeloma is a malignant tumor that occurs in plasma cells. Normally, plasma cells produce antibodies to protect the body from various pathogens, injuries, and other harmful factors.

Plasma cells are generated in the bone marrow. In multiple myeloma, the bone marrow produces excessive plasma cells and fails to generate the normal blood cells the body needs. This leads to symptoms such as bone pain, susceptibility to fractures, weakness, fatigue, frequent infections, and numbness or weakness in the limbs.

Multiple myeloma is a malignant disease. However, with advances in medical technology, the survival time of patients has significantly improved.

Is multiple myeloma common?

Multiple myeloma is not a rare disease and is one of the most common malignant hematological tumors.

Are multiple myeloma, myeloma, and bone cancer the same type of disease?

Myeloma is often a colloquial term for multiple myeloma, referring to the same disease.

Bone cancer is a malignant tumor that occurs in the skeletal system, while multiple myeloma is a malignant disease originating from plasma cells and belongs to hematological or lymphatic system malignancies. Therefore, they are not the same type of disease.

Are multiple myeloma and leukemia the same type of disease?

Multiple myeloma is a malignant disease that occurs in plasma cells. Currently, the WHO classifies it as a type of B-cell lymphoma. Thus, both are hematological diseases, and after onset, they may cause symptoms such as infections, bone pain, anemia, and bleeding, but none of these symptoms are specific.

Moreover, the two diseases differ in terms of age of onset, diagnostic methods, treatment principles, and prognosis. Therefore, they are not the same type of disease but rather different diseases within the same system.

SYMPTOMS

What are the symptoms of multiple myeloma?

In the early stages, multiple myeloma has no obvious specific symptoms. In later stages, clinical manifestations vary and mainly include susceptibility to infections, persistent infections, anemia, bone pain, abnormal fractures, dizziness, blurred vision, visual disturbances, and sudden onset of syncope or impaired consciousness.

Blood tests may reveal abnormal kidney function, anemia, elevated blood calcium levels, etc.

Why is multiple myeloma prone to infections?

This disease is a malignant tumor that occurs in plasma cells, which are responsible for producing antibodies. As a result, antibody secretion is impaired, weakening the body's ability to fight pathogens and leading to susceptibility to infections, which often become persistent.

Why does multiple myeloma often cause bone pain and fractures?

Plasma cells continuously proliferate malignantly and secrete abnormal substances (osteoclast-activating factors) that destroy bones, ultimately leading to bone erosion, dissolution, and damage, resulting in bone pain or even fractures.

Bone pain most commonly occurs in the spine, ribs, and thoracic vertebrae, with over two-thirds of patients experiencing bone pain at the time of diagnosis.

Why does multiple myeloma cause anemia?

Hematopoietic cells in the bone marrow are replaced or destroyed by cancerous plasma cells, impairing bone marrow function and reducing red blood cell production, leading to anemia. Additionally, malignant tumor cells secrete certain cytokines that increase the destruction of peripheral red blood cells, further worsening anemia.

CAUSES

What causes multiple myeloma?

The exact cause of multiple myeloma is currently unknown. It may be related to chronic infections, viral infections, or family history, but none of these factors are definitive. Additionally, there is no clear conclusion on whether common carcinogenic factors such as pollution, radiation, or medications can lead to multiple myeloma.

Is multiple myeloma hereditary?

Similar to other malignant tumors, this disease has genetic susceptibility but is not considered a hereditary condition.

DIAGNOSIS

Can Multiple Myeloma Be Detected Early?

Multiple myeloma predominantly affects the elderly over 60 years old. In its early stages, symptoms may be absent or nonspecific, making it difficult for patients to recognize and seek timely medical attention, often leading to delayed diagnosis.

Additionally, some patients presenting with foamy urine or anemia may initially be misdiagnosed with kidney disease, and a correct diagnosis of multiple myeloma is only made when other symptoms gradually appear.

Regular health check-ups are essential. If symptoms such as bone pain, anemia, or increased foamy urine occur, they should not be dismissed as normal signs of aging. Seeking medical evaluation promptly may facilitate earlier detection of multiple myeloma.

What Tests Are Needed for Multiple Myeloma?

Since the clinical manifestations of multiple myeloma are nonspecific, diagnosis relies primarily on laboratory tests in addition to clinical symptoms. Key tests include:

• Blood tests: Serum M protein, free light chains, immunofixation electrophoresis, complete blood count (CBC), blood biochemistry, and tumor-associated carbohydrate antigens;
• Urine tests: Urinary M protein and urinalysis;
• Bone marrow aspiration and biopsy: Examination of bone marrow cell morphology, with additional immunophenotyping and chromosomal analysis if necessary;
• Imaging studies: CT, MRI, and PET/CT scans.

The most critical tests for diagnosis are bone marrow biopsy, serum/urine M protein, and immunofixation electrophoresis. Chromosomal analysis, among others, can help assess prognosis.

TREATMENT

Which department should I visit for multiple myeloma?

Hematology.

How is multiple myeloma treated?

A professional doctor will assess whether active treatment or regular follow-up is needed.

Treatment methods include chemotherapy, radiotherapy, hematopoietic stem cell transplantation (autologous or allogeneic stem cell transplantation), and supportive therapy.

Chemotherapy is the most conventional and essential treatment, commonly using drugs such as bortezomib, thalidomide, lenalidomide, glucocorticoids, doxorubicin, cyclophosphamide, vincristine, cisplatin, etoposide, and melphalan.

Can multiple myeloma be cured?

The goal of treatment is long-term disease-free survival. Recent improvements in autologous hematopoietic stem cell transplantation have enhanced treatment outcomes, allowing many patients to achieve long-term disease-free survival, with some even being cured.

When is hematopoietic stem cell transplantation chosen for multiple myeloma?

All symptomatic multiple myeloma patients under 65 years old should consider hematopoietic stem cell transplantation as early as possible, with autologous stem cell transplantation being the preferred option.

For younger patients, those classified as high-risk at diagnosis, or those who fail or progress after autologous stem cell transplantation, allogeneic stem cell transplantation may be chosen.

How effective is hematopoietic stem cell transplantation for multiple myeloma?

Autologous stem cell transplantation has proven efficacy for some multiple myeloma cases, with no risk of rejection or HLA matching issues. It is also relatively low-cost and plays a significant role in treatment.

What should be noted after hematopoietic stem cell transplantation for multiple myeloma?

Since autologous stem cell transplantation is the primary treatment, post-transplant monitoring for infections is crucial. Symptoms like fever, cough, sore throat, diarrhea, dizziness, or headaches should prompt immediate medical attention.

How is bone disease caused by multiple myeloma treated?

The most important step is controlling the disease with chemotherapy. Other treatments include:

• Treating hypercalcemia: A low-calcium diet, adequate hydration, intravenous fluids, diuretics, or calcitonin may be used.
• Reducing bone resorption: Bisphosphonates like clodronate, zoledronic acid, or pamidronate are recommended for symptomatic bone disease.
• Managing fractures: Seek orthopedic care promptly if fractures occur.
• Low-dose radiotherapy: Used for uncontrolled pain, impending fractures, or spinal cord compression as palliative treatment.
• Pain relief: Analgesics may be prescribed for severe pain.

How is anemia caused by multiple myeloma treated?

Chemotherapy to control the disease is the priority, which often improves anemia. Other treatments include:

• Erythropoietin therapy;
• Blood transfusions;
• A balanced diet to ensure proper nutrition.

How is kidney dysfunction caused by multiple myeloma treated?

• Regular monitoring of kidney function to prevent severe damage.
• Supportive care: Hydration, alkalization, diuretics, and dialysis for kidney failure.
• If kidney dysfunction occurs, fast-acting chemotherapy is preferred. Recovery is likely within 3 months but becomes unlikely after 6 months.

How is hyperviscosity syndrome caused by multiple myeloma treated?

• Avoid smoking, follow a low-fat diet, and stay hydrated.
• Patients on lenalidomide or thalidomide should take prophylactic anticoagulants like aspirin or dipyridamole.
• Plasmapheresis may assist in symptomatic hyperviscosity.

How should asymptomatic or stable multiple myeloma patients be monitored?

• Check every 3 months: Blood count, kidney/liver function, calcium, serum immunoglobulins, electrophoresis, 24-hour urine protein, and free light chains (FLC).
• Annual bone marrow aspiration.
• Seek immediate care for symptoms like bone pain, fractures, dizziness, blurred vision, recurrent infections, or corneal opacity.

Can multiple myeloma recur after cure?

Due to its high malignancy and limited treatment options, recurrence rates remain high.

What factors affect long-term survival in multiple myeloma patients?

• Early detection and treatment significantly improve prognosis.
• Clinical stage: Stage I has better outcomes than Stages II or III.
• Cytogenetic markers: t(14;16)(q32;q23) or 17p deletion (p53 loss) indicate poor prognosis.
• Chemotherapy tolerance and drug resistance.
• Timely management of complications.
• Scientific and healthy daily care.

DIET & LIFESTYLE

What should be paid attention to during the treatment of multiple myeloma?

• Maintain personal hygiene and living environment to prevent infections and colds.
• Engage in regular, moderate exercise, choosing appropriate methods to reduce decalcification and alleviate bone disease symptoms.
• Regulate emotions and maintain an optimistic mindset.
• Avoid collisions during activities, brush teeth gently, and refrain from strenuous exercise.
• A firm mattress is recommended.

What should multiple myeloma patients pay attention to after discontinuing medication?

• Long-term disease-free survival is possible after treatment, and hematopoietic stem cell transplantation can lead to a cure, so maintaining an optimistic attitude is essential.
• Due to the highly aggressive nature of multiple myeloma, especially in high-risk patients, relapse rates after stopping medication are high. Monitor for related symptoms and seek prompt medical attention.
• Maintain a proper diet and care routine, avoid infections, and reduce physical stress.
• Engage in moderate activity and avoid injuries.

Can young adult multiple myeloma patients conceive after being cured?

The disease has a certain genetic predisposition but is not a hereditary condition. Therefore, younger patients may choose to conceive after stopping medication.

However, due to intensive chemotherapy or radiotherapy during treatment—which strongly suppresses immunity and may temporarily impair reproductive cell function—recovery time is needed.

Before planning pregnancy, immune function tests and pre-conception reproductive health checks for both partners should confirm normal results.

PREVENTION

Can multiple myeloma be prevented?

Since the cause of this disease is still unclear, there is no effective prevention method.