Multiple Myeloma Masquerades as Pain and Fatigue
Prevention & Treatment The blood cancer multiple myeloma can be easily missed, but new therapies mean it's becoming easier to treat.
Multiple myeloma is a blood cancer that affects plasma cells, a type of white blood cell. Each year, more than 20,000 Americans are diagnosed with multiple myeloma, but treatment options and detection methods are now better than ever.
While multiple myeloma can strike anyone, it is most common in adults over the age of 65, and the risk of developing myeloma increases with age. It is also more common among men and African-Americans. People with a close family member who suffers from multiple myeloma are also at an increased risk for developing it.
It can be difficult to tie specific symptoms to multiple myeloma without ruling out other possible causes.
“It can present in many ways, the most common in the form of bone pain or fractures, but it can also be seen with kidney damage, fatigue from a low hemoglobin, or other symptoms like numbness, weakness or even repeated infections,” said Joseph Mikhael, associate dean of the Mayo School of Graduate Medical Education and deputy director for Education at the Mayo Clinic Cancer Center.
Fortunately, the tests to detect myeloma, such as the free light chain blood test (Freelite®), are extremely reliable, and early diagnosis improves outcomes. “Almost all patients have the abnormal protein in their blood for months or years," Mikhael added. “Catching it early can often prevent the organ damage that the proteins can cause.”
“Almost all patients have the abnormal protein in their blood for months or years. Catching it early can often prevent the organ damage that the proteins can cause.”
A likely candidate for testing would be “someone who develops a bone pain or anemia without any particular cause, or a reduction in kidney function without high blood pressure, high blood pressure or diabetes,” said Dr. Robert Kyle, professor of medicine and laboratory medicine at the Mayo Medical School.
Often, the signs are subtle. Barb Hansen broke a rib 8 months before her myeloma diagnosis in 2006. “I had x-rays, I wasn’t diagnosed while I was in all this pain, and when I did get the diagnosis it was kind of a shocker,” Hansen said. “I had never heard of myeloma before. Nothing had shown up in my physical.”
Typical treatments include chemotherapy and drugs like proteasome inhibitors, but researchers are identifying new immune therapies, some which can be taken orally, as well as targeted antibody treatments. With the wide choice of therapies, Freelite® and other laboratory tests are useful to evaluate patient progress.
“In the past 15 years there’s been a huge improvement in our ability to treat myeloma and to have patients that go into remission and have remissions that last for many years,” said Brian Durie, a doctor specializing in multiple myeloma at Cedars-Sinai Outpatient Cancer Center in Los Angeles, and Chairman of the International Myeloma Foundation.
Hansen was put on the drug lenalidomide after her myeloma diagnosis, followed by a stem cell transplant in 2007. She’s been in remission for over six years.
“Stay strong, think positively, learn what you can about the disease, be your own advocate, accept the support that people give you and be encouraged by the research that’s being done and the new drugs that are being developed,” Hansen said. “There is hope.”