What is myeloma?

Updated 24 Oct 2017

Myeloma is a type of cancer which affects plasma cells. A plasma cell is a type of white blood cell which produces antibodies to fight infection.

When you have myeloma, too many abnormal plasma cells are made in your bone marrow (the spongy tissue inside your bone where your blood cells are made). This also means there isn’t enough room for normal red and white blood cells, which both play an important role in keeping you well.

Usually the bone marrow is affected in a number of places around your body, which is why myeloma is sometimes known as ‘multiple myeloma’.

Myeloma is not usually considered a curable disease, but it is very treatable. Many people with myeloma have a good overall quality of life.

Watch Newton talk about life with myeloma

Antibodies, paraproteins and myeloma

To understand myeloma, it can be helpful to understand antibodies.

Plasma cells normally make antibodies which are made of two different kinds of protein: heavy chains and light chains. An antibody is shaped like a ‘Y’, with two ‘heavy chains’ and two ‘light chains’.

Structure of an antibody

We all have antibodies. When your body is responding to infections, your plasma cells make five main types of antibody (also known as immunoglobulins) with different heavy chains called G, A, M, D or E.

You might hear them called IgG, IgA, IgM, IgD, and IgE. The light chains are called either κ (kappa) or λ (lambda).

When you have myeloma you produce abnormal antibodies instead, called paraproteins. These antibodies can’t fight infections properly.

You might hear a paraprotein also being called a monoclonal gammopathy, an M protein or an M-spike.

The presence of paraprotein can be an important sign of myeloma.

 

What causes myeloma?

When you’re diagnosed with any cancer, one of the first things you might think is: why me?

You’re not alone: Nearly 5,000 people are diagnosed with myeloma every year in the UK.

With myeloma, there are no clear causes but there are some things which can increase your risk. Here’s what we do know:

  • About one person in 200 will develop myeloma at some point in their life.
  • Nearly 5,000 people are diagnosed with it each year in the UK.
  • People with a condition called MGUS are slightly more likely to develop myeloma.

Age

People who get myeloma are usually in their 70s or older. It’s very rare for people under 40 to get myeloma. Myeloma doesn’t affect children.

Gender

Men are about one and a half times more likely than women to develop myeloma; we don’t know why.

Family history

A parent, child, brother or sister of a myeloma patient is two or three times more likely to develop myeloma than other people. However, the risk for any person is still very low.

Because of this, experts don’t recommend testing family members unless they’re being considered as donors for a stem cell transplant.

Ethnicity

People from an African-Caribbean background are roughly two times more likely to get myeloma compared to people from other backgrounds; we don’t know exactly why.

MGUS

Sometimes, small clones of plasma cells develop and produce a low amount of paraprotein but you have no other features of myeloma. This is called monoclonal gammopathy of unknown significance (MGUS).

MGUS is quite a common condition which affects about 5% of people in the UK. In itself it’s harmless and causes no obvious damage, so no treatment is needed and people aren’t routinely screened for it.

People with MGUS have a higher risk of developing myeloma – around 1% of people with MGUS go on to develop myeloma per year.

Anyone with MGUS will have regular blood and urine tests, to make sure it’s not progressing.

Types of myeloma

Myeloma is divided into two main groups:

Smouldering or asymptomatic myeloma

This is where there are no symptoms or tissue damage.

Symptomatic myeloma

This is where there are symptoms and/or tissue damage.

Types of myeloma

 

IgG or IgA myeloma

A large majority of myeloma patients will have a type of disease called IgG or IgA myeloma. If you’re healthy your body will produce a similar number of each of the heavy chain antibodies. In myeloma, too many of one type of antibody is produced, meaning that the healthy ones can’t effectively fight infection.

IgG is the most common type of myeloma – 66% of cases are this type.

20% of patients will have type IgA, whilst the other types are very rare. However, all of these five types of myeloma are treated in the same way.

Free light chain myeloma (formerly known as Bence Jones myeloma)

One in five people get this type. This is where the body produces antibodies that are incomplete, so they may not have a Y shaped heavy chain, only the light chain (either kappa or lambda).

If you have this type of myeloma a special test known as the serum free light chain assay, or Freelite assay, will be done to detect the abnormal light chains.

Patients with this type of myeloma should receive guidance from their healthcare team about taking extra care of their kidneys, because these free light chains can damage them. These antibodies are referred to as ‘free light chains’ because they are unattached to the heavy chains.

Non-secretory myeloma and oligosecretory myeloma

Fewer than one in 100 people get true non-secretory myeloma. This is where the cancerous plasma cells do not produce any paraprotein at all. Oligosecretory myeloma is when the plasma cells only produce very small amounts of paraprotein.

Blood, bone marrow and the immune system

Bone marrow and how blood cells are made

A lot of blood cells are made in the bone marrow (the soft material inside your bones) every second, because your body needs them.

If everything’s working normally, your body makes the right number of each type of cell to keep you healthy.

All blood cells start off in your bone marrow as a type of cell called a stem cell. Stem cells divide again and again, each time becoming more like a mature, fully formed blood cell. One type of blood cell created when stem cells divide is a white blood cell called a lymphocyte.

There are lots of different kinds of lymphocyte, but the important ones to know about are B cells and T cells.

B-cell lymphocytes divide to form plasma cells that produce proteins called antibodies, which fight infections in your body. T-cell lymphocytes also play a number of supportive roles in our immune system.

In myeloma it’s the plasma cells which are affected – they make abnormal antibodies.

It also means that too many plasma cells are made, so there’s not enough room in the bone marrow for other blood cells to develop. This means they can’t do the jobs they normally do to keep you well.

Your immune system is a network of cells, tissues and organs which protect your body against infections. Antibodies are a crucial part of the immune system. In myeloma the normal antibodies can be swamped by the production of an abnormal antibody, so your body’s defences will often be low.

This means you might get:

Bacterial infections

They could be more severe than usual and last longer. Your healthcare team can let you know ways to reduce your risk.

Shingles

Shingles is an infection of a nerve and the skin around it. It can affect you if you’ve had chickenpox, even if you had it a long time ago. You’re more likely to get shingles if your immune system isn’t working well – for example if you have myeloma.

Cold sores (herpes simplex virus)

Because of your weakened immune system, you may be more prone to getting a viral infection called herpes simplex, which can lead to an outbreak of cold sores. If you develop these, you should ask your specialist for tablets to stop the cold sores spreading, because over-the-counter creams will not be enough to control them in people who have myeloma.

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