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What Is Multiple Myeloma?

Contributor: Noopur S. Raje, MD
5 minute read
Dr. Raje talks with a patient about multiple myeloma.

Multiple myeloma is a rare bone marrow cancer that affects about 30,000 people in the United States each year. Bone marrow is a crucial part of the immune system, which helps protect the body from germs and infections.

Multiple myeloma weakens the body’s immune response and can result in infections. If left untreated, it also can cause problems in your bones, kidneys, and blood counts. Noopur S. Raje, MD, director of the Center for Multiple Myeloma at Mass General Cancer Center, answers common questions about the condition.

What causes multiple myeloma?

Multiple myeloma starts in the bone marrow as a plasma cell, a type of white blood cell. 

We don’t know what causes the cells in the bone marrow to mutate (change) into myeloma cells, but once the cells have mutated, they reproduce far more quickly than normal cells do. The root cause of the mutation may be due to factors such as race, sex, or family history. Some behavioral or environmental factors, such as occupation and exposure to certain chemicals or pesticides, also may be to blame.

Risk factors for multiple myeloma

Multiple myeloma affects some populations more than others, including:

  • People in their 60s and 70s
  • Men
  • African Americans
  • People with a family history of the disease
  • People who are overweight or have obesity

What are the symptoms of multiple myeloma?

Common multiple myeloma signs and symptoms can include:

  • Weakness or exhaustion
  • Loss of appetite or weight loss
  • Confusion or “brain fog”
  • Back pain

Less common or rare multiple myeloma signs and symptoms can include:

  • Nausea
  • Thirst
  • Constipation
  • A frequent urge to urinate (pee)

Over time, multiple myeloma symptoms can also lead to complications, including:

  • Pain in the spine, hips, or other bones
  • Persistent infections, including pneumonia, skin, sinus, and bladder infections
  • Kidney problems, including infections and kidney failure
“No other cancer has seen this degree of progress. We are at an incredible time in research in multiple myeloma, and we are at a threshold where I think we are curing a significant proportion [of patients] already.”

Noopur S. Raje, MD
Hematologist, Medical Oncologist
Mass General Cancer Center

Diagnosing multiple myeloma

Doctors diagnose multiple myeloma using:

  • Blood tests
  • Urine tests
  • Bone marrow tests
  • Imaging tests

Examples of imaging tests used include:

  • X-rays use small amounts of electromagnetic radiation to see inside the body and produce 2D black-and-white images of bones and internal organs.
  • MRI (magnetic resonance imaging) scans use magnetic fields and radio waves to create highly accurate images from inside the body and look for diseases or other abnormalities.
  • CT scans (computerized tomography, sometimes called “CAT” scans) use ionizing radiation to combine multiple ‘slice’ x-rays into a layered, 3D image referred to as tomography.
  • PET scans (positron emission tomography) use radioactive ‘tracers’ that are swallowed, injected, or inhaled to be able to see the structure and functioning of cells and internal organs.

Multiple myeloma treatments

For many years, chemotherapy was the standard for multiple myeloma treatment. However, traditional chemotherapy often produced unwanted side effects, including:

  • Nausea
  • Vomiting
  • Hair loss

Today, new treatments for the cancer have greatly reduced side effects and allow patients to live much more normally, and much longer. In years past, multiple myeloma patients had a life expectancy in the range of only 3 to 4 years.

“These last 20 years have seen a lot of advances,” says Dr. Raje. “We are using newer drugs to treat the same disease. We are using drugs in pill forms as well as more targeted approaches.”

Medications for multiple myeloma

Modern medications for multiple myeloma can include:

  • Monoclonal antibodies, antibodies made from cloned white blood cells. Antibodies are blood proteins the body makes to fight foreign invaders like viruses, bacteria, and other abnormal cells.
  • Proteasome inhibitors, drugs that can kill myeloma cells by allowing an excess of proteins to build up
  • Immunotherapies, medications designed to activate your immune cells and boost your body’s immune response

“These new treatments allow us to make this into a chronic disease where side effects are increasingly absent,” says Dr. Raje. “In fact, patients can continue living their lives, continue working full-time if they're on these medications.”

CAR-T and cellular therapies

Though many of these exciting developments in treatment have changed lives, the ultimate goal is still to find a cure for the disease. Dr. Raje says that much of her research and practice at Mass General Cancer Center has been at the forefront of these advances.

Dr. Noopur Raje with patient Sheila Swiderek

We have a lot of immunotherapeutic approaches for the treatment of myeloma,” she says. “We have cellular therapies such as CAR-T cells, and we now have two CAR-T cell products approved for the treatment of multiple myeloma patients.”

Dr. Raje says the treatment continues to show very promising results for the future, including very high response rates — as high as 80 to 90% — in myeloma patients. Many new treatments are still in development, or are still being studied in clinical trials.

“All of the novel drugs for multiple myeloma have been FDA approved in the last 15 to 20 years,” she notes, “and that is remarkable progress for this disease. No other cancer has seen this degree of progress. We are at an incredible time in research in multiple myeloma, and we are at a threshold where I think we are curing a significant proportion [of patients] already.”

Noopur S. Raje, MD headshot


Hematologist, Medical Oncologist