Shedding Light on What Myeloma Is, and What It Isn’t

Health spoke to Dr. Brian Durie, chairman of the board of the International Myeloma Foundation and director of the Myeloma Clinic at Cedars-Sinai Comprehensive Cancer Center.

Question: Myeloma has been in the news a lot lately, especially in the sports world. The last six months has seen announcements that Mel Stottlemyre, pitching coach for the New York Yankees; Bill Musselman, an assistant coach for the Portland Trailblazers who died May 5; and Roger Neilson, head coach of the Philadelphia Flyers, all had myeloma. But I think many people are still sketchy on the disease and might confuse it with a form of skin cancer.

Answer: It’s not melanoma, that’s the first point. Myeloma is a fatal cancer of the bone marrow caused by the uncontrolled growth of plasma cells within the marrow. Plasma cells of myeloma patients produce an antibody that lacks the ability to fight infection and substances that dissolve bone. We call it multiple myeloma because multiple areas in the bone are affected, usually in the spine and pelvic areas. When the spine is weakened, you develop collapse in the vertebra that’s extremely painful and disabling. It also makes you lose height, up to several inches. The collapse is asymmetrical so the spine tends to curve. Patients end up looking like they’re partially curved and stooping forward. It makes it difficult to get around. You can end up paralyzed.

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Q: Do we know what causes it?

A: We don’t know what causes it, but 75,000 to 100,000 Americans have it, and it’s one of the cancers that’s shown a significant growth, up 82% since the 1950s, according to the American Cancer Society. Each year, 13,500 new cases develop. A number of culprits have been suggested, such as environmental pollution. Scientists are also exploring a link to SV-40, a monkey virus that contaminated polio vaccines given to millions of people from 1955 to 1963 and is thought by some to be causing a number of cancers, including brain tumors and bone cancers such as myeloma.

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Q: Who gets it?

A: More than half those with myeloma are over age 60, but 15% to 20% of patients are now under 45. There is also a family predisposition to the disease. Seven percent of patients have a family member with the disease. Also, men have a 50% higher chance of developing it than women, and African American men are 2 1/2 times as likely to get myeloma as Caucasian men. Again, we don’t know why. It may be that they’re more predisposed to the risk factors or are more likely to be working in industries where they’re exposed to toxic chemicals. It’s known that people process chemicals differently.

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Q: What are the symptoms?

A: The biggest one is bone pain, frequently in the back and ribs, if bones in the vertebra collapse. Other symptoms include exhaustion, thirst, bruising, nosebleeds, hazy vision and headaches. Because of the bone damage, you can get pressure on the nerve or spinal cord and even paralysis caused by reduced blood and oxygen supply to nerve tissue.

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Q: If you suspect you have myeloma, whom should you see?

A: Your primary care physician can refer you to a hematologist/oncologist. Because myeloma is close to leukemia, you want someone who’s a specialist in cancer of the blood, rather than an oncologist who specializes in breast cancer, lung cancer or the like.

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Q: Once you’ve been diagnosed with myeloma, what’s the recommended treatment?

A: The standard treatment is chemotherapy to achieve remission. Seventy to 80% of patients can achieve some degree of remission that lasts an average of two to four years. We try to maintain the remission with something like prednisone and/or alpha interferon, which can increase remission time for up to a year. But it will come back. When that happens, we try the same treatment, and if you’re lucky, you’ll go into a second remission. When benefits from standard treatment wear off or stop working, then thalidomide is a new option available as a backup.

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Q: What’s the prognosis?

A: There’s no known cure. Following a diagnosis, the median survival rate for patients is three to five years, although I’ve got patients who have lived 20 years.

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For more information, contact the International Myeloma Foundation at (800) 452-CURE or go to https://www.myeloma.org.