Myeloma

Blood and urine tests

There are a number of blood and urine tests used to diagnose myeloma. The main blood test measures the amount and type of paraprotein in the blood. Paraprotein is an abnormal antibody that myeloma cells produce.

Urine tests can check for the presence of Bence Jones protein, which is paraprotein in the urine.

X-rays

X-rays are usually taken of the head, spine, ribs, hips, legs and arms to see if there is any bone damage caused by myeloma cells.

Scans

A CT scan produces three-dimensional images to see a part of the body in more detail, or to look for areas of bone damage that may not appear on an x-ray.

An MRI scan may be used as it can sometimes find myeloma in the bones and outside the bones. Less commonly used scans include FDG/PET and Sestamibi scans.

Bone marrow biopsy

A bone marrow aspirate and trephine biopsy is used to examine cells from the marrow. It is usually done with a local anaesthetic. A thin needle is used to remove a sample of bone marrow to examine under a microscope.

Cytogenetic tests

Using the bone marrow biopsy, cytogenetic tests look for changes in the chromosomes within the myeloma cells, which are different to the normal cells in the body. This can help determine treatment options.

Active monitoring

Active monitoring, which involves regular check-ups, is most often used for early-stage myeloma, when it is considered that immediate treatment will not affect prognosis.

Treatments to control myeloma

Initial treatment usually includes a combination of chemotherapy and other drugs such as thalidomide and steroids.

Chemotherapy

Chemotherapy aims to kill cancer cells, and it can be administered as tablets, injected into a vein (intravenously) or under the skin (subcutaneously).

Thalidomide

Thalidomide works by blocking the blood supply to cancerous cells and by stimulating the body's immune system to attack myeloma cells. It is taken in tablet form. A relatively new drug called lenalidomide works in a similar way, and is commonly used for people with relapsed myeloma.

Bortezomib

Bortezomib, a drug that blocks the breakdown of protein within myeloma cells, causing them to stop growing and die, may also be used as a treatment for myeloma.

Steroids

Steroids (corticosteroids) can be used to modify the body's immune system responses, relieve swelling and inflammation and actively kill myeloma cells. Corticosteroids are usually taken as tablets, and can be given on their own, or more commonly, with chemotherapy or other anti-myeloma drugs.

Bisphosphonate

Bisphosphonate drugs are used to reduce bone pain and prevent further bone weakness or damage caused by myeloma cells. They also prevent dangerous rises in blood calcium levels.

Radiation therapy (radiotherapy)

Radiation therapy (also known as radiotherapy), the use of x-rays to kill or injure cancer cells, can be used to relieve some of the symptoms of multiple myeloma, such as bone pain.

Plasma

Plasma exchange may be used if the level of paraprotein in the blood is very high and interfering with blood circulation. It is a way of removing some extra proteins in the blood. The blood is removed via a needle in a vein in one arm, passing through a separating machine, which then puts the healthy portion of the blood combined with new replacement plasma back into a vein in the other arm.

Stem cell transplant

Stem cell transplant involves a high dose of chemotherapy to destroy the bone marrow, followed by transplanted blood-forming stem cells to rescue the bone marrow and help restore the blood cell numbers. This is an intense form of treatment which is completed in several stages. The entire procedure can take several months to complete and it is not suitable for everyone.

Most people who undergo a stem cell transplant receive their own previously collected stem cells (autologous transplant). Sometimes stem cells from another person are used (allogeneic transplant).

Palliative care

In some cases of myeloma, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of myeloma, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.