Multiple myeloma is the second most common blood cancer in the United States, accounting for about one percent of all cancers. It originates in plasma cells – a type of white blood cell found in the bone marrow that produces antibodies to help the body fight infection. When these plasma cells become cancerous, the disease is known as myeloma.
The good news about this common and potentially deadly disease is that the medical community is getting better at treating it in ways that prolong patients’ lives.
“In the last 10 to 15 years, treatments have evolved significantly, and [average] survival rates now exceed 10 to 13 years after treatment,” said Dr. Alex Mejia Garcia, director of hematology and clinical research at Scully-Welsh Cancer Center at Cleveland Clinic Indian River Hospital.
Unlike many cancers that form solid tumors, myeloma develops within the bone marrow itself.
Cancerous plasma cells multiply rapidly, crowding out healthy blood-forming cells and interfering with normal immune function. Over time, this disruption can lead to serious complications, including weakened bones and fractures, anemia, kidney damage and a compromised immune system.
According to the Cancer Research Institute, approximately 160,000 new cases of multiple myeloma are diagnosed worldwide each year, with an estimated 110,000 deaths attributed to the disease globally.
In the United States alone, about 36,000 new cases are diagnosed annually, and roughly 10,850 deaths occur each year, according to the American Cancer Society. Overall, about 1 in 132 men and women will develop multiple myeloma at some point in their lifetime.
The exact cause of the disease remains unknown, but researchers have identified several risk factors. These include advancing age, family history, exposure to radiation or certain chemicals, and some pre-existing health conditions. For decades, treatment centered on chemotherapy followed by donor stem cell transplantation to rebuild diseased bone marrow. Today, however, the treatment landscape has changed dramatically.
“Historically, allogeneic stem cell transplantation – which uses healthy stem cells from a donor – was an option, but it carried substantial risks, including severe complications and even death,” said Dr. Mejia Garcia. “Now, immunotherapy allows us to harness a patient’s own immune system to attack cancer cells, producing long-term remission rates similar to donor transplantation but with far fewer risks.”
The Cancer Research Institute describes immunotherapy as a smart and precise way to fight cancer. Unlike chemotherapy, which affects both healthy and cancerous cells, immunotherapy helps the immune system target cancer cells specifically while sparing healthy tissue. Just as importantly, the immune system can adapt. If cancer cells evade detection, immune cells can recalibrate and mount a renewed attack.
Several forms of immunotherapy are now used to combat multiple myeloma.
Targeted antibodies are proteins designed to recognize specific markers on cancer cells and interfere with their growth.
Antibody-drug conjugates (ADCs) combine these antibodies with powerful anti-cancer drugs, delivering treatment directly to cancer cells.
Bispecific T-cell-engaging antibodies, known as BiTEs, bind both cancer cells and T cells, helping the immune system respond faster and more effectively. The immune system’s built-in memory also allows it to recognize and eliminate cancer cells if the disease returns.
Another breakthrough approach is adoptive cell therapy, which uses a patient’s own immune cells. These cells are collected, genetically modified, and then reintroduced into the body to seek out and destroy cancer. In CAR T-cell therapy, immune cells are engineered with receptors that enhance their ability to recognize and attack cancer cells.
Additional immune-based treatments include immunomodulators, which enhance immune responses by targeting molecules on immune cells. Cytokines help regulate immune cell growth, maturation and activity, while adjuvants stimulate immune pathways to prolong protection and increase antibody production.
Symptoms of multiple myeloma often do not appear until the disease has advanced. One of the most common complications is hypercalcemia, which occurs when weakened bones release calcium into the bloodstream. Elevated calcium levels can affect the heart, kidneys, gastrointestinal system and brain.
Symptoms may include constipation, fatigue, frequent urination, excessive thirst, muscle weakness and confusion. Patients may also experience bone pain, weight loss, shortness of breath, leg weakness, back or rib pain and fractures. In some cases, myeloma is discovered incidentally through blood or urine tests ordered for unrelated reasons.
When abnormalities are detected during routine blood work, physicians may order additional diagnostic testing. MRI scans use powerful magnetic fields to produce detailed three-dimensional images of bone and soft tissue. CT scans compile multiple X-ray images to create detailed views of bones, blood vessels and organs. A bone marrow aspiration or biopsy involves using a needle to collect marrow fluid or solid tissue, which is then examined under a microscope for cancerous changes.
“Typically, we treat patients with three or four cycles of immunotherapy,” Dr. Mejia Garcia explained. “After that initial phase, we collect and store their stem cells. Patients then receive a more potent chemotherapy regimen to eliminate remaining cancer cells. Once chemotherapy is complete, the harvested stem cells are reintroduced so they can restore healthy blood production.
Some patients, however, do not require a stem cell transplant and can be treated effectively with immunotherapy alone.”
While multiple myeloma is still not considered curable, outcomes continue to improve. “Many patients are living longer and better lives thanks to these newer therapies,” Dr. Mejia Garcia said.
“Today, oncologists focus on sequencing treatments, determining which therapies work best and in what order, while tailoring care to each patient’s disease.”
New treatments for multiple myeloma are emerging every year as researchers continue to push the boundaries of therapeutic knowledge. From innovative immunotherapies to smarter use of existing drugs and increasingly personalized treatment strategies, the story of multiple myeloma is no longer defined solely by diagnosis, but by hope, resilience and scientific progress.
Dr. Alex Mejia Garcia completed his hematology-oncology fellowship at Thomas Jefferson University in Philadelphia before pursuing a fellowship in cancer drug development at UT Health San Antonio MD-Mays Anderson Cancer Center in San Antonio. Later he joined the Department of Hematology and Medical Oncology at Cleveland Clinic Taussig Cancer Institute in Cleveland Ohio. He sees patients at the Scully-Welsh Cancer Center, 3535 10th Ct. Vero Beach. Call 866-223-8100 for an appointment.
