Understanding Multiple Myeloma: Answering The Questions

Multiple myeloma is a deadly cancer that lives in the bone marrow, resulting in abnormal plasma cells that reduce the ability to fight infections, cause osteoporosis, lead to kidney problems, and more. It can affect someone of any ethnicity. However, it disproportionately affects Blacks because of genetics, socioeconomic status, and lack of representation in clinical trials. Keep reading to learn more about multiple myeloma and how it affects the Black population more than other races.

Multiple Myeloma: Plasma Cell Cancer

Plasma is the fluid part of your blood, making up over half of its volume, that carries blood cells, platelets, water, salt, and other essential components throughout your body. Another vital component created by plasma is the antibodies that make up part of your immune system. It is created in the bone marrow, a spongy tissue inside your bones. “B cells” (B lymphocytes) and “T cells” (T lymphocytes and thymocytes) live in the bone marrow along with plasma. When activated by the immune system, these lymphocytes mature into plasma, giving the body the additional plasma it needs to fight infections.

Cancerous myeloma cells crowd the bone marrow, leaving no room for healthy blood cells and plasma-producing tissue. Myeloma cells produce harmful proteins that cause a long list of symptoms and complications. By the time it is diagnosed, this cancer has usually spread to several locations throughout the body, making it multiple myeloma.

Symptoms of Multiple Myeloma

While many of the signs of multiple myeloma are general and could indicate several health conditions, the most notable symptom is bone pain. This is most commonly felt in your spine or chest and can be persistent and, at times, debilitating. However, in the early stages, the disease may present very mild symptoms or none at all. In fact, routine blood work finds many cases without any complaints of symptoms or ones a patient assumes are because of a common illness like the flu. Still, you should know the symptoms of multiple myeloma that include:

• Fatigue/lethargy
• Brain fog or confusion
• Nausea
• Constipation
• Loss of appetite/weight loss
• Excessive thirst
• Numbness in your legs
• Frequent infections

As abnormal plasma cells grow in number, patients are likely to experience additional symptoms related to complications, like kidney problems. The body’s inability to attack germs leads to frequent infections, resulting in acute symptoms that should be treated as they arise.

Possible Complications

The symptoms of multiple myeloma are because of the breakdown of health bone marrow as myeloma cells crowd the limited space. Fewer healthy blood cells as the cancer worsens results in complications felt throughout the body.

• Anemia: Red blood cells are produced in the bone marrow. With fewer red blood cells, anemia may lead to a lack of energy, rapid heartbeat, dizziness, headache, and more. Some of the treatment options for multiple myeloma may even contribute to anemia in some patients.
• Bone Disease: As myeloma cells crowd the bone marrow, osteoporosis can set in, making bones thinner and more brittle. Eventually bone lesions may form, creating holes. These bones are much more likely to fracture.
• Gastrointestinal Issues: These problems are typically caused by treatments and not necessarily the disease itself. There are many ways to help relieve symptoms, including self care and medications.
• Heart and Lung Problems: Those with multiple myeloma are more likely to suffer from a blood clot, cardiovascular disease, and pulmonary hypertension because of the disease itself, treatment options, and living a more sedentary lifestyle as the disease progresses.
• Kidney Failure: One of the harmful antibodies created by abnormal plasma cells, monoclonal proteins, damages the renal tubes and glomeruli of the kidneys, eventually leading to kidney failure.
• Myelosuppression: Anemia is just one side effect of bone marrow suppression caused by the reduced production of red blood cells. Other disorders that may develop because of myelosuppression include neutropenia (low white blood cells) and thrombocytopenia (low platelets).
• Chronic Pain: The two most common forms of pain experienced by those with multiple myeloma are bone pain and peripheral neuropathy. Peripheral neuropathy is caused by damage to the nerves, especially those of the arms and legs.
• Steroid Side Effects: Long-term use of steroids can lead to both physical and mental effects that can be short-term, returning to normal once the medication is stopped, or long-term. They can include everything from muscle cramps to cataracts to personality changes.

Causes and Risk Factors

Research has suggested that monoclonal gammopathy of undetermined significance, or MGUS, can cause multiple myeloma cells to form. Excess amounts of M protein in your blood begin formation in the bone marrow, which could be the first sign that something is amiss. There is no treatment required for MGUS, but your healthcare provider should monitor it for any changes.

Researchers and providers have determined other risk factors for multiple myeloma that include:

• Age: MM is rare in those under 35, but those over 65 are at highest risk.
• Gender: Men are more likely to develop multiple myeloma than women.
• Family History: Many people with multiple myeloma do not have any family history of the disease. Still, genetics may contribute to risk.
• Health: Pre-existing conditions affecting the immune system or inflammatory conditions like cardiovascular disease increase risk.
• Chemical or Radiation Exposure: Being exposed to some pesticides and herbicides increases risk, as does prolonged exposure to radiation.
• Previous Plasma Cell Tumor: Also known as solitary plasmacytoma, these tumors increase the chance of develop multiple myeloma in the future.
• Occupation: Some studies have shown that those in certain professions are at higher risk, like firefighters.

Multiple Myeloma Treatments

Those with multiple myeloma will likely work with a team of providers to help treat the cancer and improve quality of life. This will include a primary care provider, dietician, physical or occupational therapist, orthopedic surgeon, radiation oncologist, bone marrow transplant specialist, and others. It’s vital for the team to coordinate efforts to ensure you get the best care possible and that treatments are effective at managing symptoms.

Types of multiple myeloma treatment options include:

• Surgery
• Radiation therapy
• Medication
• Stem cell transplant
• CAR T-cell therapy
• Supportive treatments
• Clinical trails
• Complementary medicine
• Palliative care

Multiple Myeloma and Black People

As frightening a disease as multiple myeloma is, it is more so for the black race. From genetics to socioeconomic status, Black people suffer from more risk factors than white people. These risk factors are compounded by clinical trials that fail to account for them.

Startling Statistics

The International Myeloma Foundation estimates that African Americans will make up nearly a quarter of the newly diagnosed cases of multiple myeloma by 2034. Yet, today, they only account for 8% of the participants in clinical trials.

Just as alarming is how many Black people are affected by multiple myeloma today. Black people are typically diagnosed at an earlier age and are twice as likely to be diagnosed as white people. They are also twice as likely to die from the disease. It is the number one most common blood cancer in the African American population, including those of mixed race.

More troubling is that the average African American patient is less likely to:

• Receive a timely diagnosis
• Turn to novel therapies like bortezomib
• Research new treatments
• Utilize stem cell transplant or CAR T-Cell therapy
• Receive inpatient chemotherapy
• Have access to culturally sensitive palliative care options

Biological Factors

Studies published in the Blood Cancer Journal have shown that MGUS and other plasma cell disorders are much more likely in those with family history, making them strong risk factors. Because Black women are already twice as likely to experience MGUS as white women, this increases the risk of developing multiple myeloma as well. Other studies seem to support these findings. Studies have shown that multiple myeloma is closely linked with biological risk factors, such as cardiovascular disease, diabetes, and obesity. These health conditions, and cancer in general, are known to affect the Black race disproportionately.

Socioeconomic Factors

The black community is less likely to receive preventative healthcare because they are also less likely to have adequate health insurance to cover such care. Many cases of multiple myeloma are diagnosed before symptoms even arise, caught early during routine lab work. A primary medical provider can often detect MGUS, a precursor to multiple myeloma, early and monitor it closely. Even with health insurance, Black people may not have a clinic or hospital nearby at which to seek such preventative care, “letting it slide” when they do experience mild symptoms.

If diagnosed, many African Americans don’t have access to the most effective new treatments. Socioeconomic status may mean they have limited or no health insurance to cover them and lack proximity to clinics with modern healthcare technology. When cancer symptoms worsen, lack of access to the most effective treatments, combined with limited palliative care options, may decrease quality of life and life expectancy. Without racial equality in cancer care because of socioeconomic factors, the black population suffers.

Cancer Research

Black Americans are often underrepresented in research studies and clinical trials for multiple myeloma. In one study referenced by WebMD, they estimated that only 18% of those taking part were from various ethnic groups. Non-Hispanic white people made up the vast majority. Considering the biological factors putting black people at higher risk for the disease, this puts them at a disadvantage for developing new and more effective treatment options. There are many reasons for this disparity, from lack of awareness of such studies to proximity to study locations. Still, this inequity in minority representation needs to be addressed for this and other plasma cell disorders, so researchers can better understand what role ethnic background plays in determining risk.

Multiple Myeloma: It’s In Our Bones

Research has shown that, when given an equal opportunity for healthcare and financial stability, outcomes for Black people are similar to those of European ancestry. By promoting clinical trials and researching new treatments, fighting for equality in healthcare and addressing disparities within Black communities, we can improve the well-being of all African Americans, including those suffering from multiple myeloma. By raising awareness, Black Health Matters is helping to address this important issue for African American and multiracial people.