Myeloma treatment at GenesisCare

Myeloma is a type of blood cancer that develops from plasma cells in the bone marrow. It is referred to as multiple myeloma if it appears in multiple parts of the body.

Plasma cells are white blood cells that form part of your immune system and help fight infection. When diseased, these plasma cells can turn into cancerous myeloma cells. If the myeloma cells multiply, they can crowd the bone marrow and prevent it from making enough red and white blood cells and platelets. As a result, people with myeloma are at risk of anaemia, infection, bleeding, and bruising.

Myeloma cells may gather in groups that form tumours in the body, usually in the bone marrow and on the surface of bones. The tumours remove calcium from the bone, which may become brittle and easy to break, and can lead to increased calcium in the bloodstream.

Myeloma symptoms differ according to the person, their stage of illness and the specific type of myeloma. In the early stages, there may be no symptoms at all. However, as myeloma progresses, it’s common for people to experience symptoms related to their calcium levels, kidney health and blood cell production. Doctors refer to this as CRAB:

C for increased calcium

R for renal (kidney) problems

A for anaemia

B for bone changes

People with myeloma may experience signs and symptoms such as:

• bone pain (often in the back or chest to start with)
• fatigue
• brittle bones
• frequent infections
• nausea
• changes in bowel movements
• vomiting
• extreme thirst
• confusion, dizziness or irritability
• vision problems
• weight loss
• numbness or tingling legs

Having one or more of these symptoms doesn’t mean you have myeloma, but you should see your doctor for a check-up.

It’s not known what causes myeloma. However, some factors appear to increase the risk. These include:

• advanced age
• being exposed to extremely high radiation levels (such as from working in a nuclear power plant)
• certain chemicals from the petroleum industry
• history of the condition MGUS (monoclonal gammopathy of undetermined significance)

Doctors may detect myeloma early before symptoms are present through routine physical exams or blood and urine tests. Your doctor may order specific tests if they suspect myeloma. These include:

• blood tests to determine the number of red cells, white cells, and platelets. Blood tests can also measure the amount and type of paraprotein (an abnormal antibody that myeloma cells produce).
• urine tests for paraprotein. This usually involves collecting urine over a 24-hour period.
• bone marrow examination of a sample from the pelvic bone to determine the number of blood cells present.
• X-rays of the head, spine, ribs, hips, legs, and arms so any bone damage can be seen.
• CT scan to provide a 3D image of bone that isn’t visible on an X-ray.
• MRI scan to provide detailed images of the organs and tissues in the body

If you are found to have myeloma, your doctor will explain how far it has progressed and will discuss a treatment approach. The most commonly used staging system for myeloma is the Revised International Staging System (R-ISS) which divides myeloma into three stages. Stage 1 is the earliest stage and stage 3 is more advanced.

Treatment for myeloma depends on several factors, including what type you have, whether it is in the early stages and your overall health. Your doctor may recommend one or more of the following treatment options:

• chemotherapy
• plasma exchange
• radiation therapy
• stem cell or bone marrow transplant
• steroids

We understand that a cancer diagnosis can be emotional and life changing. It’s natural to feel disbelief, anxiety, sadness, anger and loneliness. At GenesisCare, we strive to strengthen your confidence, settle your emotions and create care experiences that give you the best possible outcomes.

Our care team will know your name and get to know who you are as a person. We don’t want you to feel alone when you’re at GenesisCare. Your nursing team and oncology team are here to support you before, during and after your cancer treatment. We are here to guide you to get you the support you need from experts such as psychologists, exercise physiologists, physiotherapists and dietitians.

Please contact your local GenesisCare centre for more details on the services available. View a list of our centres here.

Whether you experience side effects and how severe they are depends on the type and dose of chemotherapy treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short term and can be managed. These may include:

• fatigue
• nausea or vomiting
• constipation or diarrhoea
• hair loss
• easily bruising or bleeding
• weight changes
• skin changes
• mood changes
• sores and pain around the mouth

These symptoms tend to improve gradually once treatment stops. Talk to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects.

• Get as much rest as possible
• Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
• Drink lots of water
• Reach out to support groups and others who have had chemotherapy
• Ask your team about topical treatments for your skin if you are getting irritation or pain
• Stay out of the sun as much as possible throughout your treatment
• Record your side effects in a diary or journal
• Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
• It is important to acknowledge when you are fatigued and rest when you need to
• Ask for and accept help from family, friends and neighbours
• Be open with employers about your treatment and discuss flexible working options if you need them

Side effects can be minimal¹, but may include:

• fever or chills
• muscle cramps
• skin itchiness
• skin prickling or tingling

General side effects include:

• soreness and swelling around the treatment area
• tiredness and lethargy for a few weeks after you finish

Specific side effects (depending on the area being treated):

• digestive issues – reduced appetite, pain, discomfort or bloating
• change in bowel habits
• nausea or vomiting.

Most of these side effects will ease soon after treatment is finished. Your team will discuss any long-term considerations with you depending on the tumour type.

Side effects from a bone marrow transplant can also include the side effects of chemotherapy or radiation therapy that may be performed before the transplant. These may include:

• nausea and vomiting
• bleeding
• infection
• lung issues
• weight loss
• fatigue

These may include:

• problems sleeping
• mood changes
• weight gain
• heartburn