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 anyone of any nationality. However, it disproportionately affects blacks due to genetics, socioeconomic status, and underrepresentation in clinical trials. Read on to learn more about multiple myeloma and how it affects the black population more than other races.
Multiple myeloma is a cancer of the plasma cells
Plasma is the liquid part of your blood that makes up more than half of its volume and carries blood cells, platelets, water, salt, and other important components throughout your body. Another important component created by plasma is antibodies, which are part of your immune system. It is made in the bone marrow, the spongy tissue inside your bones. “B cells” (B lymphocytes) and “T cells” (T lymphocytes and thymocytes) live in the bone marrow along with the plasma. When activated by the immune system, these lymphocytes mature into plasma, giving the body the extra 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 multiple places in the body, making it multiple myeloma.
Symptoms of multiple myeloma
Although many of the signs of multiple myeloma are common and can indicate several health conditions, the most noticeable symptom is bone pain. This is most often felt in your spine or chest and can be persistent and sometimes debilitating. However, in the early stages, the disease may show very mild symptoms or none at all. In fact, a routine blood test detects many cases without any symptom complaints or cases that the patient assumes are due to a common illness such as the flu. However, you should know the symptoms of multiple myeloma, which include:
- Fatigue / lethargy
- Brain fog or confusion
- Nausea
- Constipation
- Loss of appetite/weight loss
- Excessive thirst
- Numbness in your legs
- Frequent infections
As the abnormal plasma cells increase, patients are likely to experience additional symptoms related to complications, such as kidney problems. The body’s inability to attack germs leads to frequent infections, resulting in acute symptoms that must be treated when they occur.
Possible complications
Symptoms of multiple myeloma are related to the destruction of healthy bone marrow as myeloma cells accumulate in the confined space. Fewer healthy blood cells as the cancer progresses lead to complications that are felt throughout the body.
- AnemiaRed blood cells are produced in the bone marrow. With fewer red blood cells, anemia can lead to lack of energy, fast heart rate, dizziness, headaches, and more. Some treatment options for multiple myeloma may even contribute to anemia in some patients.
- Bone diseaseAs myeloma cells crowd the bone marrow, osteoporosis can occur, making the bones thinner and more fragile. Eventually, bony lesions can form, causing holes. These bones are much more likely to break.
- Gastrointestinal problemsThese problems are usually caused by the treatments and not necessarily the disease itself. There are many ways to help relieve symptoms, including self-care and medication.
- Heart and lung problemsThose with multiple myeloma are more likely to suffer from blood clots, cardiovascular disease, and pulmonary hypertension because of the disease itself, treatment options, and a more sedentary lifestyle as the disease progresses.
- Renal failureOne of the harmful antibodies created by the abnormal plasma cells, monoclonal proteins, damages the renal tubules and kidney glomeruli, eventually leading to kidney failure.
- MyelosuppressionAnemia is just one side effect of bone marrow suppression caused by reduced red blood cell production. Other disorders that can develop due to myelosuppression include neutropenia (low white blood cell count) and thrombocytopenia (low platelet count).
- Chronic painThe two most common forms of pain experienced by people with multiple myeloma are bone pain and peripheral neuropathy. Peripheral neuropathy is caused by injuries to the nerves, especially in the hands and feet.
- Side effects of steroids. Long-term use of steroids can lead to both physical and mental effects, which can be short-term, returning to normal after the medication is stopped, or long-term. These can include everything from muscle spasms to cataracts to personality changes.
Causes and risk factors
Research has shown that monoclonal gammopathy of undetermined significance, or MGUS, can cause multiple myeloma cells to form. Excess M protein in your blood begins to build up in your bone marrow, which can be the first sign that something is wrong. MGUS does not require treatment, but your healthcare provider should monitor it for any changes.
Researchers and providers have identified other risk factors for multiple myeloma, including:
- AgeM.
- Gender:Men are more likely to develop multiple myeloma than women.
- Family historyMany people with multiple myeloma have no family history of the disease. However, genetics may contribute to the risk.
- HealthPreexisting conditions that affect the immune system or inflammatory conditions, such as cardiovascular disease, increase the risk.
- Chemical or radiation exposureExposure to certain pesticides and herbicides increases the risk, as does prolonged exposure to radiation.
- Previous Plasma Cell TumorAlso known as solitary plasmacytoma, these tumors increase the chance of developing multiple myeloma in the future.
- Occupation:Some studies have shown that people in certain occupations are at higher risk, such as firefighters.
Treatment of multiple myeloma
Those with multiple myeloma will likely work with a team of providers to help treat the cancer and improve quality of life. This would include a primary care provider, dietician, physical or occupational therapist, orthopedic surgeon, radiation oncologist, bone marrow transplant specialist, and others. It is vital for the team to coordinate efforts to ensure that you receive the best possible care and that treatments are effective in managing symptoms.
Types of treatment options for multiple myeloma include:
- Surgery
- Radiation therapy
- Medicines
- Stem cell transplantation
- CAR T-cell therapy
- Supportive treatment
- Clinical pathways
- Complementary medicine
- Palliative care
Multiple myeloma and black people
As terrible a disease as multiple myeloma is, it is more so for the black race. From genetics to socioeconomic status, blacks suffer from more risk factors than whites. These risk factors are compounded by clinical trials that fail to account for them.
Shocking statistics
The International Myeloma Foundation estimates that African Americans will account for nearly a quarter of newly diagnosed cases of multiple myeloma by 2034. However, today they make up only 8% of clinical trial participants.
It is equally alarming how many black people are suffering from multiple myeloma today. Blacks are usually diagnosed at an earlier age and are twice as likely to be diagnosed as whites. They are also twice as likely to die from the disease. It is the number one most common blood cancer among the African-American population, including those of mixed race.
More troubling, the average African-American patient is less likely;
- Get a timely diagnosis
- Apply to a new therapy such as bortezomib
- Study of new methods of treatment
- Use a 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 journal Blood Cancer have shown that MGUS and other plasma cell disorders are much more likely in those with a family history, making them strong risk factors. Since black women are already twice as likely to develop MGUS as white women, this also increases their risk of developing multiple myeloma. Other studies seem to support these findings. Studies have shown that multiple myeloma is closely related to biological risk factors such as cardiovascular disease, diabetes and obesity. These health conditions, and cancer in general, are known to disproportionately affect the black race.
Socio-economic factors
The black community is less likely to receive preventive health care because they are also less likely to have adequate health insurance to cover such care. Many cases of multiple myeloma are diagnosed before symptoms appear, which are detected early on during routine lab work. A primary care provider can often detect MGUS, a precursor to multiple myeloma, early and monitor it closely. Even with health insurance, black people don’t have a nearby clinic or hospital where they can go for such preventive care, “letting it slide” when they experience mild symptoms.
If diagnosed, many African Americans lack access to the most effective new treatments. Socio-economic status may mean they have limited or no health insurance to cover them and lack proximity to clinics with modern health technology. When cancer symptoms worsen, lack of access to the most effective treatments, combined with limited palliative care options, can reduce quality of life and life expectancy. Without racial equity in cancer treatment, the black population suffers due to socioeconomic factors.
Cancer research
Black Americans are often underrepresented in research and clinical trials for multiple myeloma. In one study cited by WebMD, they estimated that only 18% of participants were from different ethnic groups. Non-Hispanic whites were the vast majority. Given the biological factors that put blacks at higher risk for the disease, this puts them at a disadvantage for developing new and more effective treatment options. The reasons for this disparity are many, from lack of awareness of such studies to proximity to study sites. However, this disparity in minority representation needs to be addressed for this and other plasma cell disorders so that researchers can better understand the role that ethnicity plays in determining risk.
Multiple myeloma. it’s in our bones
Research has shown that, given equal opportunities for health care and financial stability, outcomes for blacks are similar to those of European descent. By promoting clinical trials and exploring new treatments, fighting for health equity, and addressing disparities in black communities, we can improve the well-being of all African Americans, including those with multiple myeloma. By raising awareness, Black Health Matters helps address this important issue for African Americans and people of color.