Multiple Myeloma Causes and Risk Factors

Multiple myeloma (MM) is a blood cancer that affects plasma cells, a type of white blood cell found in bone marrow. Plasma cells produce antibodies to help the body’s immune system fight off infections. MM causes cancerous plasma cells to accumulate in the bone marrow, crowding out healthy blood cells and producing abnormal antibodies that can cause complications throughout the body.

Multiple myeloma is relatively uncommon, accounting for approximately 1.8% of new cancer diagnoses and approximately 10% of all blood-related (hematologic) cancers.

What causes multiple myeloma?

Researchers have determined that MM results from genetic mutations in the DNA of plasma cells, which cause uncontrolled cell growth and proliferation. As a result, an abundance of abnormal plasma cells accumulates in the bone marrow and interferes with the production of normal blood cells. The precise triggers of the genetic mutations that lead to the transformation of healthy plasma cells into cancerous cells are not well understood.

What are the risk factors for multiple myeloma?

Through extensive research, scientists have identified several risk factors for multiple myeloma, including:

• Advanced age – Most MM cases are diagnosed after age 65.
• Monoclonal gammopathy of undetermined significance (MGUS) – Many patients who have MM were initially diagnosed with MGUS, a rare plasma cell disorder.
• Family history – Individuals with a parent, sibling or child who was diagnosed with MGUS or MM are two to three times more likely to develop multiple myeloma.
• Weakened immune system – Individuals who have human immunodeficiency virus (HIV) or human T-lymphotropic virus (HTLV), and those who take immunosuppressants to reduce the risk of organ rejection after a transplant, are at heightened risk of developing MM.
• Radiation exposure – Prior radiation therapy for another type of cancer may increase the risk of multiple myeloma.
• Chemical exposure – Contact with certain insecticides, herbicides, petroleum products, heavy metals, plastics and asbestos can elevate the risk of developing MM.
• Industrial exposure – Some studies suggest that farmers, woodworkers, painters, hairdressers, firefighters and workers in the oil and gas, leather and rubber industries are at heightened risk for MM due to the harmful substances they may be exposed to in the workplace.

A racial disparity

Multiple myeloma affects people of all races. However, as compared to their white American counterparts, African Americans are twice as likely to develop multiple myeloma and also have an earlier average age at diagnosis (by 5 to 10 years). In fact, multiple myeloma is the leading hematologic malignancy in African Americans.

Currently an active area of research, the reason for the racial disparity is not yet fully understood. The racial difference in incidence cannot be explained by tobacco use, alcohol use, obesity or socioeconomic status. However, scientists believe certain genetic defects that can increase the likelihood of multiple myeloma development may occur more frequently in the African American population. For example, African Americans are more likely to have immunoglobulin heavy chain gene translocations in chromosome 14, which are believed to cause multiple myeloma.

Other possible reasons for the racial disparity include a general lack of awareness about multiple myeloma risk factors and barriers to healthcare access and clinical trials in African American communities. With that said, recent studies show similar outcomes among all multiple myeloma patients who receive timely and appropriate treatment, regardless of their race. These results suggest that the racial disparity can be overcome and underscores the importance of learning about multiple myeloma risk factors.

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Can any multiple myeloma risk factors be controlled?

Most known risk factors for MM cannot be controlled. That said, many individuals who are diagnosed with multiple myeloma have an early warning sign known as a precursor condition, which is an early-stage blood disorder that may progress into cancer. Precursor conditions for MM include:

• Monoclonal gammopathy of undetermined significance (MGUS) – Abnormal plasma cells in the bone marrow produce monoclonal proteins, which may be detected in a routine blood or urine test.
• Early myelodysplastic syndrome (MDS) – The bone marrow does not produce enough healthy blood cells.
• Smoldering multiple myeloma – Abnormal plasma cells in the bone marrow produce monoclonal proteins or free light chains, which are smaller units of the immunoglobulin produced by healthy plasma cells.
• Smoldering Waldenström’s macroglobulinemia – Abnormal lymphocytes and plasma cells in the bone marrow secrete monoclonal immunoglobulin M (IgM) proteins.

Most people who have a precursor condition for multiple myeloma do not experience symptoms. Additionally, because there is currently no screening test available that has proven to be reliable enough to justify its routine use in the general population, most precursor conditions are detected through blood work or a urinalysis performed for an unrelated reason.

MM precursor conditions usually do not require immediate treatment. However, a physician may recommend routine follow-up care to monitor for progression to multiple myeloma and, if necessary, begin a treatment plan early.

Can multiple myeloma be prevented?

Preventing MM is challenging because most of its risk factors cannot be controlled. However, by adopting and maintaining certain positive lifestyle practices, it may be possible to achieve better overall health and reduce the risk of cancer in general. These include:

• Consuming a nutritious diet
• Exercising regularly
• Maintaining a healthy body weight
• Avoiding tobacco use
• Limiting alcohol consumption

Additionally, it is important to promptly discuss multiple myeloma symptoms with a physician. These include:

• Persistent fatigue
• Anemia
• Bone pain
• Excessive bleeding
• Chronic infections

Benefit from world-class care at Moffitt Cancer Center

Each day, more is being learned about multiple myeloma causes and risk factors. Leading the way in this quest for knowledge is Moffitt, the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida. Through our highly focused research efforts and robust portfolio of clinical trials, we continue to transform the diagnosis and treatment of all types of blood cancer, including multiple myeloma. The physicians in our Malignant Hematology Program are among the best in the nation, and our patients have access to the latest and most advanced therapies. We take a highly individualized approach to cancer care, helping each patient achieve the best possible outcome and quality of life.

If you would like to learn more about multiple myeloma causes and risk factors, you can request an appointment with a specialist in our Malignant Hematology Program by calling 1-888-663-3488  or submitting a new patient registration form online. We do not require referrals.

References

Multiple Myeloma Awareness and African American Disparities - NCI
Multiple Myeloma Stages & Prognosis
Multiple Myeloma in African Americans - themmrf.org
Myeloma Different for African Americans | The IMF
How Multiple Myeloma Affects the Black Community