Multiple myeloma Multiple myeloma (MM), also called plasma cell myeloma, is a blood cancer that forms in plasma cells, which are a type of white blood cell. These healthy plasma cells are instrumental in the immune system, as they create antibody proteins to help fight infections and attack germs. With MM, cancerous plasma cells formulate proteins which do not function properly and begin to accumulate in bone marrow and force out the healthy blood cells. What causes MM is unclear, however it starts with one plasma cell in the bone marrow and something occurs with this cell which makes it change into a cancerous myeloma cell. Here the myeloma cell starts to rapidly manufacture more myeloma cells. The condition affects your bones and the body’s ability to make healthy red and white blood cells and platelets. MM causes lytic bone lesions (areas where bone has been destroyed, producing a hole in the bone) of the spine, pelvis and long bones, which impair patient health and quality of life. Multiple myeloma incidence and mortality rates in Australia are among the highest in the world. Signs and symptoms In the early stages of MM, there may not be any symptoms, however the signs and symptoms associated with MM include: Bone pain, especially in the spine, chest or hips. Nausea. Constipation. Loss of appetite and weight loss. Mental fogginess or confusion. Tiredness and weakness. Infections. Thirst. Needing to urinate often. Diagnosis The British Society of Haematology and UK Myeloma Society published a Good Practice Paper in October 2024 and determined that advanced imaging procedures were beneficial to the early diagnosis and morbidity prevention in patients suspected of MM. Image: Kaiser, M. et al., (2024). Advanced imaging for earlier diagnosis and morbidity prevention in multiple myeloma. British Journal of Haematology, 205(4), 1319–1325. https://doi.org/10.1111/bjh.19716 Compared to several other systemic or metastatic cancers, early detection and treatment of active disease in MM can be highly effective and successfully prevent permanent damage, both at primary diagnosis and at relapse. Research There is evidence that CD4+ and CD8+ T-cells (white blood cells which are part of the immune system) are dysfunctional in multiple myeloma and that multiple myeloma could compromise the ability of these T-cells to control disease progression. Immune dysfunction could be described as a state of exhaustion or the progressive loss of T-cell functions. A reduction in the CD4/CD8 ratio is a marker of reduced immune function. A prospective feasibility trial (Joseph et al., 2024) carried out from December 2019 to June 2022 found that physical activity seems to activate an alteration in the immune profile, leading to a less exhausted T-cell population and an improvement in the CD4/CD8 ratio. Changes were seen in both the strength training and walking groups, however a significant improvement was seen in the walking group. Perth Blood Institute (PBI) PBI has grown to become one of the largest privately-funded haematology-focussed clinical research institutes within Western Australia. Clinical trials conducted at PBI focus on all types of blood cancers including multiple myeloma. Visit our clinical trials webpage to view our current trials. Smouldering multiple myeloma (SMM) is an asymptomatic precursor to multiple myeloma, with the risk of progression to multiple myeloma in the first 5 years being approximately 10% per year, 3% per year in the next 5 years and 1% per year from then on. There is an estimated 25% of patients which never progress to the symptomatic disease. Generally, monitoring patients with SMM is the main standard of care used to evaluate the progression of the disease, outside of clinical trials. However, research has started to discover treatment options which may delay the progress of SMM to multiple myeloma. PBI played a crucial role in a ground breaking international clinical trial that has shown a new drug can significantly slow the progression of Smouldering Multiple Myeloma. PBI’s Prof. Ross Baker presented the results of the research at the 66th ASH Annual Meeting and Exposition in San Diego, 2024. References https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/symptoms-causes/syc-20353378 https://www.canceraustralia.gov.au/cancer-types/myeloma/statistics https://www.mja.com.au/journal/2024/221/2/multiple-myeloma-incidence-mortality-and-prevalence-estimates-and-projections https://www.cancer.gov/publications/dictionaries/cancer-terms/def/t-cell https://pmc.ncbi.nlm.nih.gov/articles/PMC2842494/ Joseph, J. M., Hillengass, M., Cannioto, R., Tario, J. D., Wallace, P. K., Attwood, K., Groman, A., Jacobson, H., Wittmeyer, B., Mohammadpour, H., Abrams, S. I., Moysich, K. B., & Hillengass, J. (2024). T Cell exhaustion markers in multiple myeloma patients are lower after physical activity intervention. Clinical Lymphoma, Myeloma and Leukemia, 24(9), 621–628. https://doi.org/10.1016/j.clml.2024.04.006. Kaiser, M., Goh, V., Stern, S., Spencer, N., Rabin, N., Ramasamy, K., Lawless, S., Soutar, R., Ashcroft, J., Pratt, G., Messiou, C., & Bygrave, C. (2024). Advanced imaging for earlier diagnosis and morbidity prevention in multiple myeloma: A British Society of Haematology and UK Myeloma Society Good Practice Paper. British Journal of Haematology, 205(4), 1319–1325. https://doi.org/10.1111/bjh.19716. Moore, K. L. F., Turesson, I., Genell, A., Klausen, T. W., Knut-Bojanowska, D., Redder, L., Sverrisdottir, I., Thorsen, J., Vangsted, A. J., & Blimark, C. H. (2023). Improved survival in myeloma patients–a nationwide registry study of 4,647 patients ≥75 years treated in Denmark and Sweden. Haematologica, 108(6), 1640–1651. https://doi.org/10.3324/haematol.2021.280424. Thorsteinsdóttir, S. et al., (2023). Prevalence of smoldering multiple myeloma based on nationwide screening. Nature Medicine, 29(2), 467–472. https://doi.org/10.1038/s41591-022-02183-6. Vaxman I, Gertz MA. How I approach smoldering multiple myeloma. Blood. 2022;140(8):828-838. (2023). Blood, 141(11), 1366–1366. https://doi.org/10.1182/blood.2022019523.