Myeloma (also known as multiple myeloma) and amyloid light-chain (AL) amyloidosis are serious conditions caused by abnormal antibody-producing plasma cells found in the bone marrow where all blood cells are made. While myeloma (a blood cancer) and AL amyloidosis (a blood disease) can develop independently of one another, they’re sometimes diagnosed together.
Understanding myeloma and AL amyloidosis
Myeloma and AL amyloidosis are both caused by plasma cells in the bone marrow. Plasma cells are a type of cell in your body that produce antibodies, also known as immunoglobulins, that help combat disease and infection.
The key difference between Myeloma and AL amyloidosis is how the plasma cells cause disease and make you sick.
In the case of myeloma, plasma cells multiply excessively, and the antibodies they produce become signs of disease within your body. They can harm the bone marrow, leading to low blood counts, and damage the bones causing pain, lesions, and even fractures. Excessive antibodies can also hurt your kidneys.
In AL amyloidosis, plasma cells produce abnormal antibodies. Part of these antibodies, known as light chains, clump together into fibrils and build up as a substance called amyloid in the body’s organs and tissues, especially affecting the heart and kidneys.
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Conditions
Plasma cell diseases change your body’s healthy rhythm. When you feel or suspect that something is off, know that our team of experts is well-versed in treating the following plasma cell conditions:
Age-related cardiac amyloidosis
Cardiac amyloidosis
Hereditary amyloidosis
Light-chain deposition disease
Localized AL amyloidosis
Monoclonal gammopathy of renal significance (MGRS)
Monoclonal gammopathy of undetermined significance (MGUS)
Multiple myeloma
Newly diagnosed multiple myeloma
Newly diagnosed systemic AL amyloidosis requiring therapy
POEMS syndrome
Relapsed myeloma
Relapsed or refractory myeloma
Relapsed systemic AL amyloidosis
Schnitzler’s syndrome
Scleromyxedema
Smoldering multiple myeloma
Solitary plasmacytoma
Myeloma with AL amyloidosis
Myeloma is sometimes diagnosed in association with the light-chain (AL) amyloidosis. The damage in AL amyloidosis happens when the light chains misfold, multiply and clump together as amyloid deposits in organs such as:
- Kidneys (in 70% of people)
- Heart (in 70% of people)
- Liver (in 25% of people)
- Gastrointestinal tract (in 25% of people)
- Peripheral nervous system (in 20% of people)
50% of patients with AL amyloidosis have involvement of 2 or more organ systems. The National Institutes of Health published a 2021 study revealing an estimated 10–15% of people with myeloma develop AL amyloidosis, and about 10% of people with AL amyloidosis have symptomatic myeloma at the time of diagnosis.
Testing
We use the following 3 tests to diagnose myeloma and amyloidosis:
- Protein immunofixation electrophoresis: This test measures certain proteins in your blood.
- Bone marrow biopsy and aspiration: This is a standard test we perform during your initial consultation. In bone marrow aspiration, your doctor will take a sample of the liquid part of your bone marrow called stem cells. For a biopsy, your doctor will take a solid sample to examine. We can also perform this test if you’re not responding to treatment or when you’re pre- or post-transplant.
- Cytogenetic evaluation: Part of your bone marrow aspiration sample may be examined for chromosomal abnormalities (cytogenetic evaluation). The lab may examine dividing cells or may perform a fluorescence in situ hybridization (FISH) analysis to look for chromosomal changes.
Tracking your body’s response to treatment
The key characteristic of plasma cell diseases is the production of antibody proteins called immunoglobulins. Plasma cells produce an identifiable immunoglobulin signature with a heavy chain and a light chain and frequently, only a free light chain.
We follow these signatures during therapy because as the number of malignant cells decreases, these proteins also decrease. This is a clear sign that you are responding to treatment.
One of the most rewarding moments in your health journey is discovering that your treatment has been successful. We’re able to share this news when we can no longer identify signature proteins. An even better result is becoming PET/CT and MRD negative.
It’s important to know that myeloma and amyloidosis will require lifelong care because relapsing is common. Relapse occurs because a very small amount of the disease remains in the body even after we cannot find signature proteins in your blood or urine or evidence of residual disease.
Treatments
Early diagnosis and treatment of all plasma cell diseases offer the best outlook for your overall wellness. The sooner we can control the plasma cell disease and reverse potential organ damage, the sooner we can offer you the comfort and quality you look forward to in life.
Our primary goal in treating plasma cell diseases like myeloma and amyloidosis is to target the cancerous plasma cells using approaches such as:
- Stem cell transplantation
- Bone marrow transplantation
- Affected organ or tissue transplantation (like the heart)
- Chemotherapy
- Radiation therapy
For newly diagnosed myeloma patients, treatment decisions are based on whether you are eligible for a stem cell transplant. Usually, this means your age will determine the best treatment options for you.
We’re always pursuing what’s next in healthcare and what’s next for your health. We welcome people living with plasma cell diseases to ask us about our latest research and how to participate in available clinical trials.
Treating myeloma with AL amyloidosis
Treating multiple myeloma with AL amyloidosis involves targeting the cancerous plasma cells. We can approach this with an autologous stem cell transplant, where stem cells are collected from your blood and transplanted back into your body following chemotherapy.
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Clinical trials
Analysis of Lumbar Spine Stenosis Specimens for Identification of Transthyretin Cardiac Amyloidosis
Amyloidosis
All genders
60+
Recruiting now
A Study of Daratumumab-Based Therapies
Amyloidosis
All genders
18+
Recruiting now