Is Multiple Myeloma Genetic or Hereditary?

Multiple myeloma is a cancer of the white blood cells, also called plasma cells. Multiple myeloma is linked to specific gene mutations.

Multiple myeloma is a cancer of the white blood cells, also called plasma cells. About 22,000 Americans are diagnosed with multiple myeloma annually, representing about 1% of all cancer diagnoses. Its signs and symptoms are vague and are linked to other disease symptoms like lupus rash. Though risk factors are numerous, there are associated genetic and hereditary aspects.

Your immune system contains plasma cells and other white blood cells. Plasma cells produce antibodies that help the body get rid of harmful substances. Each type of plasma cell is specific, and a variety of plasma cells respond to various harmful substances. With some cancers, the body produces too many abnormal plasma cells. The abnormal cells are called myeloma cells. They collect in the bone marrow and the outermost bone layer. The resulting disease is multiple myeloma.

Anything that changes someone’s risk of getting a disease is a risk factor. There are different risk factors for different diseases, and the factors assess statistical odds rather than certainties. Some people have several risk factors for multiple myeloma but never get the disease. Some have no risk factors but are still diagnosed with multiple myeloma. Risk factors for multiple myeloma include:

• Gender: Men are more at risk of developing multiple myeloma than women.
• Age: The risk of multiple myeloma goes up as age increases. Most people are diagnosed in their 60s.
• Obesity: There is a higher risk of developing multiple myeloma if overweight or obese.
• Exposure: Being exposed to radiation, petroleum, or other chemicals is a risk factor for multiple myeloma. 

Some components of multiple myeloma are genetic, like race. People of African American descent are more likely to get multiple myeloma than those of other lineages. Another genetic component is if you have a history of other plasma cell diseases. People who have had monoclonal gammopathy of undetermined significance (MGUS) have a higher risk of developing multiple myeloma. MGUS is a noncancerous precursor to the disease. Having solitary plasmacytoma is also a genetic factor that could lead to multiple myeloma.

Multiple myeloma is linked to specific gene mutations. A paper published found that people with the lysine (K)-specific demethylase 1A, or KDM1A, had a 6 to 9 times higher risk of developing multiple myeloma. Gene mutations can be inherited or can occur spontaneously in individuals.

Multiple myeloma does seem to run in certain families. If you have a parent or sibling with multiple myeloma, you are more likely to get it. But not everyone with a family history of myeloma develops the cancer.

A 2016 study looked at the risk associated with those who had a first-degree relative with a plasma cell cancer like multiple myeloma. People with this family history were 1.29 times more likely to develop the disease. The study also showed that the risk increased further if the person had multiple relatives with the disease.

In early multiple myeloma, there are usually no symptoms. Later on, signs and symptoms may vary. They include:

• Bone pain
• Fatigue
• Weakness/numbness in the legs
• Mental fogginess or confusion
• Frequent infections
• Loss of appetite
• Weight loss 
• Constipation
• Nausea
• Excessive thirst 

Symptoms of multiple myeloma may be very similar to other bone diseases or medical problems, so a proper diagnosis is crucial. 

Scientists have found that radiation, toxic chemicals, infection with cancerous viruses, or anything that interferes with the immune system can trigger the development of multiple myeloma. These triggers include:

• Dioxins like those in agent orange
• Benzene
• Solvents
• Agricultural chemicals
• Fuels
• Cleaning products
• Engine exhaust

Diagnosis of multiple myeloma begins with a visit to your doctor. They will complete a medical history, give you a physical, and then move on to any indicated diagnostic testing. Tests may include:

• X-ray: This imaging test takes an electromagnetic photo of internal structures like bones and organs. Bone scans are used to check for bony involvement, but the characteristics of multiple myeloma can make bone scan X-rays unreliable. 
• Laboratory tests: Lab tests of the blood may show M proteins produced by myeloma cells. The abnormal protein beta-2-microglobulin may also be seen in those with multiple myeloma. Analysis of the urine is another test to show those same M proteins. When found in urine, M proteins are called Bence Jones proteins.
• Skeletal survey: This survey involves imaging of all your major bones to look for changes due to the disease. 
• Bone marrow biopsy: Your doctor may take a piece of your bone marrow to test in the lab. Usually, this is obtained using a long, hollow needle inserted into your bone. The sample is then examined for myeloma cells. Gene mutations can be identified using specialized tests such as fluorescence in situ hybridization (FISH).
• Computed tomography or CT scan: Similar to x-ray, CT uses cross-cut computer images, or slices, to show detailed graphics of muscles, fat, organs, and bones. 
• Magnetic resonance imaging (MRI): This imaging device uses magnets and radio frequencies to make detailed images of organs and body structures.
• Positron emission tomography (PET) scan: Radioactive-tagged glucose is injected into the blood with a PET scan. Body tissues that use large amounts of glucose, like tumors, can be found anywhere in the body via the scan.  

Treatment for multiple myeloma takes several factors into account, including age, health, medical history, disease severity, and treatment tolerance. They include: 

• Medications for pain
• Medications to stop fractures
• Treatment of fractures
• Chemotherapy and steroids
• Radiation treatments
• Biological targeted therapies (Thalomid, Velcade, Revlimid)

The more complicated treatments include bone marrow/stem cell transplantation and alpha interferon. Transplantation is used a lot, but the procedures are often associated with high toxicity. Alpha interferon is a targeted biological response modifier that hampers the division of cancer cells. This slows the growth of tumors. It is very successful when teamed with chemotherapy. 

You and your medical team can determine which treatment options are best for you.