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Types of myeloma

Men and women discussing myeloma

This page tells you about the different types of myeloma. You can find the following information

 

A quick guide to what's on this page

Types of myeloma

There is really only one main type of myeloma, but in different people, the cancerous plasma cells make different antibodies. Doctors call these antibodies immunoglobulins. In each case of myeloma, only one type of immunoglobulin (Ig) is overproduced, but this varies from patient to patient. The different types are called IgG, IgA, IgD, IgM and IgE. IgG is the most common type of myeloma. IgD, IgM and IgE myeloma are very rare.

Light chain myeloma

Some people with myeloma do not produce complete immunoglobulins, they only produce a part. Doctors call this light chain myeloma or Bence Jones myeloma. The light chains are smaller than the complete immunoglobulins and can show up in the urine. The serum free light chain test can detect small amounts of light chains in the blood. So doctors may use urine and blood tests to help diagnose and monitor this type of myeloma.

Non secretory myeloma

Rarely, the myeloma cells produce little or no immunoglobulin (also called paraprotein). The serum free light chain test can help in diagnosing and monitoring some people with non secretory myeloma. But in most cases, doctors use bone marrow tests.

There are other conditions of plasma cells that are related to myeloma. These include MGUS, plasmacytoma and amyloidosis.

 

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Types of immunoglobulin

There is really only one main type of myeloma, but in different people, the cancerous plasma cells make different antibodies. Doctors call these antibodies immunoglobulins. Each immunoglobulin is made up of 2 long protein chains (called heavy chains) and 2 shorter protein chains (called light chains). 

Diagram showing the structure of an immunoglobin

Immunoglobulins can be classified into one of 5 types depending on their heavy chains. These are A, G, M, D and E. In each case of myeloma, only one type of immunoglobulin (Ig) is overproduced, but this varies from patient to patient. In myeloma, IgG is the most common. IgM, IgD and IgE are very rare. All these types of myeloma are treated in the same way.

 

Light chain myeloma

About 1 in 5 people with myeloma (20%) do not produce complete immunoglobulins. They only produce part of the immunoglobulin called the light chain. There are 2 types of light chains - called kappa and lambda. The light chains can show up in the urine. Doctors call this the Bence Jones protein (BJP). 

A test called a serum free light chain test can pick up small amounts of free light chains in the blood. Doctors measure the ratio of kappa light chains to lambda light chains. If myeloma cells make either kappa or lambda light chains, the level of that light chain is increased and the ratio becomes abnormal. 

You may have both these tests to help diagnose and monitor this type of myeloma.

Read about tests for myeloma.

 

Non secretory myeloma

In about 3 out of every 100 people with myeloma (3%), the myeloma cells produce little or no immunoglobulin (also called paraprotein). This makes it harder to diagnose. 

The serum free light chain test may pick up very low levels of paraprotein, and so can be helpful in diagnosing this type of myeloma. However for most people, doctors use bone marrow tests to diagnose and monitor non secretory myeloma.

 

Other conditions related to myeloma

Some other conditions of plasma cells are related to myeloma, including

MGUS

There is a condition called monoclonal gammopathy of undetermined significance, or MGUS for short. Your plasma cells make too many large protein molecules known as immunoglobulins or paraproteins. These show up in the blood. MGUS is often found by chance, through blood tests carried out as part of a routine check up, or tests for some other medical problem. This is because MGUS does not cause any symptoms, and does not generally affect your health.

MGUS is diagnosed if you have

  • A low level of abnormal paraprotein in your blood (less than 30 g/l)
  • A low level of abnormal plasma cells in your bone marrow (less than 10%)
  • No evidence of certain other related conditions
  • No related problems with organs or tissues

Because it does not seem to do any harm or cause problems, MGUS does not need treating. Some people with MGUS go on to develop myeloma, so your specialist or GP will see you regularly for check ups. Overall, about 1 out of 100 people with MGUS (1%) develop myeloma each year.

Plasmacytoma

A plasmacytoma is a tumour made up of plasma cells that are all one type. They can be found in bone or soft tissue. Some people have one area of plasmacytoma and this is called solitary plasmacytoma. Some people have more than one plasmacytoma and this is called multiple solitary plasmacytoma. The areas of plasmacytoma are similar to the areas of plasma cells found in people with multiple myeloma. But people with plasmacytoma don't have other symptoms of myeloma. 

More than half of people with bone plasmacytoma go on to develop myeloma later in life. Soft tissue (or extramedullary) plasmacytoma can also develop into myeloma but is less common.

Doctors usually treat plasmacytoma with radiotherapy.

Amyloidosis

This is really a collection of conditions. An abnormal protein called amyloid is made by plasma cells. The amyloid collects in body organs, such as the kidneys or heart, and gradually causes damage.

About 10 to 15 out of every 100 people with myeloma (10 to 15%) develop amyloidosis. However, it is rare for people with amyloidosis to develop myeloma. Doctors usually treat amyloidosis with chemotherapy, and use the same drugs that are used for myeloma.

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Updated: 9 December 2015