If multiple myeloma, a type of cancer affecting the immune system, runs in your family, should you be concerned? You may have heard it's hereditary — but is that really the case?

And what exactly goes awry in multiple myeloma?

"Multiple myeloma develops in the bone marrow, which is the spongy inner tissue of the bone," says Dr. Siddhartha Ganguly, a hematologist at Houston Methodist. "Specifically, it forms in the plasma cells of the bone marrow."

Normal plasma cells make antibodies to help the body fight infections. When a person has multiple myeloma, plasma cells become mutated and overcrowd the bone marrow. The expansion causes bone pain or fractures, low immunity that leaves patients vulnerable to serious infections and organ damage if abnormal protein spills into the bloodstream.

"That's why the term 'multiple' is in the name," says Dr. Ganguly. "It affects a range of body systems and vital organs such as the heart, kidneys and liver."

But is multiple myeloma hereditary? "Not truly," says Dr. Ganguly. While first degree relatives (mom, dad, children or siblings) have an increased risk of developing this cancer, researchers are still looking for a specific gene variant that causes it — which could tell us if and how this cancer may get passed down the family tree.

What causes multiple myeloma?

Research has shown that people with a precursor condition called monoclonal gammopathy of unknown significance (MGUS) have a slightly higher risk (1 in 5 chances over the course of their lifetime) of developing multiple myeloma. This earliest precursor develops into multiple myeloma slowly, at a rate of about 1% progression per year.

Smoldering multiple myeloma (SMM) is a middle-stage precursor to multiple myeloma that progresses faster, at a rate of 10% per year.

Approximately 3%-5% of people 50 and older have either MGUS or SMM.

In addition to family history and these precursor conditions, other risk factors for multiple myeloma include:

• African ancestry: People of African ancestry are two to four times more likely to develop multiple myeloma.
• Advanced age: Most patients are diagnosed at age 65 or older. Less than 1% of patients are 35 or younger.
• Exposure to toxins: Pesticides, antigens and environmental pollutants may be associated with multiple myeloma. Research suggests that September 11 first responders have MGUS at twice the rate of same-age peers.
• Obesity: Research suggests that patients with obesity are twice as likely to have their MGUS progress to multiple myeloma compared with average-weight patients. This may be due to substances in fatty tissue that may fuel tumor growth.

Are there early signs of multiple myeloma?

MGUS and SMM do not cause symptoms, so they are rarely found early.

Multiple myeloma is typically diagnosed after symptoms begin. They can include:

• Anemia
• Bone pain or fractures
• Fatigue
• Infection that comes back due to low immune system
• Kidney problems
• Lack of appetite
• Swelling around the ankles
• Tiredness

Because multiple myeloma is somewhat rare, patients with no reported symptoms or family history aren't routinely tested for the cancer.

"If you have risk factors of multiple myeloma, including a family history, or symptoms of the disease, see a doctor and get it checked out," says Dr. Ganguly. "Getting treatment can put the disease in remission and spare patients a lot of pain."

Can multiple myeloma be cured?

While there is not yet a cure, multiple myeloma is treatable and can be put in deep remission, Dr. Ganguly explains.

"When I was in medical school, there was not much treatment for multiple myeloma," he says. "Fortunately, science has advanced, and now we have very effective treatments for multiple myeloma. Patients can live symptom-free for many years with appropriate treatment and follow-up care."

Houston Methodist leads the field of multiple myeloma care and research. In 2024, the Cancer and Prevention and Research Institute of Texas (CPRIT) awarded Dr. Qing Yi, Ph.D., a Houston Methodist medical immunologist, a nearly $2 million grant to study a new combination therapy for medication-resistant multiple myeloma.

This is one example of our dedication to finding better treatments — and one day, a cure — for multiple myeloma. There are several clinical trials available for patients with multiple myeloma at the Houston Methodist Neal Cancer Center using novel drugs and immunotherapy.

"Multiple myeloma treatment is fascinating because it's an interplay of balancing the normal and the abnormal within the immune system," says Dr. Ganguly. "It is also a story of success. During my training, the average expected survival for multiple myeloma was two to three years. Now, I'm seeing patients who are alive and well 20 to 25 years after diagnosis."

If a close relative has had multiple myeloma or if you are having symptoms, see a primary care provider to talk about your risk, especially if you are of African ancestry. They can work with you to spot the source of your symptoms and get back to the lifestyle you enjoy.