Colin Powell and Multiple Myeloma: Understanding a Blood Cancer

What was confirmed, and by whom

Colin Powell served as Chairman of the Joint Chiefs of Staff and as U.S. Secretary of State. He died on October 18, 2021, at age 84. His family's announcement said he "passed away this morning due to complications from Covid 19" and added, "He was fully vaccinated."

FactCheck.org reported separately that Powell was diagnosed with multiple myeloma in 2019. His longtime assistant said he had been treated for it over the following two or three years. That is the full extent of what was made public about his cancer care, and this page stops there.

The pairing in his case, a blood cancer plus a serious infection, is not a coincidence. It is central to what myeloma does.

The cells that make antibodies

Plasma cells are white blood cells that live in bone marrow and manufacture antibodies. Antibodies are the proteins that recognize and tag germs.

In multiple myeloma, one plasma cell line turns cancerous. The National Cancer Institute (NCI) calls it a systemic cancer of plasma cells. It usually involves several sites in the marrow, and it secretes all or part of a single antibody. That single useless antibody is called an M protein, and finding it in blood or urine is often the first clue.

Two consequences follow. The abnormal cells crowd out normal marrow, so healthy blood cells and useful antibodies fall. And the cells damage the bone around them.

It almost always starts silently

Myeloma has a precursor stage. NCI states that virtually all cases are preceded by a gradually rising M protein level, a condition called MGUS, short for monoclonal gammopathy of undetermined significance.

MGUS is common and usually harmless. NCI puts the annual risk of MGUS turning into a cancer at 0.5% to 1.0% in the general population. In higher-risk patients it runs from 2% to more than 20%. Between MGUS and full myeloma sits smoldering myeloma, with 10% to 60% plasma cells in the marrow but no organ damage yet.

CRAB: the four signs of active disease

Doctors decide myeloma needs treatment when it starts harming the body. NCI lists these criteria under the acronym CRAB:

• Calcium in the blood more than 1 mg/dL above the normal range
• Renal, meaning kidney, dysfunction, with creatinine above 2 mg/dL or clearance below 40 mL/min
• Anemia, with hemoglobin below 10.0 g/dL
• Bone lesions, meaning one or more holes in bone seen on imaging

Newer criteria add three more triggers: 60% or more clonal plasma cells in the marrow, a free light chain ratio of 100 or higher, or more than one focal lesion of at least 5 mm on MRI.

When to ask for the blood work

MedlinePlus lists the symptoms that should prompt a visit. They are bone pain, often in the back or ribs, plus fractures, weakness, fatigue, weight loss, frequent infections, fevers, heavy thirst, and frequent urination.

See a clinician, and specifically raise myeloma, if you have:

• Back or rib pain lasting more than four weeks that does not ease with rest, especially after age 50
• A bone that breaks from a minor fall, or from no injury at all
• Infections that keep coming back, or take much longer than usual to clear
• Deep fatigue with pale skin, which can mean anemia
• Sudden heavy thirst, frequent urination, constipation, or confusion, which can mean high calcium

Ask for a simple panel: a complete blood count, creatinine, calcium, serum protein electrophoresis, and serum free light chains. Those five tests catch most cases.

Confirming and staging it

NCI's workup adds a bone marrow aspirate and biopsy. It is read with cytogenetics, meaning a look at the chromosomes inside the cancer cells. Blood tests include beta-2-microglobulin, albumin, and LDH. Imaging starts with a skeletal survey, with MRI if that is negative.

Staging uses the Revised International Staging System. Stage I requires beta-2-microglobulin below 3.5 mg/L and albumin at or above 3.5 g/dL. Stage III means beta-2-microglobulin at or above 5.5 mg/L. It also requires high LDH or a high-risk chromosome change such as del(17p), t(4;14), or t(14;16). NCI reports median survival of 83 months for stage II and 43 months for stage III, with stage I not yet reached in the data.

Treatment aims at long control

NCI is direct about the goal: multiple myeloma is highly treatable but rarely curable. Smoldering disease may simply be watched, though one trial of daratumumab raised five-year progression-free survival from 40.8% to 63.1%.

Active disease starts with induction therapy. That usually combines a proteasome inhibitor, an immunomodulatory drug, and an anti-CD38 antibody such as daratumumab. Eligible patients then receive high-dose melphalan followed by a stem cell transplant using their own stored cells. Maintenance therapy continues afterward to hold the disease down.

The trajectory has changed enormously. NCI notes median survivals now exceed 10 years, against roughly 7 months before chemotherapy existed.

Why infection stays a permanent risk

This is the part of Powell's story with the widest reach. The cancer itself weakens immunity, because malignant plasma cells crowd out the ones that make working antibodies. Then treatment, which targets plasma cells, suppresses immunity further.

FactCheck.org quoted Dr. Edward Stadtmauer saying such patients "have two strikes against them." Even in remission, he said, the chance of full immune recovery is "very low." Vaccine response is measurably weaker: one study found only 45% of people with active myeloma mounted an adequate antibody response to two mRNA doses.

That is why NCI points to infection prevention as standard care, through vaccination, preventive antibiotics, and immunoglobulin replacement for a small subset of patients.

The group picture

SEER, the federal cancer surveillance program, puts five-year relative survival for myeloma at 63.7%. It estimates about 36,000 new cases and 10,850 deaths in 2026. The disease is diagnosed most often between ages 65 and 74, and is more common in men and among non-Hispanic Black Americans.

These are population figures. They summarize what happened across thousands of people and cannot forecast one person's course.

Sources

• https://www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq
• https://seer.cancer.gov/statfacts/html/mulmy.html
• https://medlineplus.gov/multiplemyeloma.html
• https://www.factcheck.org/2021/10/scicheck-colin-powells-covid-19-death-followed-cancer-diagnosis-treatment/
• https://www.nbcnews.com/politics/politics-news/former-secretary-state-colin-powell-dies-covid-complications-n1281746