Multiple Myeloma
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Multiple Myeloma

(Primary Bone Marrow Cancer)

En Español (Spanish Version)More InDepth Information on This Condition

Definition

Multiple myeloma is a relatively rare cancer of the bone marrow. It results from the abnormal growth of plasma cells in the bone marrow. Plasma cells normally produce antibodies. As these abnormal or malignant plasma cells multiply, they produce enormous quantities of abnormal antibodies. These abnormal antibodies accumulate in the blood and urine. As the plasma cell tumor grows, it also destroys the surrounding bone. These events lead to bone pain, kidney damage, and a compromised immune system.

Cancer occurs when cells in the body (in this case plasma cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed. A mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissue and can spread to other parts of the body. A benign tumor does not invade or spread.

Bone Marrow in Adult

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Causes

The cause of multiple myeloma is unknown.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for multiple myeloma include:

  • Age: 50 or older
  • Race: black

Symptoms

Symptoms of early stage multiple myeloma include:

  • Persistent bone pain, often severe. It is most commonly in the back but also in the limbs or ribs.
  • Fatigue

When the disease progresses, symptoms may include:

  • Fatigue
  • Weakness
  • Broken bones
  • Repeated infections
  • Nausea and vomiting
  • Constipation
  • Difficulty urinating
  • Abnormal bleeding
  • Headache
  • Visual problems
  • Confusion

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis is based on:

  • X-rays to check for any damage to bones
  • Blood and urine tests to check for high levels of antibody proteins
  • Bone marrow aspiration or biopsy—removal of a sample of bone marrow tissue to test for myeloma cells

In addition, other blood and urine tests will be ordered to assess the various conditions associated with multiple myeloma including:

  • Anemia
  • Low levels of other blood cells (white blood cells and platelets)
  • Elevated calcium levels (blood and urine)
  • Evidence of kidney damage and bone destruction

Treatment

Once cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent. While treatment is sometimes capable of slowing the progression of the multiple myeloma, complete remission is rare. Treatment is also important for the control of symptoms. Treatment depends on your symptoms and the stage of your cancer.

Treatments include:

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

The most common initial chemotherapeutic agents are melphalan , prednisone , or a three drug combination called VAD. When young patients develop myeloma, some oncologists feel they should first receive the VAD chemotherapy followed by a bone marrow transplant, if they have had a good response to the initial VAD.

Bone Marrow Transplant

The two types of bone marrow transplant used include an autologous and allogeneic transplant.

Autologous transplant—is one where the patient’s bone marrow is stunned with very high doses of chemotherapy, and it recovers with infused stem cells.

Allogeneic transplant—is a more involved process requiring the donation of bone marrow cells from a donor (usually a first-degree relative). The bone marrow of the patient is stunned with very high doses of chemotherapy (and sometimes with low doses of radiation therapy) followed by the infusion of the donor’s cells into the blood of the patient. The stem cells then seek out the bone marrow and re-populate it.

Both techniques are potentially deadly and have significant side effects associated with them. However, these procedures (particularly the allogeneic transplant) are the only ones that have shown to result in a prolonged survival, or even a cure.

Immunomodulatory Treatments

Immunomodulatory treatments help alter the way the myeloma cells live, and ultimately makes it difficult for them to survive, reproduce, and produce the proteins that cause secondary symptoms. Drugs used for this treatment include thalidomide , lenalidomide , arsenic trioxide , neovastat, and velcade .

Other Medications

  • Strong oral analgesics to relieve bone pain
  • If anemia is present, erythropoietin to increase the amount of red blood cells
  • Prednisone and biphosphonate drugs to treat high calcium levels
  • Antibiotics to treat infections
  • Biphosphonates to protect bones from fractures and myeloma spreading

Radiation Therapy (Radiotherapy)

Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. Radiation is most often given to relieve bone pain, and by itself is not considered curative.

Surgery

Surgery is done to remove a multiple myeloma tumor that causes pain or other debilitating symptoms, when radiation therapy is not considered feasible. Surgery is not curative.

Red Blood Cell Transfusion

Red blood cell transfusion is for patients with severe anemia.

Peripheral Stem Cell Transplant

Peripheral stem cell transplant involves giving patients immature, healthy blood cells to replace bone marrow cells that are destroyed during total body radiation and high-dose chemotherapy.

Lifestyle Measures

Lifestyle measures help reduce symptoms and maintain overall health:

  • Stay as active as possible.
  • Drink plenty of fluids to help avoid dehydration and kidney damage.
  • Eat a balanced diet.
  • Do not take high doses of vitamins.

Prevention

There are no guidelines for preventing multiple myeloma because the cause is unknown.

RESOURCES:

American Cancer Society
http://www.cancer.org

Multiple Myeloma Research Foundation
http://www.multiplemyeloma.org

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca

Myeloma Canada
www.myelomacanada.ca

References:

Mayo Clinic and Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ .

The Merck Manual of Medical Information . Merck & Co., Inc. Simon and Schuster, Inc.; 2000.

National Cancer Institute, National Institutes of Health (NIH) website. Available at: http://www.cancer.gov/ .

Rajkumar, SV, Hayman, SR, Lacy, MQ, et al. Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma. Blood . 2005;106:4050 .



Last reviewed February 2008 by Igor Puzanov, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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