Multiple myeloma is cancer of the plasma cells in bone marrow.
Causes, incidence, and risk factors
Plasma cells help the body's immune system fight disease by producing proteins called antibodies. In multiple myeloma, plasma cells grow out of control in the bone marrow and form tumors in the areas of solid bone.
The growth of these bone tumors makes it harder for the bone marrow to make red blood cells, white blood cells, and platelets. This causes anemia, which makes a person more likely to get infections and have abnormal bleeding.
As the cancer cells grow in the bone marrow, they can cause pain and destruction of the bones. If the bones in the spine are affected, it can put pressure on the nerves, resulting in numbness or paralysis.
Multiple myeloma mainly affects older adults. A history of radiation therapy raises your risk for this type of cancer.
Symptoms
Bleeding problems
Bone or back pain, most often in the ribs or back
Fevers without any other cause
Increased susceptibility to infection
Symptoms of anemia (such as tiredness, shortness of breath, and fatigue)
Unexplained fractures
Weakness of the arms or legs
Signs and tests
Blood tests can help diagnose this disease. They may include:
Blood chemistry may show increased levels of calcium, total protein, and abnormal kidney function
Complete blood count (CBC) reveals low numbers of red and white blood cells and platelets
Serum beta 2 microglobulin level
Serum immunofixation electrophoresis
Urine immunofixation electrophoresis
Serum protein electrophoresis (SPEP)
Urine protein electrophoresis (UPEP) or Bence-Jones protein analysis
Quantitative immunoglobulins (nephelometry)
Serum free light chain measurements
Bone x-rays may show fractures or hollowed out areas of bone. If your doctor suspects this type of cancer, abone marrow biopsy will be performed.
Bone density testing may show bone loss.
Treatment
The goal of treatment is to relieve symptoms, avoid complications, and prolong life.
People who have mild disease or where the diagnosis is not certain are usually carefully watched without treatment. Some people have a slow-developing form of multiple myeloma that takes years to cause symptoms.
Medications for the treatment of multiple myeloma include:
Dexamethasone, melphalan, thalidomide, lenalidomide (Revlimid), and bortezomib (Velcade) can be used alone or together.
Drugs called bisphosphonates (pamidronate) are used to reduce bone pain and prevent fractures.
Radiation therapy may be performed to relieve bone pain or treat a bone tumor.
Two types of bone marrow transplantation may be tried:
Autologous bone marrow or stem cell transplantation makes use of one’s own stem cells. In younger patients, it has been shown to increase survival.
Allogeneic transplant makes use of someone else’s stem cells. This treatment carries serious risks.
People with multiple myeloma should drink plenty of fluids to prevent dehydration and help maintain proper kidney function. They should also be cautious when having x-ray tests that use contrast dye.
Support Groups
The stress of illness may be eased by joining a support group whose members share common experiences and problems. See: Cancer - support group
Expectations (prognosis)
Survival of people with multiple myeloma depends on the patient's age and the stage of disease. Some cases are very aggressive, while others take years to get worse.
Chemotherapy and transplants rarely lead to a permanent cure.
Complications
Kidney failure is a frequent complication. Other complications may include:
Bone fractures
High levels of calcium in the blood, which can be very dangerous
Increased chances for infection (especially pneumonia)
Paralysis from tumor or spinal cord compression
Calling your health care provider
Call your doctor if you have multiple myeloma and infection develops, or numbness, loss of movement, or loss of sensation develops.
References
- National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Multiple Myeloma. National Comprehensive Cancer Network; 2010. Version 1.2010. [PubMed]
- Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 110.
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