Multiple Myeloma

Multiple Myeloma, Geraldine Ferraro Battled The Disease For 12 Years

Like many others, I was shocked when I heard that Geraldine Ferraro died today. She was a key figure in the political world, but more than that, she was a beloved mother, involved teacher, lawyer, politician, and journalist. I hadn’t known she had been suffering from multiple myeloma for the past twelve years. Also, like many others, I Googled the disease to see exactly what it is.

Multiple myeloma is an incurable blood cancer.

Multiple myeloma is an incurable blood cancer. Specifically, it is cancer of the plasma cells in bone marrow.

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.

While multiple myeloma mainly affects older adults, a history of radiation therapy raises the risk for this type of cancer.

Symptoms of the disease include 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, and weakness of the arms or legs.

People who have mild disease are typically carefully watched without treatment. Some people have a slow-developing form of multiple myeloma that takes years to cause symptoms.

The Multiple Myeloma Research Foundation (MMRF) put out a statement after news of Ferraro’s death:

“Geraldine Ferraro was a true trailblazer, an inspiration to many, an incredible advocate for cancer research, and a very dear friend. She will be sadly missed, never far from our hearts, and fondly remembered for her incredible legacy and the extraordinary woman who she was. We pray that her family finds comfort and peace during this sorrowful time,” said Kathy Giusti, Founder and CEO of the Multiple Myeloma Research Foundation, and a patient with multiple myeloma.

In addition to serving on the MMRF’s Honorary Board of Directors, Ferraro was actively involved in the Foundation’s work to bring new treatments to patients. In 2002, she passionately testified before Congress for the critical need for increased research funding, and a year later, a bill was signed authorizing $250 million for blood cancer research. Congress then appropriated $5 million to the Geraldine Ferraro Blood Cancer Education Program in 2003 and renewed funding in 2006, enabling the MMRF to provide high-quality educational programs to underserved populations.

Generic Viagra Medical Drug Information

Generic Viagra Medical Drug Information Medicine Contraindications References! Discover how sildenafil citrate drug therapy works Remember that no medicine is for everyone. If you use nitrate drugs, often used to control chest pain (also known as angina), don't take Sildenafil Citrate (The active ingredient in Viagra brand and Generic Viagra). This combination could cause your blood pressure to drop to an unsafe or life-threatening level. Be sure to ask your doctor if your heart is healthy enough for sexual activity. For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity. However, sildenafil citrate (generic Viagra) may be taken anywhere from 4 hours to 0.5 hour before sexual activity. Based on effectiveness and toleration, the dose may be increased to a maximum recommended dose of 100 mg or decreased to 25 mg. The maximum recommended dosing frequency is once per day. The Following Factors are Associated with Increased Plasma Levels of Sildenafil: Age >65 (40% increase in AUC), hepatic impairment (e.g., cirrhosis, 80%), severe renal impairment (creatinine clearance <30 ml/min, 100%), and concomitant use of potent cytochrome P450 3A4 inhibitors (erythromycin, ketoconazole, itraconazole, 200%, saquinavir 210%). Since higher plasma levels may increase both the efficacy and incidence of adverse events, a starting dose of 25 mg should be considered in these patients. Given the extent of the interaction with patients receiving concomitant therapy with ritonavir, it is recommended not to exceed a single dmaximumose of 25 mg of sildenafil citrate in a 48 hour period.

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Sildenafil citrate was shown to potentiate the hypotensive effects of nitrates and its administration in patients who use nitric oxide donors or nitrates in any form is therefore contraindicated. Recommended Storage: Store at controlled room temperature, 15-30°C (59-86°F). Mechanism of Action The physiologic mechanism of genital erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood. Sildenafil citrate has no direct relaxant effect on isolated human corpus cavernosum, but enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Caverta (generic Viagra) at recommended doses has no effect in the absence of sexual stimulation. Studies in vitro have shown that sildenafil is selective for PDE5. Its effect is more potent on PDE5 than on other known phosphodiesterases (>80-fold for PDE1, >1000-fold for PDE2, PDE3, and PDE4). The approximately 4000-fold selectivity for PDE5 versus PDE3 is important because that PDE is involved in control of cardiac contractility. Sildenafil citrate is only about 10-fold as potent for PDE5 compared to PDE6, an enzyme found in the retina; this lower selectivity is thought to be the basis for abnormalities related to color vision observed with higher doses or plasma levels. In addition to human corpus cavernosum smooth muscle, PDE5 is also found in lower concentrations in other tissues including platelets, vascular and visceral smooth muscle, and skeletal muscle. The inhibition of PDE5 in these tissues by sildenafil may be the basis for the enhanced platelet antiaggregatory activity of nitric oxide observed in vitro, an inhibition of platelet thrombus formation in vivo and peripheral arterial-venous dilatation in vivo. Medicine Contraindications References: Consistent with its known effects on the nitric oxide/cGMP pathway, sildenafil citrate was shown to potentiate the hypotenive effects of nitrates and its administration to patients who are using organic nitrates, either regularly and/or intermittently, in any form is therefore contraindicated. After patients have taken sildenafil, it is unknown when nitrates, if necessary, can be safely administered. Based on the parmacokinetic profile o a single 100 mg oral dose given to healthy normal volunteers, the plasma levels of sildenafil at 24 hours post dose are approximately 2ng/ml (compared to peak plasma levels of approximately 440ng/ml, in the following patients: age >65, hepatic impairment (e.g, creatinine clearance <30mL/min), and concomitant use of potent cytochrome P450 3A4 inhibitors (erythromycin), plasma levels of sildenafil at 24 hours post dose have been found to be 3 to 8 times higher than those seen in healthy volunteers. Although plasma levels of sildenafil at 24 hours post dose are much lower than at peak concentration, it is unknown whether nitrates can be safely coadministered at this time point. Sildenafil is contraindicated in patients with a known hypersensitivity to any component o the tablet.

Generic Viagra Medical Drug Information

Generic Viagra Medical Drug Information Medicine Contraindications References! Discover how sildenafil citrate drug therapy works Remember that no medicine is for everyone. If you use nitrate drugs, often used to control chest pain (also known as angina), don't take Sildenafil Citrate (The active ingredient in Viagra brand and Generic Viagra). This combination could cause your blood pressure to drop to an unsafe or life-threatening level. Be sure to ask your doctor if your heart is healthy enough for sexual activity. For most patients, the recommended dose is 50 mg taken, as needed, approximately 1 hour before sexual activity. However, sildenafil citrate (generic Viagra) may be taken anywhere from 4 hours to 0.5 hour before sexual activity. Based on effectiveness and toleration, the dose may be increased to a maximum recommended dose of 100 mg or decreased to 25 mg. The maximum recommended dosing frequency is once per day. The Following Factors are Associated with Increased Plasma Levels of Sildenafil: Age >65 (40% increase in AUC), hepatic impairment (e.g., cirrhosis, 80%), severe renal impairment (creatinine clearance <30 ml/min, 100%), and concomitant use of potent cytochrome P450 3A4 inhibitors (erythromycin, ketoconazole, itraconazole, 200%, saquinavir 210%). Since higher plasma levels may increase both the efficacy and incidence of adverse events, a starting dose of 25 mg should be considered in these patients. Given the extent of the interaction with patients receiving concomitant therapy with ritonavir, it is recommended not to exceed a single dmaximumose of 25 mg of sildenafil citrate in a 48 hour period.

.

Sildenafil citrate was shown to potentiate the hypotensive effects of nitrates and its administration in patients who use nitric oxide donors or nitrates in any form is therefore contraindicated. Recommended Storage: Store at controlled room temperature, 15-30°C (59-86°F). Mechanism of Action The physiologic mechanism of genital erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood. Sildenafil citrate has no direct relaxant effect on isolated human corpus cavernosum, but enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Caverta (generic Viagra) at recommended doses has no effect in the absence of sexual stimulation. Studies in vitro have shown that sildenafil is selective for PDE5. Its effect is more potent on PDE5 than on other known phosphodiesterases (>80-fold for PDE1, >1000-fold for PDE2, PDE3, and PDE4). The approximately 4000-fold selectivity for PDE5 versus PDE3 is important because that PDE is involved in control of cardiac contractility. Sildenafil citrate is only about 10-fold as potent for PDE5 compared to PDE6, an enzyme found in the retina; this lower selectivity is thought to be the basis for abnormalities related to color vision observed with higher doses or plasma levels. In addition to human corpus cavernosum smooth muscle, PDE5 is also found in lower concentrations in other tissues including platelets, vascular and visceral smooth muscle, and skeletal muscle. The inhibition of PDE5 in these tissues by sildenafil may be the basis for the enhanced platelet antiaggregatory activity of nitric oxide observed in vitro, an inhibition of platelet thrombus formation in vivo and peripheral arterial-venous dilatation in vivo. Medicine Contraindications References: Consistent with its known effects on the nitric oxide/cGMP pathway, sildenafil citrate was shown to potentiate the hypotenive effects of nitrates and its administration to patients who are using organic nitrates, either regularly and/or intermittently, in any form is therefore contraindicated. After patients have taken sildenafil, it is unknown when nitrates, if necessary, can be safely administered. Based on the parmacokinetic profile o a single 100 mg oral dose given to healthy normal volunteers, the plasma levels of sildenafil at 24 hours post dose are approximately 2ng/ml (compared to peak plasma levels of approximately 440ng/ml, in the following patients: age >65, hepatic impairment (e.g, creatinine clearance <30mL/min), and concomitant use of potent cytochrome P450 3A4 inhibitors (erythromycin), plasma levels of sildenafil at 24 hours post dose have been found to be 3 to 8 times higher than those seen in healthy volunteers. Although plasma levels of sildenafil at 24 hours post dose are much lower than at peak concentration, it is unknown whether nitrates can be safely coadministered at this time point. Sildenafil is contraindicated in patients with a known hypersensitivity to any component o the tablet.

Lisinopril

GENERIC NAME: lisinopril

BRAND NAME: Zestril, Prinivil

DRUG CLASS AND MECHANISM: Lisinopril is an angiotensin converting enzyme(ACE) inhibitor. Angiotensin is a chemical that is made by the body continuously. It narrows blood vessels and thereby maintains (elevates) blood pressure. When the enzyme is blocked by lisinopril, angiotensin cannot be converted into its active form. As a result, blood vessels dilate and blood pressure falls.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: 2.5, 5, 10, 20, and 40 mg oral tablets.

STORAGE: Lisinopril should be stored in a dry place at 15-30°C (59-86 °F).

PRESCRIBED FOR: Lisinopril is used to treat elevated blood pressure, heart failureand to improve survival after a heart attack (myocardial infarction).

DOSING: Lisinopril should be taken at doses specifically directed by the physician. Lisinopril can be taken with or without food. Lisinopril should be taken at the same time each day to maintain consistent blood levels of lisinopril. Lisinopril should not be taken within two hours of taking an antacid since the antacid binds lisinopril and prevents its absorption. The dose of lisinopril is often lowered slowly when discontinuing.

The starting dose of lisinopril is 5 mg daily, and the effective dose range for treating heart failure is 5-40 mg daily. The dose can be increased by 10 mg every 2 weeks to achieve the maximum effect. The maximum dose is 40 mg daily.

The starting dose of lisinopril for treating high blood pressure is 10 mg daily. The usual dose range is 20-40 mg daily. A dose of 80 mg is not much more effective than 40 mg.

Treatment of heart attack (myocardial infarction) is started with 5 mg followed by 5 mg after 24 hours, 10 mg after 48 hours and then 10 mg daily. Treatment is continued for 6 weeks.

DRUG INTERACTIONS: In general, lisinopril should not be taken with potassium supplements or diuretics that conserve potassium [for example,hydrochlorothiazide/triamterene (Dyazide)], since blood potassium levels may rise to dangerous levels.

Nitritoid reactions (symptoms includie facial flushing, nausea, vomiting and hypotension) may occur when injectable gold (sodium aurothiomalate), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, including lisinopril.

PREGNANCY: Lisinopril should not be taken during pregnancy because fetuses and neonates have died when lisinopril was administered during pregnancy.

NURSING MOTHERS: It is not known whether lisinopril is excreted in breast milk.

SIDE EFFECTS: First doses of lisinopril can cause dizziness due to a drop in blood pressure. Lisinopril can cause nausea, headaches, anxiety, insomnia, drowsiness, nasal congestion and sexual dysfunction. Lisinopril should be stopped if there are symptoms or signs of an allergic reaction including feelings of swelling of the face, lips, tongue or throat. Severe allergic reactions (anaphylaxis) and hivesoccasionally occur. Rarely, lisinopril may cause a drop in red blood cells, white blood cells, and platelets.

Lisinopril can impair the function of the kidneys, and every person taking this medication should have their kidney function checked.

WARNING: This drug can cause serious (possibly fatal) harm to an unborn baby if used during pregnancy. Therefore, it is important to prevent pregnancy while taking this medication. Consult your doctor for more details and to discuss the use of reliable forms of birth control while taking this medication. If you are planning pregnancy, become pregnant, or think you may be pregnant, contact your doctor immediately.

USES: This drug belongs to a group of medications called ACE inhibitors. It is used to treat high blood pressure (hypertension) in adults and in children 6 years of age and older. It works by relaxing blood vessels, causing them to widen. High blood pressure reduction helps prevent strokes, heart attacks and kidney problems.This medication is also used after an acute heart attack to improve survival, and is used with other drugs (e.g., "water pills"/diuretics, digoxin) to treat congestive heart failure.OTHER This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.This medication may also be used to help protect the kidneys from damage due to diabetes.

HOW TO USE: Take this medication by mouth, usually once a day or as directed by your doctor. You may take this drug with or without food. Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time each day.If you are taking this drug in the liquid suspension form, shake the bottle well before each use. Measure the dose out carefully.Do not take potassium supplements or salt substitutes containing potassium without talking to your doctor or pharmacist first. This medicine can raise your potassium levels, which rarely can cause serious side effects such as muscle weakness or very slow heartbeats. Tell your doctor immediately if these effects occur.The dosage is based on your medical condition and response to therapy. For the treatment of high blood pressure, it may take 2 to 4 weeks before the full benefit of this drug occurs. It may take several weeks or months to see the full benefit when this drug is used for congestive heart failure.It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.

Lisinopril

GENERIC NAME: lisinopril

BRAND NAME: Zestril, Prinivil

DRUG CLASS AND MECHANISM: Lisinopril is an angiotensin converting enzyme(ACE) inhibitor. Angiotensin is a chemical that is made by the body continuously. It narrows blood vessels and thereby maintains (elevates) blood pressure. When the enzyme is blocked by lisinopril, angiotensin cannot be converted into its active form. As a result, blood vessels dilate and blood pressure falls.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: 2.5, 5, 10, 20, and 40 mg oral tablets.

STORAGE: Lisinopril should be stored in a dry place at 15-30°C (59-86 °F).

PRESCRIBED FOR: Lisinopril is used to treat elevated blood pressure, heart failureand to improve survival after a heart attack (myocardial infarction).

DOSING: Lisinopril should be taken at doses specifically directed by the physician. Lisinopril can be taken with or without food. Lisinopril should be taken at the same time each day to maintain consistent blood levels of lisinopril. Lisinopril should not be taken within two hours of taking an antacid since the antacid binds lisinopril and prevents its absorption. The dose of lisinopril is often lowered slowly when discontinuing.

The starting dose of lisinopril is 5 mg daily, and the effective dose range for treating heart failure is 5-40 mg daily. The dose can be increased by 10 mg every 2 weeks to achieve the maximum effect. The maximum dose is 40 mg daily.

The starting dose of lisinopril for treating high blood pressure is 10 mg daily. The usual dose range is 20-40 mg daily. A dose of 80 mg is not much more effective than 40 mg.

Treatment of heart attack (myocardial infarction) is started with 5 mg followed by 5 mg after 24 hours, 10 mg after 48 hours and then 10 mg daily. Treatment is continued for 6 weeks.

DRUG INTERACTIONS: In general, lisinopril should not be taken with potassium supplements or diuretics that conserve potassium [for example,hydrochlorothiazide/triamterene (Dyazide)], since blood potassium levels may rise to dangerous levels.

Nitritoid reactions (symptoms includie facial flushing, nausea, vomiting and hypotension) may occur when injectable gold (sodium aurothiomalate), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, including lisinopril.

PREGNANCY: Lisinopril should not be taken during pregnancy because fetuses and neonates have died when lisinopril was administered during pregnancy.

NURSING MOTHERS: It is not known whether lisinopril is excreted in breast milk.

SIDE EFFECTS: First doses of lisinopril can cause dizziness due to a drop in blood pressure. Lisinopril can cause nausea, headaches, anxiety, insomnia, drowsiness, nasal congestion and sexual dysfunction. Lisinopril should be stopped if there are symptoms or signs of an allergic reaction including feelings of swelling of the face, lips, tongue or throat. Severe allergic reactions (anaphylaxis) and hivesoccasionally occur. Rarely, lisinopril may cause a drop in red blood cells, white blood cells, and platelets.

Lisinopril can impair the function of the kidneys, and every person taking this medication should have their kidney function checked.

WARNING: This drug can cause serious (possibly fatal) harm to an unborn baby if used during pregnancy. Therefore, it is important to prevent pregnancy while taking this medication. Consult your doctor for more details and to discuss the use of reliable forms of birth control while taking this medication. If you are planning pregnancy, become pregnant, or think you may be pregnant, contact your doctor immediately.

USES: This drug belongs to a group of medications called ACE inhibitors. It is used to treat high blood pressure (hypertension) in adults and in children 6 years of age and older. It works by relaxing blood vessels, causing them to widen. High blood pressure reduction helps prevent strokes, heart attacks and kidney problems.This medication is also used after an acute heart attack to improve survival, and is used with other drugs (e.g., "water pills"/diuretics, digoxin) to treat congestive heart failure.OTHER This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.This medication may also be used to help protect the kidneys from damage due to diabetes.

HOW TO USE: Take this medication by mouth, usually once a day or as directed by your doctor. You may take this drug with or without food. Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time each day.If you are taking this drug in the liquid suspension form, shake the bottle well before each use. Measure the dose out carefully.Do not take potassium supplements or salt substitutes containing potassium without talking to your doctor or pharmacist first. This medicine can raise your potassium levels, which rarely can cause serious side effects such as muscle weakness or very slow heartbeats. Tell your doctor immediately if these effects occur.The dosage is based on your medical condition and response to therapy. For the treatment of high blood pressure, it may take 2 to 4 weeks before the full benefit of this drug occurs. It may take several weeks or months to see the full benefit when this drug is used for congestive heart failure.It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.

Aricept

ARICEPT (donepezil hydrochloride) is a reversible inhibitor of the enzyme acetylcholinesterase, known chemically as (±)-2, 3-dihydro-5, 6-dimethoxy2-[[1-(phenylmethyl)-4-piperidinyl]methyl]-1H-inden-1-one hydrochloride. Donepezil hydrochloride is commonly referred to in the pharmacological literature as E2020. It has an empirical formula of C₂₄H₂₉NO₃HCl and a molecular weight of 415.96. Donepezil hydrochloride is a white crystalline powder and is freely soluble in chloroform, soluble in water and in glacial acetic acid, slightly soluble in ethanol and in acetonitrile and practically insoluble in ethyl acetate and in n-hexane.

ARICEPT is available for oral administration in film-coated tablets containing 5, 10, or 23 mg of donepezil hydrochloride.

Inactive ingredients in 5 mg and 10 mg tablets are lactose monohydrate, corn starch, microcrystalline cellulose, hydroxypropyl cellulose, and magnesium stearate. The film coating contains talc, polyethylene glycol, hypromellose and titanium dioxide. Additionally, the 10 mg tablet contains yellow iron oxide (synthetic) as a coloring agent.

Inactive ingredients in 23 mg tablets include ethylcellulose, hydroxypropyl cellulose, lactose monohydrate, magnesium stearate and methacrylic acid copolymer, Type C. The film coating includes ferric oxide, hypromellose 2910, polyethylene glycol 8000, talc and titanium dioxide.

ARICEPT ODT tablets are available for oral administration. Each ARICEPT ODT tablet contains 5 or 10 mg of donepezil hydrochloride. Inactive ingredients are carrageenan, mannitol, colloidal silicon dioxide and polyvinyl alcohol. Additionally, the 10 mg tablet contains ferric oxide (yellow) as a coloring agen

Multiple myeloma

Plasma cell dyscrasia; Plasma cell myeloma; Malignant plasmacytoma; Plasmacytoma of bone; Myeloma - multiple

Last reviewed: March 2, 2010.

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

1. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Multiple Myeloma. National Comprehensive Cancer Network; 2010. Version 1.2010. [PubMed]
2. 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.