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.

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.