Multiple myeloma
Definition
Multiple myeloma is a cancer of the plasma cells in bone marrow.
Alternative Names
Plasma cell dyscrasia; Plasma cell myeloma; Malignant plasmacytoma; Plasmacytoma of bone; Myeloma - multipleCauses
Plasma cells help the body's immune system fight disease by producing substances called antibodies. Multiple myeloma occurs when plasma cells grow out of control. Too many plasma cells can form a tumor in the bone marrow called a myeloma. Many tumors are called multiple myeloma.
The excess growth of plasma cells interferes with body's ability to make red blood cells, white blood cells, and platelets. This causes anemia and makes a person more likely to get infections and have abnormal bleeding.
As the cancer cells grow in the bone marrow, they 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
- Increased susceptibility to infection
- Symptoms of anemia (such as tiredness, shortness of breath, and fatigue)
- Unexplained fractures
Exams and Tests
Blood tests can help diagnose this disease. Such tests may include:
- Blood chemistry (CHEM 20) shows increased levels of calcium, total protein, and abnormal kidney function.
- Complete blood count (CBC) reveals low number of red and white blood cells and platelets.
- Freelite diagnostic assay measures immunoglobulin pieces called light chains.
- Protein electrophoresis - serum is abnormal.
Bone x-rays show fractures or hollowed out areas of bone. If your doctor suspects this type of cancer, a bone marrow biopsy will be performed.
This disease may also alter the results of the following tests:
- Bence-Jones protein (quantitative)
- Blood differential
- Bone lesion biopsy
- Cryoglobulins
- ESR
- Ionized calcium
- Protein in urine
- Quantitative immunoglobulins (nephelometry)
- Serum globulin electrophoresis
- Serum immunoelectrophoresis
- Urine immunofixation
- Urine immunoelectrophoresis
- 24-hr urine protein
Treatment
The goal of treatment is to relieve symptoms.
People who have mild disease or have a doubtful diagnosis are usually carefully monitored without treatment. Some people have a slow-developing form of multiple myeloma that takes years to cause symptoms.
Treatment begins when the disease becomes worse or causes symptoms.
Chemotherapy and radiation therapy may be performed to relieve bone pain or treat a bone tumor
Bone marrow transplantation in younger patients has been shown to increase disease-free and overall survival, but it has significant risks.
Medications for multiple myeloma include thalidomide, lenalidomide (Revlimid), and bortezomib (Velcade).
Patients with multiple myeloma should drink plenty of fluids to prevent dehydration and help maintain proper kidney function.
Chemotherapy and transplants rarely lead to a permanent cure.
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
Outlook (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.
Possible Complications
Kidney failure is a frequent complication. Other complications may include:
- Bone fractures
- Increased chances for infection (especially pneumonia)
- Paralysis from tumor or spinal cord compression
When to Contact a Medical Professional
Call your health care provider if you experience decreased urine output.
Call your provider if you have multiple myeloma and infection develops, or numbness, loss of movement, or loss of sensation develops.
References
Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:pp. 1429-33.Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
