Multiple Myeloma

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Multiple Myeloma
(Primary Bone Marrow Cancer)
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 tissues and can spread to other parts of the body. A benign tumor does not invade or spread.
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 marow transplant, if they have had a good response to the initial VAD. The two types of bone marrow transplant used include an autologous and allogeneic transplant.
An 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.
The 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
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.