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Multiple Myeloma

Cancer of blood plasma cells

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Updated June 12, 2014

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Multiple myeloma is a blood cell (plasma cell) cancer most often diagnosed in people over the age of 65. In the United States, the risk of multiple myeloma is highest among African-Americans and lowest among Asian-Americans. It is estimated that this cancer affects five to six individuals per 100,000 each year.

Cancer means the uncontrolled growth of cells. In multiple myeloma, the bone marrow produces excessive amounts of abnormal plasma cells. Unlike other cancers where there is always a tumor, these cancer cells are most often in the bone marrow and in the blood throughout the body, although a tumor can form in the bone or in soft tissues.

Symptoms

Multiple myeloma causes many symptoms that may include:
  • Bone pain, often in the lower back or ribs

  • Fatigue and weakness due to low levels of red blood cells in the blood (anemia)

  • Frequent infections and fevers due to fewer infection-fighting white blood cells

  • Kidney problems, which can cause increased thirst, increased urination, nausea, or constipation

  • Weight loss

  • Broken bones due to weakened bones

Diagnosis

A diagnosis of multiple myeloma might be suspected based on the symptoms an individual is having. A complete blood cell count (CBC) would show high levels of plasma cells and low levels of red blood cells (anemia). Other blood tests (such as serum protein electrophoresis) would show high levels of calcium and certain blood proteins.

A urine test (urine protein electrophoresis) checks the amount of Bence Jones protein collected over a 24-hour period. In multiple myeloma there will be a high level of this protein present.

A bone marrow biopsy (sample) will be taken to look for cancer cells. A specialized radiologic test (skeletal survey) is done to help confirm the diagnosis. X-rays can check for broken or weakened bones.

The diagnosis of multiple myeloma is confirmed by the presence of myeloma cancer cells (abnormal plasma cells) in the bone marrow and the presence of excess protein in the blood or urine.

Classification and staging

Multiple myeloma may be classified into one of three categories:
  • Monoclonal gammopathy of undetermined significance (MGUS) – this condition is a sort of “pre-multiple myeloma,” meaning that the excess protein is present but the level of plasma cells is low. MGUS is by itself harmless, but about 16 percent of individuals with it develop multiple myeloma over time.

  • Solitary plasmacytoma - myeloma in only one spot or a single tumor

  • Asymptomatic or smoldering multiple myeloma – the blood tests and bone marrow biopsy show the presence of multiple myeloma but symptoms are not present.

  • Symptomatic multiple myeloma

Staging a cancer means determining its extent. Is the multiple myeloma confined to the bone marrow, or has the cancer spread to other parts of the body like the bones? The stage of the cancer determines what types of treatment will be needed. Because multiple myeloma can be widespread, its staging is often based on a rough measure of how much cancer is in the body.

Treatment

Individuals with MGUS or no symptoms are usually observed through regular physical examinations and blood tests, but are not treated. Individuals who have symptoms may be treated with:
  • Chemotherapy drugs – these may include Cytoxan (cyclophosphamide), Alkeran (melphalan), or corticosteroids such as prednisone. The combination of Thalomid (thalidomide) and Decadron (dexamethasone) has also been an effective treatment.

  • Radiation therapy

  • Stem cell (bone marrow) transplantation – the individual receives healthy bone marrow to replace the diseased bone marrow.

  • An anti-cancer drug called Velcade (bortezomib)
In addition, the individual may receive treatment for symptoms, such as receiving a blood transfusion to treat anemia or antibiotics to treat infections.

Sources:

Lonial, Sagar. "About Myeloma." Multiple Myeloma Research Foundation. 9 Sep 2005. Multiple Myeloma Research Foundation. 30 May 2007.

"What You Need to Know About Multiple Myeloma." Cancer Topics. Dec 2004. National Cancer Institute. 30 May 2007.

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