• Multiple Myeloma

    (Plasma-Cell Myeloma)

    Definition

    Multiple myeloma is a 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 large quantities of abnormal antibodies. These abnormal antibodies collect in the blood and urine. As the plasma cell tumor grows, it also destroys the bone around it. These events lead to bone pain, kidney damage, and a weak immune system.
    Bone Marrow Sites in Adults
    nucleus factsheet image
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Cancer occurs when cells in the body 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 growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.
    It is not clear exactly what causes these problems in the cells, but it is probably a combination of genetics and environment.

    Risk Factors

    Multiple myeloma is more common in people 50 years and older. It is also more common in those of Afro-Caribbean descent than in Caucasians.

    Symptoms

    Symptoms of early stage multiple myeloma include:
    • Persistent bone pain, often severe. It is most common in the back but also in the limbs or ribs.
    • Fatigue
    When the disease progresses, symptoms may include:
    • Increasing fatigue
    • Weakness
    • Broken bones
    • Repeat infections
    • Nausea and vomiting
    • Constipation
    • Difficulty urinating
    • Abnormal bleeding
    • Headache
    • Visual problems
    • Confusion

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done.
    Imaging tests evaluate your bones and other structures. These may include:
    Your doctor may order tests of your body fluids and tissues. This can be done with:
    • Blood tests
    • Urine tests
    • Bone marrow aspiration or biopsy

    Treatment

    After cancer is found, staging tests are done to find out if the cancer has spread. Treatment is sometimes able to slow the progress of multiple myeloma. Complete remission is rare. Treatment is also important to control symptoms. Treatment depends on your symptoms and the stage of your cancer. Options 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. The drugs kill mostly cancer cells. Some healthy cells may be killed in the process.
    Chemotherapy drugs are used in combination and may also be given with other types of medications, like immunomodulating agents.

    Immunomodulating Agents

    Immunomodulating agents work by changing the way the myeloma cells live. This makes it difficult for them to survive, reproduce, and produce proteins that cause symptoms. These medications are often paired with a corticosteroid.

    Corticosteroids

    Corticosteroids may be combined with other medications or given alone. Corticosteroids can also help to treat the symptoms of chemotherapy, like nausea and vomiting.

    Proteasome Inhibitor

    A proteasome inhibitor is also available to treat multiple myeloma. Proteasomes are a type of protein complex that breaks down proteins. It inhibits proteasomes, which causes more proteins to be in the cells. Because of these extra proteins, the cells eventually do not grow anymore.

    Bisphosphonates

    Bisphosphonates are given to slow the process of bone loss.

    Biologic Therapies

    Biologic therapies repair, encourage, or raise the body’s response to cancer by affecting the immune system. Interferon is one biologic agent used to treat multiple myeloma. Interferon may be used with chemotherapy to help prolong remission, slowing the speed at which myeloma cells grow.

    Radiation Therapy

    Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. External beam radiation therapy may be given to relieve bone pain. It is not considered a cure.

    Surgery

    Surgery is done to remove a tumor that causes pain or other disabling symptoms when radiation therapy is not considered a good option. Surgery is not a cure.

    Peripheral Stem Cell Transplant

    Peripheral stem cell transplant involves giving immature, healthy blood cells to replace bone marrow cells that are damaged by cancer.

    Plasmapheresis

    Plasmapheresis is done to exchange plasma in the blood. Plasma is the liquid part of the blood that does not contain cells. After the plasma is removed, fresh plasma or a plasma substitute is added back to the blood. This treatment is done to remove the myeloma proteins from the blood.

    Prevention

    There are no current guidelines to prevent multiple myeloma because the cause is unknown.

    RESOURCES

    American Cancer Society http://www.cancer.org

    Multiple Myeloma Research Foundation http://www.themmrf.org

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca

    Myeloma Canada http://www.myelomacanada.ca

    References

    Casciato D, Territo M. Manual of Clinical Oncology. 6th edition. Lippincott Williams & Wilkins; 2009.

    General information about plasma cell neoplasms. National Cancer Institute website. Available at: http://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq. Accessed August 20, 2014.

    Multiple myeloma. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003121-pdf.pdf. Accessed August 20, 2014.

    Multiple myeloma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 4, 2014. Accessed August 20, 2014.

    Rajkumar, SV, Hayman, SR, Lacy MQ, et al. Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma. Blood. 2005;106:4050 .

    Revision Information

  • LiveWell personal health survey

    How healthy are you really? Find out – free.Learn more

    It's time to stop guessing. If you want to make some changes but just aren't sure how, the free personal health survey from LiveWell is a great place to start.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease and prevent heart attacks. HeartSHAPE® is a painless, non-invasive test that checks pictures of your heart for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.


  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.