Multiple Myeloma
En Español (Spanish Version)More InDepth Information on This ConditionMultiple 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 tissue and can spread to other parts of the body. A
benign tumor
does not invade or spread.
Bone Marrow in Adult
© 2011 Nucleus Medical Media, Inc.
The cause of multiple myeloma is unknown.
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 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
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
Once cancer is found, staging tests are done to find out if the cancer has spread and, if so, to what extent. While treatment is sometimes capable of slowing the progression of 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. Options include:
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.
Examples of chemotherapy drugs that are used to treat multiple myeloma include:
These drugs are used in combination and may also be given with other types of medicines, like immunomodulating agents.
Immunomodulating agents work by altering the way the myeloma cells live, making it difficult for them to survive, reproduce, and produce proteins that cause symptoms. Examples of these agents include
thalidomide
and
lenalidomide
. These medicines are often paired with the corticosteroid
dexamethasone
(Decadron).
Corticosteroids, such as
prednisone
and dexamethasone, may be combined with other medicines or given alone. Corticosteroids can also help to treat the symptoms of chemotherapy, like nausea and vomiting.
A proteasome inhibitor called
bortezomib
(Velcade) is also available to treat multiple myeloma. Proteasomes are a type of protein complex that breaks down proteins. Bortezomib inhibits proteasomes, which causes more proteins to be in the cells. Because of these extra proteins, the cells eventually do not grow anymore.
Biologic therapies repair, stimulate, or enhance 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
is the use of radiation to kill cancer cells and shrink tumors. External beam radiation therapy may be given to relieve bone pain, and by itself is not considered curative.
Surgery is done to remove a tumor that causes pain or other debilitating symptoms when radiation therapy is not considered a good option. Surgery is not curative.
Plasmapheresis
is done to exchange plasma in the blood. Plasma is the liquid part of the blood that does not contain cells. Once 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.
There are no guidelines for preventing multiple myeloma because the cause is unknown.
Multiple Myeloma Research Foundation
Mayo Clinic and Foundation for Medical Education and Research website. Available at:
http://www.mayo.edu/
.
The Merck Manual of Medical Information
. Merck & Co., Inc. Simon and Schuster, Inc.; 2000.
National Cancer Institute, National Institutes of Health (NIH) website. Available at:
http://www.cancer.gov/
.
Rajkumar, SV, Hayman, SR, Lacy, MQ, et al. Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma.
Blood
. 2005;106:4050
.
Last Reviewed December 2010