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Multiple Myeloma

Definition

Multiple myeloma occurs when a specialized white cell, known as a plasma cell, becomes malignant.

What is going on in the body?

Like all blood cells, plasma cells are produced in the bone marrow. Plasma cells produce proteins that help protect the body from infection. After one or more of these cells becomes malignant , they multiply rapidly.
These abnormal cells produce very large amounts of proteins that do not work as well as normal proteins.. They may also crowd out normal cells.
Some of the cancerous plasma cells will leave the bone marrow and enter the bloodstream. From there they may enter bones and destroy them. The disease usually takes many years to develop.

Risks

What are the causes and risks of the disease?

There is no known cause of multiple myeloma.

Prevention

What can be done to prevent the disease?

There is no known way to prevent multiple myeloma.

Diagnosed

How is the disease diagnosed?

A person who has symptoms of multiple myeloma will have a number of tests done, including:
  • a complete blood count, or CBC, to detect a low red blood cell count called anemia
  • a blood test called total protein, which will show elevated levels of protein in the blood
  • a blood test known as serum protein electrophoresis, which will reveal an abnormal amount of some of the body's proteins. Too much protein in the blood may cause kidney damage.
  • a blood test to measure the amount of calcium in the bloodstream. Calcium is released into the bloodstream as the myeloma spreads to the bones.
  • a urine electrophoresis test, which may show abnormal proteins in the urine
  • x-rays of the bones, which may show weakened areas caused by the cancerous plasma cells. The bones can be so weakened that there may be breaks even if there has been no injury.
  • a bone marrow biopsy, to see how much the marrow is affected

Long Term Effects

What are the long-term effects of the disease?

Multiple myeloma is a slow-growing cancer that may take many years to cause problems. However, it may eventually cause severe kidney damage if it is not treated. The disease can be controlled for some time but not cured. If it is not controlled, it can be fatal.

Other Risks

What are the risks to others?

There are no risks to others from this disease. It cannot be spread from person to person.

Treatments

What are the treatments for the disease?

Treatment is designed to control the cancer and treat the symptoms. Chemotherapy involves a combination of medications given by mouth or through the veins. These medications may control the disease for many years. Steroids are sometimes added to chemotherapy to make it more effective.
Radiation therapy aimed at a section of bone to which cancer has spread can reduce pain at that location and possibly prevent the bone from breaking.
Surgery to stabilize the bone may be required if the bone has broken.
Plasmapheresis is a procedure that removes a large amount of abnormal protein from the blood, thus reducing damage to the kidneys A special medication called pamidronate (Aredia), can be given to reduce excess calcium in the blood. This will also strengthen the bones.

Side Effects

What are the side effects of the treatments?

Specific side effects of chemotherapy depend on the medication selected. Mild nausea is the most common symptom, and fortunately is easily controlled. Temporary hair loss, known as alopecia, may occur.
Intensive chemotherapy may have moderate to severe side effects that require more supportive care. Radiation treatment for this cancer is designed to offer relief from pain. It is generally well tolerated.

After Treatment

What happens after treatment for the disease?

The person will be followed closely after treatment. Treatment may be repeated after the person recovers from the side effects. Problems such as weakened bones will be treated as they occur.

Monitor

How is the disease monitored?

Total protein blood tests, serum protein electrophoreses, and kidney function tests will be done regularly. Complete blood counts (CBCs) will be done to measure the number of white cells and red cells. All of these tests monitor the effects of chemotherapy and the course of the disease. Bone marrow biopsies may be needed periodically.

Sources

Salmon, S.&Cassady, J.R (1999). Plasma Cell Neoplasms in Cancer: Principles and Practice of Oncology. 5th Edition DeVita, V.T. (ed). J.B. Lippincott:Phildephia. Pp.2344-2387.

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