Health Encyclopedia

Multiple myeloma

Definition

Multiple myeloma is a cancer of the plasma cells in bone marrow.

Alternative Names

Plasma cell dyscrasia; Plasma cell myeloma; Malignant plasmacytoma; Plasmacytoma of bone; Myeloma - multiple

Causes, incidence, and risk factors

Plasma cells help the body's immune system fight disease by producing substances called antibodies. Multiple myeloma occurs when plasma cells grow out of control. Too many plasma cells can form a tumor in the bone marrow called a myeloma. Many tumors are called multiple myeloma.

The excess growth of plasma cells interferes with body's ability to make red blood cells, white blood cells, and platelets. This causes anemia and makes a person more likely to get infections and have abnormal bleeding.

As the cancer cells grow in the bone marrow, they cause pain and destruction of the bones. If the bones in the spine are affected, it can put pressure on the nerves, resulting in numbness or paralysis.

Multiple myeloma mainly affects older adults. A history of radiation therapy raises your risk for this type of cancer.

Symptoms

Bleeding problems
Bone or back pain
Increased susceptibility to infection
Symptoms of anemia (such as tiredness, shortness of breath, and fatigue)
Unexplained fractures

Signs and tests

Blood tests can help diagnose this disease. Such tests may include:

Blood chemistry (CHEM 20) shows increased levels of calcium, total protein, and abnormal kidney function.
Complete blood count (CBC) reveals low number of red and white blood cells and platelets.
Freelite diagnostic assay measures immunoglobulin pieces called light chains.
Protein electrophoresis - serum is abnormal.

Bone x-rays show fractures or hollowed out areas of bone. If your doctor suspects this type of cancer, a bone marrow biopsy will be performed.

This disease may also alter the results of the following tests:

Bence-Jones protein (quantitative)
Blood differential
Bone lesion biopsy
Cryoglobulins
ESR
Ionized calcium
Protein in urine
Quantitative immunoglobulins (nephelometry)
Serum globulin electrophoresis
Serum immunoelectrophoresis
Urine immunofixation
Urine immunoelectrophoresis
24-hr urine protein

Treatment

The goal of treatment is to relieve symptoms.

People who have mild disease or have a doubtful diagnosis are usually carefully monitored without treatment. Some people have a slow-developing form of multiple myeloma that takes years to cause symptoms.

Treatment begins when the disease becomes worse or causes symptoms.

Chemotherapy and radiation therapy may be performed to relieve bone pain or treat a bone tumor

Bone marrow transplantation in younger patients has been shown to increase disease-free and overall survival, but it has significant risks.

Medications for multiple myeloma include thalidomide, lenalidomide (Revlimid), and bortezomib (Velcade).

Patients with multiple myeloma should drink plenty of fluids to prevent dehydration and help maintain proper kidney function.

Chemotherapy and transplants rarely lead to a permanent cure.

Support Groups

The stress of illness may be eased by joining a support group whose members share common experiences and problems. See: Cancer - support group

Expectations (prognosis)

Survival of people with multiple myeloma depends on the patient's age and the stage of disease. Some cases are very aggressive, while others take years to get worse.

Complications

Kidney failure is a frequent complication. Other complications may include:

Bone fractures
Increased chances for infection (especially pneumonia)
Paralysis from tumor or spinal cord compression

Calling your health care provider

Call your health care provider if you experience decreased urine output.

Call your provider if you have multiple myeloma and infection develops, or numbness, loss of movement, or loss of sensation develops.

References

Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:pp. 1429-33.

Review Date:7/11/2008
Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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