Multiple Myeloma

Multiple myeloma is a rare form of cancer characterized by excessive production (proliferation) and improper function of certain cells (plasma cells) found in the bone marrow. Plasma cells, which are a type of white blood cell, are produced in the bone marrow and eventually enter the bloodstream. Excessive plasma cells may eventually mass together to form a tumor or tumors in various sites of the body, especially the bone marrow. If only a single tumor is present, the term solitary plasmocytoma is used.

When multiple tumors are present, the term multiple myeloma is used. Plasma cells are a key component of the immune system and secrete a substance known as myeloma proteins (M-proteins), a type of antibody. Antibodies are special proteins that the body produces to combat invading microorganisms, toxins, or other foreign substances. Overproduction of plasma cells in affected individuals results in abnormally high levels of these proteins within the body.

Our patients with multiple myeloma are treated at the Moores Leukemia and Lymphoma Unit. See the Leukemia and Lymphoma Unit for more information.

You can also review the tabs at top of this page for information on multiple myeloma symptoms and treatment.

Symptoms

Sometimes multiple myeloma does not cause any symptoms. However, the following may be caused by multiple myeloma or other conditions:

• Bone pain, often in the back or ribs
  
• Bones that break easily
  
• Fever for no known reason or frequent infections
  
• Easy bruising or bleeding
  
• Trouble breathing
  
• Weakness in arms or legs
  
• Feeling very tired
  

When the tumor damages the bone, hypercalcemia (a condition in which there is too much calcium in the blood) may occur. Hypercalcemia symptoms may include:

• Loss of appetite
  
• Nausea or vomiting
  
• Thirst
  
• Frequent urination
  
• Constipation
  
• Fatigue
  
• Muscle weakness
  
• Restlessness
  
• Mental confusion
  

In rare cases, multiple myeloma can cause organs to fail. This may be caused by a condition called amyloidosis, where organs become stiff and unable to function.

In plasmacytoma, where the myeloma cells collect in one location and form a single tumor, symptoms depend on where the tumor is.  In bone, the cancer may cause pain or broken bones; in soft tissue, the tumor may press on nearby areas, causing pain.

In macroglobulinemia, abnormal plasma cells build up in the bone marrow, lymph nodes and spleen.  Symptoms depend upon the body part affected, but can include most of the symptoms mentioned for multiple myeloma.

In MGUS, there are abnormal cells in the bone marrow, but no cancer.  It can, however, later become a more serious condition such as multiple myeloma or lymphoma.

Several treatment options are available for multiple myeloma and other plasma cell neoplasms:

Chemotherapy

This intensive anti-cancer drug therapy is administered orally or via injection.  Generally, a combination of drugs are given in cycles over a period of time.

Blood and Marrow Transplant (BMT)

The two primary types of BMT are autologous (using your own previously harvested cells) and allogeneic (using cells from a donor).  Both are preceded by high-dose chemotherapy and/or radiation, which destroy not only the cancerous cells in your body, but healthy cells as well.  You will be in the hospital during this time, to ensure that you are not exposed to possible infection.  Then, during the transplant procedure, you’ll receive healthy cells which make their way to your bone marrow and start producing new blood cells.

Biologic therapy

In biologic therapy, also known as immunotherapy, substances made by the body or in a laboratory are used to boost, direct or restore the body’s natural defenses against cancer.  Monoclonal antibody therapy is one type of biologic therapy.

Radiation therapy

This cancer treatment uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The radiation method chosen depends on the type of the cancer being treated.

Surgery

Surgery may be performed to remove tumors, and is usually followed by radiation therapy.

Watchful waiting

In cases where cancer is progressing extremely slow, your doctor may recommend that your cancer be closely monitored, but no immediate treatment given until symptoms appear or change.

Plasmapheresis

In this procedure, blood is removed and sent through a machine that separates the plasma (the liquid part of the blood) from the blood cells.  Normal blood cells are returned to the bloodstream along with donated plasma or a plasma replacement.