Multiple Myeloma

What is multiple myeloma?

Multiple myeloma is a cancer of plasma cells. Plasma cells are white blood cells made by the spongy tissue inside bones called bone marrow. They make antibodies to fight infection. When you have multiple myeloma, the abnormal plasma cells grow more quickly and out of control. They often form tumors in bone, which lead to holes that weaken the bones.

What are the effects and how does it occur?

Normal plasma cells make proteins called antibodies to fight infection. When plasma cells are not normal, they make a lot of abnormal antibodies that are not useful. There may be so many of these proteins in your blood that your blood becomes thick.

The plasma cell tumors slow down the growth and function of normal cells made by the bone marrow. Too few blood cells can cause a number of problems, such as anemia, trouble fighting infection, and blood that is slower to clot when you hurt yourself.

All of the added plasma cells in the bone marrow also cause pain in the bones. Bone tissue may be destroyed, and the bones may break more easily. Calcium from destroyed bone can build up in the blood. This condition, called hypercalcemia, can hurt the kidneys, brain, heart, and digestive tract. The damage to these organs can cause serious health problems. Collapsed bones in the spine may press on the spinal cord and nerves, causing numbness or even paralysis. If it is not treated, multiple myeloma can spread throughout your body and quickly be fatal.

The cause of multiple myeloma is not known. It is seen mostly in people who are middle-aged or older. It affects more men than women, and African Americans have it twice as often as Caucasians.

What are the symptoms?

Sometimes it may not cause any symptoms. When it does cause symptoms, they may be:

• bone pain, especially in the back or ribs
• frequent infections
• tiredness, weakness, drowsiness
• easy bruising or bleeding
• trouble breathing
• bones that break easily.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and do a physical exam. Tests include:

• blood and urine tests
• a bone marrow biopsy, a procedure in which a needle is used to take a sample of bone marrow from your back to look for myeloma cells
• X-rays of bones.

How is it treated?

The goals of treatment are to decrease the number of the abnormal plasma cells, reduce pain, correct anemia, fight infection, and relieve any other problems caused by the disease. Your healthcare provider will determine your treatment plan based on the spread of the cancer, your symptoms, your age, and your general health.

Your provider may recommend a combination of the following therapies:

• anticancer drugs (chemotherapy), including thalidomide, to destroy cancer cells and slow their growth
• bone marrow transplant (the best chance for a cure but risky)
• radiation treatments to lessen bone pain and prevent fractures
• antibiotics to treat infections, which can occur more often before, during, and after chemotherapy
• blood transfusions or bone marrow stimulants if needed for anemia
• medicines to lessen pain
• corticosteroid drugs
• intravenous medicine called Zometa to strengthen bones weakened by myeloma
• biological therapy (also called immunotherapy), which uses your body's immune system to fight the cancer
• a pneumonia shot
• yearly flu shots.

In rare cases the disease is so mild that treatment is not necessary.

How long will the effects last?

Treatment may slow or stop the growth of the cancer for a time and ease the symptoms. The disease may go away completely for a time (go into remission) but then return. The average survival is 2 to 7 years, depending on the stage at the time of diagnosis. In some cases the disease can be cured.

How can I take care of myself?

Follow these guidelines:

• Complete the full course of recommended treatment.
• See your provider right away if symptoms that were gone come back or if you develop new symptoms.
• Learn about the side effects you may have from radiation or chemotherapy. It can help to be prepared for side effects such as hair loss.
• Do not take other cancer treatments without talking with your provider first. Besides costing money, other treatments may get in the way of possibly life-saving, standard treatment.

You may also find it helpful to join a cancer support group during your illness and recovery.

For more information, contact organizations such as:

• American Cancer Society, Inc.
  Phone: 800-ACS-2345 (800-227-2345)
  Web site: http://www.cancer.org
• AMC Cancer Research Center and Foundation
  Phone: 800-525-3777
  Web site: http://www.amc.org
• National Cancer Institute Cancer Information Service
  Phone: 800-4-CANCER (1-800-422-6237)
  Web site: http://cis.nci.nih.gov