Multiple Myeloma
Multiple myeloma, a cancer of the plasma cell, is an incurable but treatable disease. While a myeloma diagnosis can be overwhelming, it is important to remember that there are several promising new therapies that are helping patients live longer, healthier lives. The estimated frequency of multiple myeloma is 5-6 new cases per 100,000 persons per year. Accordingly, in the USA 15,980 new cases are expected to be diagnosed in 2005. At present there are more than 50,000 people in the United States living with multiple myeloma. Multiple myeloma is a malignant proliferation of plasma cells that involves more than 10 percent of the bone marrow. It is a prototype primary malignancy of the bone associated with malignant plasma cells that secrete monoclonal immunoglobulins into the serum, the urine or both. Multiple myeloma is the most common primary cancer of the bones in adults. The annual incidence in the United States is three to four cases per 100,000 population. Multiple myeloma represents 1 percent of all cancers diagnosed in the United States and 10 percent of all hematologic malignancies. The median age at diagnosis of multiple myeloma is 62 years. Only 2 to 3 percent of cases are reported in patients younger than 30 years.2 The disease is called multiple myeloma because myeloma cells can occur in multiple bone marrow sites in your body. If you have multiple myeloma but aren't experiencing symptoms, your doctors may just need to monitor your condition. If you're experiencing symptoms, a variety of treatments are available. Blacks in the United States are twice as likely to suffer from multiple myeloma as whites. In fact, multiple myeloma is the most common hematologic malignancy in the U.S. black population.3 Multiple myeloma is rare among persons of Asian descent, with an incidence of only one to two cases per 100,000 population. Standard therapy for multiple myeloma includes alkylating agents administered with prednisone. The most commonly used alkylating agent is melphalan (Alkeran). Melphalan, 9 mg per m2, is given orally with 100 mg of prednisone on days 1 through 4. Courses of therapy are repeated at four- to six-week intervals for at least one year. |
Symptoms of Multiple Myeloma
Getting to Know Myeloma early..... | Multiple Myeloma Resources..
| Multiple myeloma is a cancer of your plasma cells. Plasma cells are a type of white blood cell present in your bone marrow — the soft, blood-producing tissue that fills in the center of most of your bones. The exact cause of multiple myeloma isn't known. Although multiple myeloma may not cause symptoms early in the disease, it's likely that you'll experience symptoms as the disease progresses. Signs and symptoms of the disease can vary from person to person. One of the most common symptoms, however, is bone pain. A common sign is the presence of abnormal proteins, which can be produced by myeloma cells, in your blood or urine. These proteins which are antibodies or parts of antibodies — are called monoclonal, or M, proteins. |
| Often discovered during a routine exam, monoclonal proteins may indicate multiple myeloma, but also can indicate other conditions. Common potential sign of multiple myeloma is a high level of calcium in your blood. This can occur when calcium from affected bones dissolves into your blood. As a result, you may experience signs and symptoms such as: Excessive thirst and urination Constipation Nausea Loss of appetite Mental confusion Plasma cells usually make up less than 5 percent of the cells in your bone marrow. But if you have multiple myeloma, a group of abnormal plasma cells (myeloma cells) multiplies, raising the percentage of plasma cells to more than 10 percent of the cells in your bone marrow. The result can be erosion of your bones. The disease also interferes with the function of your bone marrow and immune system, which can lead to anemia and infection. Multiple myeloma may also cause problems with your kidneys. |
How does Myeloma Begin?
Catching Myeloma Early..
| The Beginning of Myeloma Multiple myeloma is the most common type of plasma cell tumor. Myeloma begins when a plasma cell becomes abnormal. The abnormal cell divides to make copies of itself. The new cells divide again and again, making more and more abnormal cells. The abnormal plasma cells are myeloma cells. Myeloma cells make antibodies called M proteins. Multiple myeloma is the malignant proliferation of plasma cells involving more than 10 percent of the bone marrow. The multiple myeloma cell produces monoclonal immunoglobulins that may be identified on serum or urine protein electrophoresis. Bone pain related to multiple lytic lesions is the most common clinical presentation. However, up to 30 percent of patients are diagnosed incidentally while being evaluated for unrelated problems, and one third of patients are diagnosed after a pathologic fracture, commonly of the axial skeleton. Multiple myeloma must be differentiated from other causes of monoclonal gammopathy, including monoclonal gammopathy of undetermined significance, heavy chain disease, plasmacytoma and Waldenstrom macroglobulinemia. Chemotherapy with melphalan-prednisone is the standard treatment for multiple myeloma. Other treatment modalities include polychemotherapy and bone marrow transplantation. Only 50 to 60 percent of patients respond to therapy. The aggregate median survival for all stages of multiple myeloma is three years. It is normal for plasma cells to develop from B cells in lymph nodes as an immune response to disease or infection. Transformation of a normal B cell into a malignant plasma cell involves a multi-step process that includes multiple genetic abnormalities. Finally, the resulting plasma cells become malignant, meaning they continue to divide unchecked, generating more malignant plasma cells (see figure). These myeloma cells travel through the bloodstream and collect in the bone marrow, where they cause permanent damage to healthy tissue. We have recently learned that the interaction between the plasma cells and the bone marrow microenvironment is as important as the genetic changes in the development of these malignant cells. Myeloma, like other cancers, begins in cells. Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place. In cancer, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor. In time, myeloma cells collect in the bone marrow. They may crowd out normal blood cells. Myeloma cells also collect in the solid part of the bone. The disease is called multiple myeloma because it affects many bones. Multiple Myeloma Resources |
 |