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    Multiple myeloma

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

    Multiple myeloma is cancer that starts in the plasma cells in bone marrow. Bone marrow is the soft, spongy tissue found inside mostbones. It helps make blood cells.

    Plasma cells help your body fight infection by producing proteins called antibodies. With multiple myeloma, plasma cells grow out of control in the bone marrow and form tumors in the areas of solid bone. The growth of these bone tumors weakens the solid bones and also makes it harder for the bone marrow to make healthy blood cells and platelets

    Causes

    The exact cause of multiple myeloma is not clear. Past treatment with radiation therapy raisesthe riskof this type of cancer. Multiple myeloma mainly affects older adults.

    Symptoms

    Multiple myeloma most commonly causes a low red blood cell count (anemia), which can lead to fatigue and shortness of breath.It can also cause low white blood cell count, which makes you more likely to get infections. Multiple myeloma also causes lowplatelet count, which can lead to abnormal bleeding.

    As the cancer cells grow in the bone marrow, you may havebone or back pain most often in the ribs or back.

    Ifcancer grows in the spinebones, pressure on the nerves may result. This can lead tonumbness or weakness of the arms or legs.

    Exams and Tests

    Blood tests can help diagnose this disease. These tests include:

    • Albumin level
    • Calcium level
    • Total protein level
    • Kidney function blood tests
    • Complete blood count (CBC)
    • Blood and urine tests to check to identify proteins, or antibodies (immunofixation)
    • Blood tests to quickly and accurately measure the specific level of certain proteins called immunoglobulins (nephelometry)

    This list is not all-inclusive.

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

    Bone density testing may show bone loss.

    Treatment

    People who have mild disease orin whomthe diagnosis is not certain are often not treated. Instead they areclosely watched. Some people have a slow-developing form of multiple myeloma (smoldering myeloma)that takes years to cause symptoms.

    Chemotherapy is usually used to treat multiple myeloma. It is most often given toprevent complications of multiple myeloma such as bone fractures and kidney damage.

    Radiation therapy may be done to relieve bone pain or treat a bone tumor.

    Two types of bone marrow transplants may be tried:

    • Autologous bone marrow or stem cell transplantation is done using the person's own stem cells.
    • Allogeneic transplant uses of someone else’s stem cells. This treatmenthas serious risks but mayoffer the chance of long-term cure.

    Support Groups

    You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

    Outlook (Prognosis)

    Survival of multiple myeloma depends on the patient's age and the stage of disease. In some cases, the diseaseprogresses very rapidly. Inother cases, ittakes years to worsen.

    Chemotherapy and transplants rarely lead to a permanent cure.

    Possible Complications

    Kidney failure is a frequent complication. Others may include:

    • Bone fractures
    • High levels of calcium in the blood, which can be very dangerous
    • Increased chances for infection, especially in the lungs
    • Weakness or loss of movement due to tumor pressing on spinal cord

    When to Contact a Medical Professional

    Call your doctor if you have multiple myeloma and you develop aninfection, or numbness, loss of movement, or loss of sensation.

    References

    National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Multiple Myeloma. Version 1.2013. Available at http://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf.Accessed 01/10/2013.

    Rajkumar SV, Dispenzieri A. Multiple myeloma and related disorders. In: Abeloff MD, Armitage JO, Niederhuber JE, et al., eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2008:chap 110.

    Rajkumar SV. Plasma cell disorders. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011: chap 193.

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      A Closer Look

        Self Care

          Tests for Multiple myeloma

            Review Date: 2/8/2013

            Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Blackman, Stephanie Slon, and Nissi Wang.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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