Multiple myeloma was first identified in 1848. It is a treatable, but incurable, form of cancer. It is the second most common form of blood cancer behind non-Hodgkinís lymphoma.
This type of cancer – also known as Kahler Disease, Myelomatosis, plasma cell myeloma, and plasma cell dyscrasia – begins in the plasma cells of blood. Myeloma begins once the abnormal plasma cells begin to divide and create new, abnormal plasma cells.
These cells are found in bone marrow where they do irreversible damage. Multiple myeloma occurs when abnormal cells are found in multiple bones, tissues, or organs. In 2008, the American Cancer Society reported 19,920 new cases of multiple myeloma and 10,690 deaths from the disease.
Risk Factors
Doctors do not know what causes multiple myeloma; however, they have found some similarities in patients. Men are more frequently stricken with multiple myeloma than women.
The average age for male patients’ diagnoses is 62 while females’ is 61; the disease is rare for those under the age of 35. African Americans seem to be the highest risk race, while Asian Americans seem to be the lowest risk race. Specifically, one study in October 2008 concluded “The age-adjusted annual incidence of multiple myeloma is 4.3 cases per 100,000 white men, 3 cases per 100,000 white women, 9.6 cases per 100,000 black men, and 6.7 cases per 100,000 black women.”
People with monoclonal gammopathy of undetermined significance (MGUS) seem to be at higher risk for developing multiple myeloma, but MGUS patients are generally watched very closely for abnormalities. Those with family members with multiple myeloma are also at a slightly higher risk of developing the disease as well. A small number of cases of patients with high radiation exposure have also lead to multiple myeloma.
Finally, some industries – including agricultural, petroleum, leather, and cosmetology – seem to report a higher number of cases. However, having any of these risk factors does not necessarily mean that multiple myeloma will develop.
Prognosis
There are about 5 to 7 cases per 100,000 people each year, and about 56,200 people were living with multiple myeloma in 2005. The median survival is about three years after diagnosis. Once the kidneys are impacted, the prognosis deteriorates quickly. The Cleveland Clinic Myeloma Research Program in Ohio seems to be at the forefront for research of this disease and offers the largest hospital-based support group in the US.
Prevention
To date, researchers have been unable to determine a cause for multiple myeloma, making preventative action nearly impossible.
Signs & Symptoms
The earliest stages have no noticeable symptoms, so a diagnosis is often made under routine blood testing. The following list offers signs and symptoms of multiple myeloma; however, they may also be a sign of other health concerns. A doctor should be consulted if any of these traits are exhibited.
Common Signs & Symptoms
- Bone pain (often lower back, spine, and ribs)
- Broken bones or osteoporosis (pelvis, spine, ribs, and skull)
- Weakness/exhaustion/fatigue
- Loss of appetite
- Confusion
- Parched
- Fevers/Infections, especially pneumonia
- Weight loss
- Nausea/vomiting
- Constipation
- Abnormal frequency of urination
Other Signs & Symptoms
- Hyperviscosity syndrome (thickening of blood): signs include shortness of breath, confusion, or chest pain.
- Cryoglobulinemia: signs include pain and numbness in extremities in cold weather.
- Amyloidosis: signs include low blood pressure, numbness in extremities, and kidney, heart, or liver failure.
Associated Disorders
- Anemia
- Spinal cord compression
- Hypercalcemia, which often leads to renal damage
- Renal damage due to excess protein in the blood
- Impaired production of immogobulin
- Pain, tingling, and/or numbness
Diagnosis & Staging
Multiple myeloma is often discovered through routine blood tests or as a result of a broken bone. All myeloma patients will show a spike in M protein, which is produced by myeloma cells, in a blood or urine test. Also, both tests will identify poorly functioning immuglobulin, a sign of myeloma.
A diagnosis typically requires one major (a positive biopsy; bone marrow with 30%+ plasma cells; or high MCIG levels) and one minor criterion (bone marrow with 10-30% plasma cells; minor MCIG levels; tumor holes in bones; or low antibody levels) or three minor criteria.
There are typically four tests commonly employed to diagnose multiple myeloma:
- Blood tests: to check for high levels of proteins, low levels of white blood cells and/or platelets, high levels of calcium, and creatinine levels from the kidneys.
- Urine tests: to check for high levels of Bence Jones proteins.
- X-rays: to check for broken or thinning bones
- Biopsies: to check tissue and/or bone marrow for cancerous cells.
Staging Mulitple Myeloma
Staging involves figuring out how advanced multiple myeloma is. To determine this, doctors are likely to order three tests:
- Blood tests
- CT scan
- MRI
Stages
The stages of multiple myeloma are based on the levels of M protein, the number of bone lesions, the number of red blood cells, and calcium levels. These levels can also be subdivided into A and B based on the function of the kidney. Note that doctors are increasingly rejecting the Stage I-III system for case-by-case markers.
Stage I: Early disease with symptoms and some bone damage.
Stage II: More advanced symptoms and damage.
Stage III: Still more myeloma cells are found throughout the body.
A new staging system, called the International Staging System (ISS), is becoming more widely accepted. It is based on the results of two blood tests (for beta 2-microglobulin and albumin) and seems to be a more reliable way to stage the disease.
Treatment
Once myeloma is confirmed, patients are classified into three categories based on their test results.
- MGUS
- Asymptomatic
- Symptomatic
This classification will help with treatment options.
Common Treatment Options
Treatment, of course, depends on how advanced the disease is (or what stage it is in). For those in the smoldering stage, doctors typically do not prescribe any treatment but rather monitor the patient very closely for changes in plasma cells. Even some Stage I patients postpone treatment to delay adverse side effects from treatments.
Once symptoms begin appearing, patients typically get induction therapy. This typically involves various drugs, including chemotherapy to kill myeloma cells, targeted therapy to block the growth of myeloma cells, and steroids to kill myeloma cells. Some of the more common drugs include: Thalomid (thalidomide), Velcade (bortezomib), pamidronate, and Zometa (zoledronic acid).
In most cases, these treatments can be done as outpatients or at home. However, treatment does not come without side effects. Low levels of healthy blood cells can result in infections, bruising, bleeding, weakness, and exhaustion. Temporary hair loss is common with chemotherapy. Digestive problems, including diarrhea or constipation, nausea, and sores, often arise as well. Drug treatment can also cause dizziness, drowsiness, numbness in extremities, and low blood pressure.
Other Treatment Options
Stem cell transplants, sometimes multiple surgeries, can be part of the treatment. A patient can store his own stem cells, or a donorís cells can be used.
Treatment can often mitigate the progression of multiple myeloma; however, myeloma is rarely cured. Seeing a specialist – hemotologists, medical oncologists, and radiation oncologists – may also be warranted. Further, before undergoing any procedure, consider seeking a second opinion to decide on the best course of action for the patient.
Finally, seek supportive care to prevent or control ailments associated with fighting multiple myeloma. Patients are more likely to develop infections and/or anemia and/or kidney problems and/or amyloidosis, feel pain, and risk bone fractures and/or high levels of calcium in the blood.
