Disease: Multiple Myeloma

    What is multiple myeloma?

    Multiple myeloma is often referred to simply as myeloma. It is a type of cancer that starts in the plasma cells of the bone marrow. These are protein-making cells which normally make all of the different kinds of proteins that comprise the antibodies of the immune system. In multiple myeloma, the plasma cells undergo what is referred to as a malignant transformation and thereby become cancerous. These myeloma cells stop making different forms of protein in response to the immune system's needs and instead start to produce a single abnormal type of protein referred to as a monoclonal or M protein. Multiple myeloma plasma cell populations accumulate and these collections of cells called plasmacytomas can erode the hard outer shell or cortex of the bone that normally surrounds the marrow. These weakened bones show thinning of the bone such as is seen in nonmalignant osteoporosis or what appear to be punched out or lytic bone lesions. These lesions may cause pain and even breaks or fractures of the bones so damaged. They may cause other systemic problems listed below.

    What causes multiple myeloma?

    What triggers plasma cells to become malignant in multiple myeloma is not known. The cancerous myeloma plasma cells proliferate and crowd out normal plasma cells and can etch away areas of bones. The proteins produced in large amounts can cause many of the symptoms of the disease by making the blood more thickened (viscous) and depositing the proteins in organs that can interfere with the functions of the kidneys, nerves, and immune system.

    What are risk factors for multiple myeloma?

    The definitive cause of multiple myeloma has not been established, but research has suggested several factors may be risk factors or contribute to multiple myeloma development in an individual. A genetic abnormality such as c-myc oncogenes and others have been associated with multiple myeloma development. Currently, there is no evidence that heredity plays a role in multiple myeloma development. Environmental exposures to herbicides, insecticides, benzene, hair dyes, and radiation have been suggested as causes but definitive data is lacking. Inflammation and infection have been suggested but again not proven to cause multiple myeloma. However, a benign proliferation of a plasma cell can result in a situation where a monoclonal antibody is produced in high amounts (but not as high as seen with multiple myeloma). This result is termed monoclonal gammopathy of unknown or undetermined significance (abbreviated as MGUS). About 19% of MGUS patients develop multiple myeloma in about two to 19 years after MGUS diagnosis.

    What are multiple myeloma symptoms and signs?

    Patients with myeloma may be found asymptomatic with an unexplained increase in protein in the blood. With more advanced disease, some myeloma patients may present with weakness due to anemia caused by inadequate production of red blood cells, with bone pain due to the aforementioned bone damage, and as the abnormal M protein can accumulate in and damage the kidneys thereby resulting in a patient being found to have otherwise unexplained kidney damage and decreased kidney function.

    The following is a list symptoms and signs of multiple myeloma:

    • Anemia
    • Bleeding
    • Nerve damage
    • Skin lesions
    • Enlarged tongue (macroglossia)
    • Bone tenderness or pain
    • Weakness or tiredness
    • Infections
    • Pathologic bone fractures
    • Spinal cord compression
    • Kidney failure

    How is multiple myeloma diagnosed?

    In many patients, multiple myeloma is first suspected when a routine blood test shows an abnormal amount of protein in the bloodstream or an unusual stickiness of red blood cells causing them to stack up almost like coins in a pattern called rouleaux, an unusual formation for red blood cells. The doctor will do a history and physical exam, looking for signs and symptoms (see above) of multiple myeloma. If multiple myeloma is suspected, several studies help confirm the diagnosis. They include a bone marrow aspiration and biopsy most commonly from the large bones of the pelvis. Cells obtained from the marrow are studied by a pathologist to determine if there are abnormal types or numbers of cells. A sample of the bone marrow aspirate is also studied for more detailed characteristics such as the presence or absence of abnormal numbers or types of chromosomes by what is called cytogenetic testing. Other molecular testing may be done on the marrow sample as well. The bone marrow biopsy can assess the concentrations of cells in the marrow and the presence of abnormal invasive growth of cellular elements. Blood testing and urine testing by several methods can determine levels and types of monoclonal protein produced. The M protein may be a complete form of a type of antibody called an immunoglobulin or only a portion of the protein called a light chain. Normal antibodies consist of both heavy and light chain components. In 2011, the National Comprehensive Cancer Network (NCCN) recommended that a serum free light chain assay and fluorescence in situ hybridization (FISH) test be used to further identify multiple myeloma in patients. Most clinicians will use X-ray studies to identify skeletal lesions and MRI for spinal, paraspinal, or spinal cord lesions in multiple myeloma. In addition, several routine tests (CBC, sedimentation rate, BUN, C-reactive protein, and others) are also done.

    What are the stages of multiple myeloma?

    There are four stages of multiple myeloma. While many doctors use different staging, these are various stages cited by many clinicians:

    • Smoldering: multiple myeloma with no symptoms
    • Stage I: early disease with little anemia, relatively small amount of M protein and no bone damage
    • Stage II: more anemia and M protein as well as bone damage
    • Stage III: still more M protein, anemia, as well as signs of kidney damage

    Because staging criteria differ according to different groups, some clinicians simply define the individual's multiple myeloma without assigning a stage and simply estimate a prognosis (see below) for their patient. In 2013, an international group divided stages into three stages based on two criteria, the concentration of beta-2-microglobulin and serum albumin levels; over time this defined criteria may become widely accepted.

    What is the treatment for multiple myeloma?

    There is no known treatment that cures multiple myeloma. However, there are methods to decrease the occurrence and severity of symptoms and prolong life. The therapy is decided based upon the patient's condition and the cancer management team, made with the patient's input. The team will likely involve both a medical specialist in the treatment of myeloma called a medical oncologist, as well as a radiation oncologist and other consultants as appropriate. Oncology trained nurses and other personnel will likely be important members of the treatment team.

    The choices for treatment(s) often include combinations drugs, some of which are given as pills and others by intravenous injection. These include drugs which affect or modulate the immune system, steroids, and some oral or injectable chemotherapy drugs. These are usually used in combinations. There may be a role for high-dose chemotherapy followed by the administration of bone marrow stem cells called a stem cell transplant. Numerous factors come into play in determining whether or not to do such a transplant. Further information may be obtained from the National Comprehensive Cancer Network Guidelines (NCCN.org) which are updated at least yearly.

    Painful areas of bone damage may be treated with radiation therapy. Broken bones can be surgically repaired in many cases.

    There are many drugs used to treat multiple myeloma. Research is ongoing and newer drugs are being investigated and used for treatment with some frequency. For example, a clinical trial in 2013 reported that lenalidomide (Revlimid) produced a significant increase in the survival of individuals newly diagnosed multiple myeloma. Most doctors who specialize in cancer treatment will be aware of the newest treatments for multiple myeloma.

    What are multiple myeloma symptoms and signs?

    Patients with myeloma may be found asymptomatic with an unexplained increase in protein in the blood. With more advanced disease, some myeloma patients may present with weakness due to anemia caused by inadequate production of red blood cells, with bone pain due to the aforementioned bone damage, and as the abnormal M protein can accumulate in and damage the kidneys thereby resulting in a patient being found to have otherwise unexplained kidney damage and decreased kidney function.

    The following is a list symptoms and signs of multiple myeloma:

    • Anemia
    • Bleeding
    • Nerve damage
    • Skin lesions
    • Enlarged tongue (macroglossia)
    • Bone tenderness or pain
    • Weakness or tiredness
    • Infections
    • Pathologic bone fractures
    • Spinal cord compression
    • Kidney failure

    How is multiple myeloma diagnosed?

    In many patients, multiple myeloma is first suspected when a routine blood test shows an abnormal amount of protein in the bloodstream or an unusual stickiness of red blood cells causing them to stack up almost like coins in a pattern called rouleaux, an unusual formation for red blood cells. The doctor will do a history and physical exam, looking for signs and symptoms (see above) of multiple myeloma. If multiple myeloma is suspected, several studies help confirm the diagnosis. They include a bone marrow aspiration and biopsy most commonly from the large bones of the pelvis. Cells obtained from the marrow are studied by a pathologist to determine if there are abnormal types or numbers of cells. A sample of the bone marrow aspirate is also studied for more detailed characteristics such as the presence or absence of abnormal numbers or types of chromosomes by what is called cytogenetic testing. Other molecular testing may be done on the marrow sample as well. The bone marrow biopsy can assess the concentrations of cells in the marrow and the presence of abnormal invasive growth of cellular elements. Blood testing and urine testing by several methods can determine levels and types of monoclonal protein produced. The M protein may be a complete form of a type of antibody called an immunoglobulin or only a portion of the protein called a light chain. Normal antibodies consist of both heavy and light chain components. In 2011, the National Comprehensive Cancer Network (NCCN) recommended that a serum free light chain assay and fluorescence in situ hybridization (FISH) test be used to further identify multiple myeloma in patients. Most clinicians will use X-ray studies to identify skeletal lesions and MRI for spinal, paraspinal, or spinal cord lesions in multiple myeloma. In addition, several routine tests (CBC, sedimentation rate, BUN, C-reactive protein, and others) are also done.

    What are the stages of multiple myeloma?

    There are four stages of multiple myeloma. While many doctors use different staging, these are various stages cited by many clinicians:

    • Smoldering: multiple myeloma with no symptoms
    • Stage I: early disease with little anemia, relatively small amount of M protein and no bone damage
    • Stage II: more anemia and M protein as well as bone damage
    • Stage III: still more M protein, anemia, as well as signs of kidney damage

    Because staging criteria differ according to different groups, some clinicians simply define the individual's multiple myeloma without assigning a stage and simply estimate a prognosis (see below) for their patient. In 2013, an international group divided stages into three stages based on two criteria, the concentration of beta-2-microglobulin and serum albumin levels; over time this defined criteria may become widely accepted.

    What is the treatment for multiple myeloma?

    There is no known treatment that cures multiple myeloma. However, there are methods to decrease the occurrence and severity of symptoms and prolong life. The therapy is decided based upon the patient's condition and the cancer management team, made with the patient's input. The team will likely involve both a medical specialist in the treatment of myeloma called a medical oncologist, as well as a radiation oncologist and other consultants as appropriate. Oncology trained nurses and other personnel will likely be important members of the treatment team.

    The choices for treatment(s) often include combinations drugs, some of which are given as pills and others by intravenous injection. These include drugs which affect or modulate the immune system, steroids, and some oral or injectable chemotherapy drugs. These are usually used in combinations. There may be a role for high-dose chemotherapy followed by the administration of bone marrow stem cells called a stem cell transplant. Numerous factors come into play in determining whether or not to do such a transplant. Further information may be obtained from the National Comprehensive Cancer Network Guidelines (NCCN.org) which are updated at least yearly.

    Painful areas of bone damage may be treated with radiation therapy. Broken bones can be surgically repaired in many cases.

    There are many drugs used to treat multiple myeloma. Research is ongoing and newer drugs are being investigated and used for treatment with some frequency. For example, a clinical trial in 2013 reported that lenalidomide (Revlimid) produced a significant increase in the survival of individuals newly diagnosed multiple myeloma. Most doctors who specialize in cancer treatment will be aware of the newest treatments for multiple myeloma.

    Source: http://www.rxlist.com

    There is no known treatment that cures multiple myeloma. However, there are methods to decrease the occurrence and severity of symptoms and prolong life. The therapy is decided based upon the patient's condition and the cancer management team, made with the patient's input. The team will likely involve both a medical specialist in the treatment of myeloma called a medical oncologist, as well as a radiation oncologist and other consultants as appropriate. Oncology trained nurses and other personnel will likely be important members of the treatment team.

    The choices for treatment(s) often include combinations drugs, some of which are given as pills and others by intravenous injection. These include drugs which affect or modulate the immune system, steroids, and some oral or injectable chemotherapy drugs. These are usually used in combinations. There may be a role for high-dose chemotherapy followed by the administration of bone marrow stem cells called a stem cell transplant. Numerous factors come into play in determining whether or not to do such a transplant. Further information may be obtained from the National Comprehensive Cancer Network Guidelines (NCCN.org) which are updated at least yearly.

    Painful areas of bone damage may be treated with radiation therapy. Broken bones can be surgically repaired in many cases.

    There are many drugs used to treat multiple myeloma. Research is ongoing and newer drugs are being investigated and used for treatment with some frequency. For example, a clinical trial in 2013 reported that lenalidomide (Revlimid) produced a significant increase in the survival of individuals newly diagnosed multiple myeloma. Most doctors who specialize in cancer treatment will be aware of the newest treatments for multiple myeloma.

    Source: http://www.rxlist.com

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