Multiple Myeloma - Symptoms & Treatment

Multiple myeloma (say: "my-el-oh-ma") is a kind of cancer in the bone marrow. Multiple myeloma is a disseminated neoplasm of marrow plasma cells. It's also called malignant plasma-cytoma, plasma cell myeloma, and myelomatosis. The disease infiltrates bone to produce osteolytic lesions throughout the skeleton (flat bones, vertebrae, skull, pelvis, and ribs). In late stages, it infiltrates the body organs as well (liver, spleen, lymph nodes, lungs, adrenal glands, kidneys, skin, and GI tract).

Multiple myeloma strikes mostly men over age 40. It usually carries a poor prognosis because by the time it's diagnosed, it has already infiltrated the vertebrae, pelvis, skull, ribs, clavicles, and sternum. By then, skeletal destruction is widespread and, without treatment, leads to vertebral collapse. Within 3 months of diagnosis, 52 % of patients die; within 2 years, 90% die. If the disease is diagnosed early, treatment can often prolong life by 3 to 5 years.

Causes

Although the cause of multiple myeloma isn't known, genetic factors and occupational exposure to radiation have been linked to the disease.

It is slightly more common in men than in women. It doesn't usually run in families. Myeloma is more common in blacks than in whites. Some studies suggest that workers in agriculture or petroleum-based industries may be at greater risk.

Signs and Symptoms

The following are the most common symptoms for myeloma bone disease. However, each individual may experience symptoms differently. Myeloma cells and antibodies may cause the following:

• back pain
• bone pain
• constipation
• fatigue
• fractures in bones
• problems with urination
• repeated infections
• rib pain
• vomiting
• weakness
• weakness or numbness in legs
• weight loss

The symptoms of myeloma bone disease may resemble other bone disorders or medical problems. Always consult your physician for a diagnosis.

Diagnostic tests 

The diagnosis of myeloma depends on three abnormal findings:

1. A bone marrow containing more than 15% plasma cells. Normally no more than 4% of the cells in the bone marrow are plasma cells.
2. X-rays showing generalised thinning of the bones and/or punched out lesions and
3. serum and/or urine showing the presence of an abnormal protein.

Treatment

Long-term treatment of multiple myeloma consists mainly of chemotherapy to suppress plasma cell growth and control pain. Combinations of melphalan and prednisone or of cyclophosphamide and prednisone are used. Adjuvant local radiation reduces acute lesions and relieves the pain of collapsed vertebrae.

Other treatment usually includes administration of analgesics for pain. If the patient develops vertebral compression, he may require a laminectomy; if he has renal complications, he may need dialysis. Maintenance therapy with interferon may prolong the plateau phase when the initial chemotherapy is complete.

Because the patient may have bone demineralization and may lose large amounts of calcium into blood and urine, he's a prime candidate for renal calculi, nephrocalcinosis, and, eventually, renal failure from hypercalcemia. Hydration, diuretics, corticosteroids, oral phosphate, and gallium l.V. to decrease serum calcium levels control the hypercalcemia. Plasmapheresis removes the M protein from the blood and returns the cells to the patient, although this effect is only temporary.

Prevention

The following tips may help you keep multiple myeloma under control:

• Exercise helps keep your bones stronger. If pain keeps you from being active, ask your doctor about ways to lessen the pain.
• One way to promote your overall health and cope with any form of cancer is to eat well. The amount of M protein in your system isn't affected by how much protein you eat, so there's no need to limit protein intake unless told otherwise by your doctor.
• Drinking fluids can help keep you from becoming dehydrated.