Multiple Myeloma

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Introduction

What is multiple myeloma?

Multiple myeloma is a type of blood cancer that begins in the bone marrow and represents a cancer of the plasma cell, a particular type of blood cell. Healthy plasma cells are like small factories that produce antibodies – and lots of them! In myeloma, there is an abnormal proliferation of plasma cells, clogging the circulation with excess antibodies. Multiple myeloma is not a very common cancer; approximately 20,000 people are diagnosed with multiple myeloma each year in the United States.(Source: LLS).

Some myelomas, called smoldering myelomas, do not have symptoms and may not need immediate treatment. If treatment is delayed, careful follow-up is important so that treatment can be started as soon as significant progression or symptoms become apparent. While multiple myeloma is not curable, treatment can often control disease progression and symptoms.

Multiple myeloma can interfere with production of new blood cells in the bone marrow, which can result in anemia, increased risk of infection, and easy bruising and bleeding. It also produces a substance that weakens bones and abnormal proteins that can cause kidney damage and other problems.

The cause of multiple myeloma is not known, but it is most common in people over the age of 50 and in African Americans.

Because multiple myeloma can decrease production of new blood cells, people who have it can have problems with bleeding and serious infections. Seek immediate medical care (call 911) if you, or someone you are with, have uncontrolled bleeding, severe sweating, severe difficulty breathing, pale or blue lips, fast heart rate, confusion, or loss or change in level of consciousness.

Seek prompt medical care if you have experienced unexpected weight loss, persistent fever, frequent infections, night sweats, tiredness, or bone pain.

Symptoms

What are the symptoms of multiple myeloma?

Multiple myeloma may produce a variety of symptoms or none at all.

Common symptoms of multiple myeloma

Symptoms that can be experienced with multiple myeloma include:

Serious symptoms that might indicate a life-threatening condition

In some cases, multiple myeloma or its complications can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms:

  • Bluish coloration of the lips or fingernails

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • Chest pain, chest tightness, chest pressure, palpitations

  • High fever (higher than 101 degrees Fahrenheit)

  • Rapid heart rate (tachycardia)

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing

  • Seizure

  • Uncontrolled or heavy bleeding, hemorrhage

Causes

What causes multiple myeloma?

The specific cause of multiple myeloma is not known, but there are a number of factors associated with its development. Multiple myeloma is more common among older adults, African Americans, and men.

What are the risk factors for multiple myeloma?

A number of factors increase the risk of developing multiple myeloma. Not all people with risk factors will get multiple myeloma. Risk factors for multiple myeloma include:

  • African American race
  • Advanced age
  • Exposure to certain chemicals
  • Family history of multiple myeloma
  • Male gender
  • Obesity
  • Personal history of certain blood disorders
  • Radiation exposure
Treatments

How is multiple myeloma treated?

Goal of cancer treatment

The goal of multiple myeloma treatment is to bring about a complete remission of the disease. Remission means that there is no longer any sign of the disease in the body, although it may recur or relapse later.

It is important to continue regular visits with your medical care team so that significant progression or relapse can be identified early and to watch for and treat any complications that might result from the disease or its treatments.

Common treatments for multiple myeloma

There are many approaches to treating multiple myeloma; the specific approach taken will depend on the stage of the disease, what symptoms are present, whether kidney damage has occurred, and whether any other health problems exist. Treatment approaches include:

  • Biologic therapy to enhance the immune system’s ability to fight cancer

  • Chemotherapy to attack cancer cells

  • Immunomodulators to help reduce the production of abnormal proteins by cancer cells

  • Participation in a clinical trial testing promising new treatments for multiple myeloma

  • Radiation therapy to help control pain and reduce fracture risk

  • Stem cell transplant to provide healthy stem cells that can make new blood cells

  • Steroids to slow growth of cancer cells and enhance other therapies

  • Targeted therapy to limit the production of new cancer cells

  • Watchful waiting to identify when to start treatment

Other treatments for multiple myeloma

Other therapies may be added to help with your general state of health and any complications of the cancer or its treatment including:

  • Antinausea medications if needed

  • Bisphosphonates to help strengthen bones

  • Blood transfusions to temporarily replace blood components (such as red blood cells or platelets) that have been reduced or lost

  • Dietary counseling to help maintain strength and nutritional status

  • Intravenous fluids to help flush excess calcium out of the bloodstream

  • Pain medications if needed to increase comfort

  • Plasmapheresis to remove excess proteins from the blood

  • Surgery to support weakened bones or treat bone fractures

  • Vaccinations to prevent diseases like the flu and pneumonia

Complementary treatments

Some complementary treatments may help some people to better deal with multiple myeloma and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

Hospice care

In cases in which multiple myeloma has progressed to an advanced stage and has become unresponsive to treatment, the goal of treatment may shift away from controlling the disease and focus on measures to keep a person comfortable and maximize the quality of life. Hospice care involves medically controlling pain and other symptoms while providing psychological and spiritual support as well as services to support the patient’s family.

What are the potential complications of multiple myeloma?

Complications of untreated or poorly controlled multiple myeloma can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of multiple myeloma include:

  • Adverse effects of multiple myeloma treatment

  • Amyloidosis (rare immune-related disorder characterized by protein buildup in organs and tissues that can cause serious complications)

  • Anemia (low red blood cell count)

  • Broken bones

  • Hypercalcemia (increased calcium in the blood)

  • Hyperviscosity syndrome (thickened blood that is difficult for the heart to pump)

  • Immune deficiency and frequent infections

  • Kidney failure

  • Spinal cord compression, which can cause paralysis and loss of sensation

  • Spread of cancer

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Myeloma. The Leukemia & Lymphoma Society. http://www.lls.org/#/searchresults?action=search&query=myeloma
  2. Multiple myeloma. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001609/
  3. Rajkumar SV, Merlini G, San Miguel JF. Haematological cancer: Redefining myeloma. Nat Rev Clin Oncol 2012; 9:494.
  4. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013; 63:11.
  5. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
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