The large numbers of abnormal myeloma cells crowd out normal cells in the bone marrow, suppressing or stopping the growth of red blood cells. This can result in anemia. Like normal plasma cells, myeloma cells produce antibodies--too many of them. This overproduction of antibodies builds up in blood and urine and damage the kidneys and other organs. Myeloma cells also damage bones and can cause painful fractures.
Myeloma is often referred to as multiple myeloma because 90% of patients with this disease have multiple bone lesions at the time they are diagnosed. It is possible to have a single mass of myeloma cells involving only one bone or organ. These are called solitary plasmocytomas.
Approximately 21,700 adults are diagnosed each year in the United States with multiple myeloma. Men are more likely than women to get it.
No one knows what causes multiple myeloma, so at this time, there is nothing that you can do to reduce your risk of prevent this disease. The major risk factors are:
The signs and symptoms of multiple myeloma are not specific to this disease. They can be caused by many conditions. It is not unusual for myeloma to be first discovered in a blood test or during an examination for another medical condition. Sometimes people report feeling bad for weeks or months without knowing the cause. Symptoms include:
A doctor may suspect that you have myeloma based on your symptoms, a blood test or an x-ray done for another reason. Some people are diagnosed when they have a broken bone or severe back pain without an obvious cause. The first step in diagnosing any cancer is always a complete physical examination and medical history. Some of these are common tests and others are very specific for myeloma. The doctor may order the following tests:
The M Protein or monoclonal protein is found in the blood and urine of people with multiple myeloma. Doctors test for this protein to diagnose multiple myeloma, assess the extent of the disease, and to monitor whether treatment is working or not.
Risk Groups: In some centers, doctors use all of the information they obtain from these tests to assign patients to "risk groups," which help determine prognosis and guide the treatment plan.
The purpose of all these tests is both to establish an accurate diagnosis of myeloma and to assess the extent of the disease. Staging is a way of describing the cancer, where it is located and how far it has spread. Staging is critical to determining the best treatment plan and evaluating the prognosis of any cancer.
Myelomas behave differently from many other types of cancer, and for this reason, the staging system is somewhat different as well. Myelomas are categorized by the level of the disease and the presence or absence of symptoms.
The stage indicates the overall prognosis. Researchers are currently studying other factors that may predict how aggressive a cancer is and what the prognosis will be for individuals with myeloma.
Patients with smoldering myeloma do not usually receive treatment until their disease progresses and they become symptomatic, known as active surveillance. The treatment recommendations are for patients with active, symptomatic myeloma.
Myeloma is a complex disease. There are many treatment options with new ones emerging all the time. The average survival for multiple myeloma is improving steadily with these new treatments. The goal of treatment is to eliminate the myeloma cells and control the disease for as long as possible, but myeloma can affect many organs, bones and body systems. For this reason, it is important to be treated in a cancer center that has experience and expertise in managing the symptoms of this disease and providing supportive care.
One of the first steps in treating active myeloma is to assess whether the patient is a candidate for high dose chemotherapy and stem cell transplant or will receive chemotherapy without a transplant. Two of the main factors that influence that decision are age and kidney function, but it is important to know that some older patients and those with kidney failure can be eligible for stem cell transplants.
Every patient with multiple myeloma should also receive supportive care to address the many possible symptoms and issues that can be caused by this disease. These include bone problems, pain, kidney problems, hypercalcemia and blood problems. This is a critical part of treating myeloma.
Today, there are a number of chemotherapy drugs and targeted therapies used to treat myeloma. The first phase of treatment is known as induction therapy and it is designed to kill as many myeloma cells as possible. For induction therapy, doctors use several drugs that work in different ways. In most instances, standard chemotherapy drugs are combined with drugs that target the myeloma cells.
The specific choice of which drugs to use in induction therapy depends on whether the patient is considered a candidate for a stem cell transplant. Among the most common drugs are:
Remember, the choice of treatments depends on a number of factors, including the type of myeloma you have, the symptoms you are experiencing, your age and overall health. Clinical trials are underway to find new agents, and to determine the best use of existing therapies--including reducing side effects as much as possible.
Patients who are candidates for stem cell transplants will receive more aggressive treatment, much higher doses of drugs designed to destroy the diseased bone marrow and kill the myeloma cells prior to the transplant. Those patients will also experience more side effects as a result.
Patients who are not candidates for stem cell transplants will receive many of the same drugs as those who are, but often in lower doses or different combinations. Doctors measure the patient's response to the induction therapy and use that information to decide how long to continue treatment and what drugs to use. Patients usually receive steroids and drugs designed to strengthen their bones.
Myeloma patients often have good responses to induction or primary therapy and may achieve what is known as a complete remission in which all the signs and symptoms of the disease disappear, but this does not result in a cure. The myeloma will come back, or relapse. For many patients, treatment involves a stem cell transplant in which the patient's diseased bone marrow is replaced with healthy stem cells.
Not every myeloma patient is a candidate for a stem cell transplant. The procedure has many risks and can be life threatening. Stem cell transplants are not a good option for patients who are in overall poor health or are quite elderly.
The decision as to whether to do a stem cell transplant is often made after the patient has undergone two cycles of treatment and lab tests to determine if the myeloma is responding to treatment or progressing. At that point, it is possible to continue on with the primary therapy for as long as it continues to work well, or to move forward with the stem cell transplant.
The first step is to harvest stem cells from the patient's bone marrow.(known as an AUTO transplant) This is done after induction therapy when the number of myeloma cells is at its lowest. Today, doctors usually harvest enough stem cells for a "tandem" procedure. That means a planned second course of high dose chemotherapy and a second stem cell transplant within six months of the first one.
Next, the patient undergoes high dose chemotherapy to kill any remaining myeloma cells and destroy the diseased bone marrow. Finally, the harvested stem cells are returned to the patient to begin producing new blood cells. It takes about two weeks for the transplanted stem cells to begin working. During that time, the patient is very susceptible to infection and bleeding, so is hospitalized.
In some instances, it is possible to use stem cells from a donor whose blood matches the patient. (Known as an ALLO transplant) This is usually a family member. Stem cell transplants from donors have a higher possibility of achieving a cure because they create a new immune system from the donor's healthy cells, but they also involve a much higher risk of serious complications. The most common complication occurs when the donor cells begin to attack the patient's immune system. This is known as graft vs. host disease, and can be difficult to manage or fatal. Allogeneic stem cell transplants for multiple myeloma are only occasionally used in younger patients. In general, the advantages of harvesting stem cells from the patient outweigh the risks of obtaining them from a donor. Stem cell transplants have high response rates and are considered the standard of care after primary therapy for eligible patients. The value of the tandem stem cell transplant approach is still being evaluated.
Even after a successful stem cell transplant, there is a significant risk that the myeloma will return. For this reason, many doctors now recommend that patients receive maintenance therapy, which can include standard lenalidamide, thalidomide, bortezomib and/or steroids.
It is not uncommon for myeloma to return after successful treatment. When this happens, there are additional options for chemotherapy and targeted therapies. In some cases, it is possible to do a second stem cell transplant. Patients who relapse, especially those whose myeloma has recurred more than once, should also discuss the possibility of participating in clinical trials studying new ways to treat myeloma.
Myeloma can affect many different parts of the body causing anemia, bone and kidney damage. It is critical to manage the symptoms that result from this damage and provide supportive care to patients. This includes medication to help strengthen bones and reduce bone pain. Many patients receive a red blood cell growth factor to help with anemia and antibiotics to reduce the risk of infection. It is also important to manage calcium levels to prevent kidney damage. When a patient has very high levels of the M protein, it can result in thickened blood that harm the kidneys. Doctors use a technique called plasmapheresis to thin the blood. Exercise and a balanced diet also help maintain bone strength and overall health.
Myeloma is a cancer that begins in blood cells called plasma cells. It is a complex disease that can affect many body parts including the bones and kidneys. There are many treatment options available for patients with myeloma but the best hope for long term remissions lies with stem cell transplants that replace the patient's diseased bone marrow with healthy cells. It is also very important to manage the symptoms that result from myeloma's damage to bone and organs. Myeloma should be treated in a cancer center experienced in all phases of myeloma therapy and capable of providing a full range of supportive care. Cancer bites.