Multiple myeloma is cancer of the bone marrow caused by the uncontrolled growth of plasma cells, a form of white blood cells. Normally, plasma cells make antibodies called immunoglobulins to fight infections. In multiple myeloma, however, plasma cells multiply uncontrollably and make too much of a single type of immunoglobulin. The level of other types of immunoglobulin drops dangerously low, leaving the patient open to infections. The cancerous plasma cells collect in the bones and bone marrow and sometimes form tumors that destroy the bone tissue, causing the bones to become weak and possibly break.

In addition, the presence of these large quantities of immunoglobulins in the blood stream may cause the blood to become excessively thick, leading to blood clots and abnormalities of kidney function. The result of the destruction of the bones can cause high levels of calcium to accumulate in the blood stream, leading to both kidney and neurological problems.

Multiple myeloma is a fairly rare form of cancer, affecting only 3 to 4 of every 100,000 people in the United States each year. It tends to occur in older people. The average age that this cancer develops is 60. Other risk factors include exposure to radiation, benzene or pesticides.

There may not be any symptoms early in the illness. However, as multiple myeloma progresses, symptoms can include:

• Pain in the bones, especially in the back, ribs, and, sometimes, the arms � Pain occurs when bone is being destroyed by the myeloma cells.
• Frequent infections
• Fatigue
• A tendency to bleed easily, especially from the nose or gums
• Easy bruising
• A general numbness of the skin
• Severe kidney problems
• Loss of appetite
• Nausea and vomiting
• Confusion

Your doctor will order blood tests to check for anemia, which is a low level of red blood cells. The disease causes anemia when plasma cells crowd the bone marrow and prevent it from producing red blood cells normally. Blood tests also can check whether your blood has unusually high levels of protein, a sign of the large amounts of immunoglobulin being formed by cancerous plasma cells. You may be asked to collect your urine for 24 hours so that it can be analyzed to see if it contains too much protein.

Your doctor may order X-rays of the long bones in your body, your skull and chest to help confirm the diagnosis and to check for bone weakness. A bone marrow biopsy also will be done to confirm an abnormally high level of plasma cells. This procedure is done under local anesthesia in your doctor's office. A long needle is used to withdraw a small amount of bone marrow so it can be examined under a microscope. Normally, plasma cells account for less than 5% of the cells in the bone marrow. However, in patients with multiple myeloma, this percentage increases to 10% to 90%. Multiple myeloma is diagnosed if a bone marrow biopsy shows more than 30% plasma cells.

After diagnosis, laboratory tests will determine the extent of the cancer, which is described in terms of stages. Staging is complicated and is based on protein levels, calcium levels, kidney function, and the presence of cancer in the bone.

• Stage I � Few cancer cells have spread through the body, and there may not be any symptoms of the disease.



• Stage II � A moderate number of cancer cells have spread through the body.



• Stage III � A large number of cancer cells have spread through the body. There also can be anemia resulting from a decrease in red blood cells; high levels of calcium in the blood because of damaged bones; more than three bone tumors; or a high level of M-protein in the blood, a reflection of the extent of tumor growth throughout the body.

About 15% of patients die within the first three months after diagnosis. In most cases, the illness progresses slowly for two to five years, followed by a relatively brief period when symptoms rapidly worsen.

It may be possible to prevent some cases of multiple myeloma by avoiding exposure to radiation, benzene or pesticides.

If you do not have any symptoms, treatment may be delayed until the disease progresses, depending on your overall health. When treatment is started, it can include:

• Several four- to six-week courses of chemotherapy , given over a period of one to two years. With this treatment, about 70% of patients improve, and no evidence of disease remains in about 10% of patients.



• Intravenous infusions of bisphosphonates � This class of drug, often given once a month, can decrease the risk of bone fractures and improve survival in myeloma.



• Chemotherapy � Several new classes of drugs have recently been developed that have proven very effective in the management of multiple myeloma. Cancer specialists who are experienced in the management of myeloma will be able to select the most appropriate new treatment once the diagnosis of myeloma has been made.



• Radiation therapy to treat tumors in the bone



• Intravenous infusions of immunoglobulins to prevent serious infections



• Bone marrow transplant � This may help patients younger than 65, especially if done early in the course of the illness.

It is not clear that any of these therapies can cure patients, though they often can control the disease for years.

Call your doctor if you experience any of the symptoms of multiple myeloma, especially frequent infections, bone pain, frequent nosebleeds, prolonged bleeding after minor cuts, easy bruising or unusual fatigue. People older than 50 should be especially alert to these symptoms.

Overall, about 29% of patients diagnosed with multiple myeloma live more than five years after diagnosis. The average 5-year survival rate varies depending on the stage of their illness:

• Stage I � 25% to 40%
• Stage II � 15% to 30%
• Stage III � 10% to 25%

Multiple Myeloma Research Foundation
51 Locust Ave.
Suite 201
New Canaan, CT 06840
Phone: 203-972-1250
E-Mail: info@themmrf.org
http://www.multiplemyeloma.org/

National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
Building 31, Room 10A03
31 Center Drive, MSC 8322
Bethesda, MD 20892-2580
Phone: 301-435-3848
Toll-Free: 1-800-422-6237
TTY: 1-800-332-8615
E-Mail: cancergovstaff@mail.nih.gov
http://www.nci.nih.gov/

American Cancer Society (ACS)
1599 Clifton Road, NE
Atlanta, GA 30329-4251
Toll-Free: 1-800-227-2345
http://www.cancer.org/