Definition Multiple myeloma occurs when a specialised white cell, known as a plasma cell, becomes cancerous.
What is going on in the body? Like all components of blood, plasma cells are produced in the bone marrow. Plasma cells produce proteins that help protect the body from infection. After one or more of these cells becomes cancerous, they multiply rapidly. The proteins these cancerous cells make do not work as well as normal proteins. The cancerous cells produce very large amounts of the faulty proteins. These cancerous cells may also crowd out normal cells. Some of the cancerous plasma cells will leave the bone marrow and enter the bloodstream. Some of these cells may enter bones and destroy them. The disease usually takes many years to develop.
What are the signs and symptoms of the disease? A person with multiple myeloma may not have any symptoms early in the disease. Some individuals do notice problems, including:
pain, which occurs when the bones are affected. The bones may be so weak that they break easily.
frequent infections, which may cause illness for some time before the cancer is diagnosed
fatigue, casued by too much protein or calcium in the body
What are the causes and risks of the disease? There is no known cause of multiple myeloma.
What can be done to prevent the disease? There is no known way to prevent multiple myeloma.
How is the disease diagnosed? A person who has symptoms of multiple myeloma will have a number of tests done, including:
a full blood count, or FBC, to detect a low red blood cell count called anaemia
a blood test called Total protein, which will show elevated levels of protein in the blood
a blood test known as serum protein electrophoresis, which will reveal an abnormal amount of some of the body's proteins. Too much protein in the blood may cause kidney damage.
a blood test to measure the amount of calcium in the bloodstream. Calcium is released into the bloodstream as the myeloma spreads to the bones.
a urine electrophoresis test, which may show abnormal proteins in the urine
x-rays of the bones, which may show weakened areas caused by the cancerous plasma cells. The bones can be so weakened that there may be breaks even if there has been no injury.
What are the long-term effects of the disease? Multiple myeloma is a slow-growing cancer that may take many years to cause problems. Multiple myeloma may eventually cause severe kidney damage if it is not treated. The disease can be controlled but not cured. Multiple myeloma leads to death if it is not controlled.
What are the risks to others? There are no risks to others from this disease. It cannot be spread from person to person.
What are the treatments for the disease? Treatment is designed to control the cancer and treat the symptoms.
Chemotherapy involves a combination of medications given by mouth or through the veins. These medications may control the disease for many years. Steroids are sometimes added to chemotherapy to make it work better.
Radiation therapy can treat a bone involved with the cancer. Pain will be reduced. Radiation may help prevent a break in the bone.
Plasmapheresis is a procedure that removes a large amount of abnormal protein from the blood. This will reduce the damage to the kidneys from too much protein. If a person is having other symptoms from high proteins, those symptoms will be reduced.
A special medication, called Aredia, can be given to reduce excess calcium in the blood. This will also strengthen the bones.
What are the side effects of the treatments? Specific side effects of chemotherapy depend on the medication selected. Mild nausea is the most common symptom. This is easily controlled. Temporary hair loss, known as alopecia, may occur. Intensive chemotherapy may have moderate to severe side effects that require more supportive care. Radiation treatment for this cancer is designed to offer relief from pain. It is well tolerated.
What happens after treatment for the disease? The person will be followed closely after treatment. Treatment may be repeated after the person recovers from the side effects. Problems like weakened bones will be treated as they occur.
How is the disease monitored? total protein blood tests and serum protein electrophoresis will be done regularly, along with kidney function tests. Full blood counts, or FBC's, will be done to measure the number of white cells and red cells. All of these tests will monitor the effects of chemotherapy and the course of the disease. Bone marrow biopsies may be done periodically.
Author: Miriam P. Rogers, EdD, RN, AOCN, CNS Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
