MULTIPLE MYELOMA

Multiple myeloma is cancer of the mature lymphocytes (plasma cells). A lymphocyte is a white blood cell involved in the immune system. Lymphocytes are produced in the bone marrow (the soft substance in the center of bones). They produce antibodies that attack any foreign substance (e.g., virus, bacteria) in the body. The cause of multiple myeloma is not known. Many different theories exists, including genetic, viral, and radiation-related causes. More than 14,000 new cases of multiple myeloma were diagnosed last year in the United States. The disease is not contagious.

Multiple myeloma is diagnosed when a patient has the following findings: (1) an abnormal protein in the blood, (2) characteristic findings on bone radiographs (x-rays), and (3) an abnormal bone marrow biopsy (marrow removed from the bone and examined under a microscope). There is no cure for multiple myeloma.

Symptoms of multiple myeloma are caused by (1) expansion and invasion of the bone marrow, which prevents formation of blood cells and (2) production of substances by the cancer cells. Bone pain is the most common symptom of multiple myeloma. The back is most often affected. Myeloma cells destroy the bone and release calcium into the blood system, leading to other complications, such as nerve compression, lower leg weakness, and kidney failure. Elevated calcium levels in the blood can cause increased urination, weakness, and confusion. Anemia and infections are common among patients with multiple myeloma.

Once the diagnosis is confirmed, multiple myeloma is classified into one of three stages. To determine this, the physician orders blood tests and radiographs of the bones. The staging of the cancer gives a prognosis. Many people live longer than 5 years if they have disease in stage I; patients with stage III disease have an average survival time of 15 months.

Management of multiple myeloma may involve no treatment at all unless signs and symptoms of bone pain, elevated calcium level, kidney failure, anemia, or compression of the spinal cord are present. Decisions about starting chemotherapy, the choice of chemotherapeutic drugs, the duration of treatment, and monitoring response are made by an oncologist (physician specializing in cancer). Side effects of chemotherapy are nausea, vomiting, loss of appetite, weight loss, hair loss, easy bruising and bleeding, and infections.

Radiation therapy is used to relieve bone pain and medical emergencies such as compression of the spinal cord. Side effects of radiation depend on which part of the body is irradiated. If the pelvic area is irradiated, nausea, vomiting, diarrhea, urinary difficulties, and fatigue may occur.

Orthopedic operations are needed for bone fractures. Supportive treatment such as use of antibiotics for infections, diuretics (water pills) for elevated blood calcium levels, and narcotic pain medications for relief of pain improve well-being.

• Stay active. This helps keep calcium in your bones.
• Drink lots of fluid. This is the first line of management of elevated calcium blood levels.
• Take your medications as prescribed. A diuretic may be prescribed to help keep your calcium level down. Medicines for pain and infections may be prescribed in the appropriate situations.
• Use back support if needed.

• Do not be immobile. This can lead to a rise in calcium level.
• Do not do heavy lifting.
• Do not be afraid to ask for pain medication. Multiple myeloma can be painful because it involves the bone.
• Do not miss follow-up appointments. Your physician needs to repeat blood tests, radiographs, and urine collections to monitor response to treatment or to decide to start treatment.

• If you are having pain.
• If you are having fevers.
• If you are having back pain, leg numbness or weakness, stool or urinary incontinence (leaking or loss of control). These can be caused by compression on the spinal cord.
• If you notice blood in stool, urine, phlegm, or vomit.
• If you feel depressed.

_______________________________________________________________________________________________________________________________
Copyright © 2000 Mosby, Inc.
All rights reserved.  No part of this publication may be reproduced or transmitted in any form or for any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher.
_______________________________________________________________________________________________
For Comments/Suggestion send email to: webmaster@apma-nc.com