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Multiple myeloma is an incurable but treatable disease. Also known as myeloma or plasma cell myeloma, it is a hematologic cancer, meaning it develops in the blood. It is a cancer of the plasma cell, an important part of the immune system that produces immunoglobulins (antibodies) to help fight infection and disease.
As tumors grow inside the bone marrow, they invade the hard, outer part of the bone. In most cases, the myeloma cells spread into the cavities of all the large bones of the body, forming multiple small lesions. Hence the name "multiple" myeloma. In some cases, however, the myeloma cells collect in a single bone and form a tumor called plasmacytoma.
A patient's myeloma is often referred to by the type of immunoglobulin or light chain (kappa or lambda type) produced by the cancerous plasma cell. The frequency of the various immunoglobulin types of myeloma parallels the normal serum concentrations of the immunoglobulins. The most common myeloma types are IgG and IgA. IgG myeloma accounts for about 60-70% of all cases of myeloma and IgA accounts for about 20% of cases. Few cases of IgD and IgE myeloma have been reported.
Incidence; Risk Factors
Multiple myeloma is the second most prevalent blood cancer after non-Hodgkin's lymphoma. It represents approximately 1% of all cancers and 2% of all cancer deaths. Although the peak age of onset of multiple myeloma is 65 to 70 years of age, recent statistics indicate both increasing incidence and earlier age of onset. At the time of writing, there are approximately 45,000 people in the United States living with multiple myeloma and an estimated 14,600 new cases of multiple myeloma are diagnosed each year.
Multiple myeloma affects slightly more men than women. African Americans and Native Pacific Islanders have the highest reported incidence of this disease and Asians the lowest. Results of a recent study found the incidence of myeloma to be 9.5 cases per 100,000 African Americans and 4.1 cases per 100,000 Caucasian Americans. Among African Americans, myeloma is one of the top 10 leading causes of cancer death.
Agricultural occupations, petroleum workers, workers in leather industries, and cosmetologists with exposure to herbicides, insecticides, petroleum products, heavy metals, plastics, and various dusts, including asbestos, seem to have a higher-than-average chance of multiple myeloma. In addition, individuals exposed to large amounts of radiation are at increased risk for myeloma.
Signs & Symptoms
There are often no symptoms in the early stages of myeloma. In some cases, myeloma may be discovered by accident during routine blood testing. When present, symptoms may be vague and similar to those of other conditions. Here are possible symptoms; rarely does one patient have all of them:- Kidney problems -- Excess protein in the blood, which is filtered through the kidneys, can cause kidney damage and lead to renal failure. Increased calcium in the blood (hypercalcemia) overworks the kidneys and can cause a variety of symptoms, including loss of appetite, fatigue, muscle weakness, restlessness, difficulty in thinking or confusion, constipation, increased thirst, increased urine production, and nausea and vomiting.
- Pain -- A common early symptom of multiple myeloma is pain in the lower back or in the ribs. This is the result of tiny fractures in the bones caused by accumulation of plasma cells and weakened bone structures.
- Fatigue -- As the number of malignant plasma cells increases in the bone marrow, the growth and development of red blood cells in the bone marrow may be suppressed, leading to low levels of red blood cells in the blood (anemia). Anemia can result in unusual tiredness and abnormal paleness.
- Recurrent infection -- Increased numbers of myeloma cells can also decrease the production of infection-fighting white blood cells, leading to reduced immunity and the possibility of frequent recurrent infections, such as bacterial pneumonia, urinary-tract infections, and shingles.
Much less frequent symptoms with multiple myeloma are related to complications that may occur with the disease. These complications include:- Hyperviscosity syndrome, which occurs when the protein concentration in the blood becomes very high and the blood becomes very thick and sticky. Signs and symptoms of hyperviscosity are shortness of breath, confusion, and chest pain.
- Cryoglobulinemia, which may occur when the paraprotein is of a specific type that comes out of solution as particles when exposed to cold temperatures. These particles may block small blood vessels and cause symptoms such as pain and numbness in the fingers and toes in cold weather.
- Amyloidosis is a rare complication that occurs more often in patients whose plasma cells produce only light chains. Light chains can combine with other serum proteins to produce amyloid protein, a starch-like substance. The amyloid protein may be deposited in various tissues and organs, including the kidneys, liver, and heart, and disrupt their normal functions. Also, amyloid protein can stick to the walls of blood vessels, causing them to lose their elasticity and make it difficult to maintain blood pressure. Symptoms of amyloidosis may include low blood pressure and kidney, heart, or liver failure. Amyloidosis is a disease that also occurs in individuals who do not have multiple myeloma.
Diagnosis & Tests
The diagnosis of multiple myeloma is often made incidentally during routine blood tests for other conditions. For example, the existence of anemia and a high serum protein may suggest further testing.
A diagnosis of myeloma is made based on the presence of an increased number of plasma cells in the bone marrow and, in most cases, the presence of excess protein (M protein) in the blood or urine. At that point, patients are generally classified into categories based on their clinical and laboratory evaluation. Patients are also staged according to the severity of their disease based on a number of criteria.
A number of laboratory tests and medical procedures are used to help confirm a diagnosis of myeloma. These tests should be conducted on all patients as part of an initial evaluation.- A Complete Blood Count (CBC)
- A Chemistry profile checks levels of blood urea nitrogen (BUN) and blood levels of calcium, creatinine, and lactate dehydrogenase (LDH). Increased BUN and creatinine indicate decreased kidney function, while LDH levels help assess tumor cell burden.
- Urinalysis measures levels of protein in the urine.
- Electrophoresis (EP) measures the levels of various proteins in the blood or urine.
- X-rays and other imaging tests can assess changes in the bone structure and determine the number and size of bone lesions. These tests include:
- Bone marrow aspiration or bone marrow biopsy can detect an increase in the number of plasma cells in the bone marrow. An aspiration requires a sample of liquid bone marrow, and a biopsy requires a sample of solid bone tissue. The procedure for doing these tests is similar except that a biopsy involves a larger needle. In both tests, samples are taken from either the hip or breast bone and are examined under a microscope. The percentage of plasma cells present is determined. Multiple myeloma is probable if 10% or more of the cells in the bone marrow sample are plasma cells.
Patients may be classified into 1 of 4 myeloma categories to help to determine treatment options.- Monoclonal Gammopathy of Undetermined Significance (MGUS)
- Smoldering Multiple Myeloma (SMM)
- Indolent Multiple Myeloma (IMM)
- Symptomatic Multiple Myeloma (MM)
Treatment & Prevention
While a myeloma diagnosis can be overwhelming, it is important to remember that there are several promising, new therapies that are helping patients live longer, healthier lives.
Patients in some myeloma categories do not have to receive treatment immediately. In these cases, postponing therapy may help avoid unnecessary side-effects and the risk of complications associated with chemotherapy and delay development of resistance to chemotherapy. Thus, knowing your classification is very important in deciding when it is appropriate to begin treatment.
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Conditions that suggest Multiple Myeloma:
Multiple Myeloma suggests the following may be present:
Multiple Myeloma can lead to:
Recommendations and treatments for Multiple Myeloma: | | | | | Digestion |  Digestive Enzymes | 166 subjects with multiple myeloma who took 2 Wobe-Mugos tablets (pancreatic enzymes) tid for the first year and then 1 tablet tid for the second year of the study, along with conventional treatement, experienced an extended lifespan (for stage III myeloma) from 47 months to 83 months over those who did not use the enzymes. The addition of oral enzyme therapy for more than 6 months reduced the hazard of death for patients at all stages of disease by approximately 60%. [Cancer Chemother Pharmacol, 2001;47(Supp1.): S38-S44 ] |
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Drug |
 LDN - Low Dose Naltrexone |
Mineral |
Selenium |
Nutrient |
 Butyrate |
Vitamins |
Vitamin K |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Aspiration
Inhalation, or removal of fluids or gases from a cavity using suction.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Biopsy
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Chemotherapy
A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells. Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel throughout the body. Usually, a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.
Complete Blood Count (CBC)
A set of measurements that are generally determined by specially designed machines that analyze the different components of blood in less than a minute. The values generally included are:- White blood cell count (WBC). The number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter. This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 - 10.8 x 10^9 cells per liter.
- Automated white cell differential. A machine-generated percentage of the different types of white blood cells, usually split into granulocytes, lymphocytes, monocytes, eosinophils, and basophils.
- Red cell count (RBC). The number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 - 5.9 million cells per cubic millimeter. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 - 5.9 x 10^12 cells per liter.
- Hemoglobin (Hb). The amount of hemoglobin in a volume of blood. Normal range for hemoglobin is different between the sexes and is approximately 13 - 18 gm/dl for men and 12 - 16 for women (international units 8.1 - 11.2 millimoles/liter for men, 7.4 - 9.9 for women).
- Hematocrit (Hct). The ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45 - 52% for men and 37 - 48% for women.
- Mean cell volume (MCV). The average volume of a red cell. This is a calculated value derived from the hematocrit and red cell count. Normal range is 86 - 98 femtoliters.
- Mean cell hemoglobin (MCH). The average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 - 32 picograms.
- Mean cell hemoglobin concentration (MCHC). The average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32 - 36%.
- Red cell distribution width (RDW). A measurement of the variability of red cell size. Higher numbers indicate greater variation in size. Normal range is 11 - 15.
- Platelet count. The number of platelets in a volume blood. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 - 400,000 per cubic millimeter (150 - 400 x 10^9 per liter).
Computerised Tomography (CAT Scan, Computed Tomography, Computerized Axial Tomography, CT Scan)
A scanning procedure using X-rays and a computer to detect abnormalities of the body's organs. This technique provides cross-sectional images of body organs, which is much clearer than those provided by conventional X-rays.
Constipation (Constipated)
Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Hypercalcemia
Excess calcium in the blood.
IgE (Immunoglobulin E)
Immunoglobulin E is a type of antibody produced by IgE plasma cells. These are specialized B-cell lymphocytes that make free-floating antibodies for what is termed humoral resistance. IgE is not made to be specific against only one antigen, like other gamma globulins, but instead can bind with a number of dangerous proteins. IgE travels to mast cells, sticks to their surfaces, and when antigens get stuck to the IgE, the mast cells secrete inflammatory compounds such as histamine. Since IgE is a generalist, coded for a number of potential toxins, it can decide for example that grass pollen and cat dander are antigens... and you have an allergy. Elevated production of IgE is often inherited, which is why allergies run in a family.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Immunoglobulin A (IgA)
Supports mucosal immunity.
Indolent
A sluggish and unresolving condition, often with ulcerations and necrosis.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Lactation (Lactate, Lactates, Lactating)
Production of milk; period after giving birth during which milk is secreted in the breasts.
Lesion (Lesions)
Any damage to tissue structure or function; an abnormal change in body tissue caused by disease or injury. A scar is a lesion, as is cancer, a stomach ulcer or a pimple.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Lymphoma (Lymphomas)
Any tumor of the lymphatic tissues.
Magnetic Resonance Imaging (MRI)
A technique used in diagnosis that combines radio waves and magnetic forces to produce detailed images of the internal structures of the body.
Malignant (Cancerous)
Dangerous. Mainly used to describe a cancerous growth -- when used this way, it means the growth is cancerous and predisposed to spreading.
Millimeter (Millimeters, mm)
A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.
Nausea
Symptoms resulting from an inclination to vomit.
Pancreas (Pancreatic)
Opposite the liver and behind the stomach, the pancreas has two main functions - to manufacture various enzymes for digestion, and to release hormones to help control the body's use of carbohydrates. It releases insulin to help each cell absorb glucose to burn as energy. In this way, insulin controls the amount of sugar (glucose) in the blood. Proper pancreatic function is very important: too much, too little, or no insulin production can be life-threatening. Some of the chemicals released by the pancreas are not hormones, but stimulate other glands to make hormones. Once again, balance is necessary. Nutritional requirements for the pancreas are many. Research indicates that chromium vitamins C, E, B-complex, calcium, magnesium and potassium are especially important.
Pneumonia (Pneumonitis)
Inflammation, usually infectious, of the lungs. Unless the result of only moderate chemical or smoke irritation, it is a potentially life-threatening condition. There are so many defenses against an infection this deep in the body that the very presence of pneumonia signals a pathogen of great virulence or impaired or exhausted immunity, or all three. Pneumonitis: Inflammation of the lungs, from whatever cause. It may be concurrent with pneumonia or pleurisy.
Precursor (Precursors)
A biochemical substance, such as an intermediate compound in a chain of enzymatic reactions, from which a more stable or definitive product is formed.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Prothrombin
Protein needed for clotting of the blood.
Red Blood Cell (Erythrocyte, Erythrocytes, RBC, Red Blood Cells)
Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Shingles (Herpes Zoster)
A severe infection caused by the Varicella-Zoster virus (VZV), affecting mainly adults. It causes painful skin blisters that follow the underlying route of brain or spinal nerves infected by the virus. Also know as herpes zoster.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
TID
Three times a day.
Vitamin K
Helps the blood clot when the body is injured.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Jul 19, 2008
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