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Multiple Myeloma
What do doctors call this condition?
Doctors also call this condition malignant plasmacytoma, plasma cell myeloma, and myelomatosis.
What is this condition?
Multiple myeloma is a disseminated cancer of marrow plasma cells that infiltrates bone to produce lesions throughout the skeleton (flat bones, vertebrae, skull, pelvis, and ribs). These lesions cause destruction of bone tissue. In late stages, cancer infiltrates the body organs (liver, spleen, lymph nodes, lungs, adrenal glands, kidneys, skin, and gastrointestinal tract).
Multiple myeloma strikes about 10,000 people yearly - mostly men over age 40. Usually, the prognosis is poor because diagnosis is often made after the disease has already infiltrated the vertebrae, pelvis, skull, ribs, clavicles, and sternum. By then, skeletal destruction is widespread and, without treatment, leads to vertebral collapse. However, early diagnosis and treatment prolong the lives of many people by 3 to 5 years .
What are its symptoms?
The earliest symptom of multiple myeloma is severe, constant back pain that increases with exercise. Arthritic symptoms may also occur: achiness, joint swelling, and tenderness, possibly from compression of the vertebrae. Other effects include fever, malaise, slight evidence of peripheral neuropathy (such as tingling in the fingers or toes), and pathologic fractures.
As multiple myeloma progresses, symptoms of vertebral compression may become acute, accompanied by anemia, weight loss, chest deformities (ballooning), and loss of body height - 5 inches (13 centimeters) or more-due to vertebral collapse. Kidney complications such as inflammation may occur. Severe, recurrent infection, such as pneumonia, may follow damage to nerves associated with respiratory function.
How is it diagnosed?
After the physical exam and careful review of the individual's medical history, the doctor orders diagnostic tests of blood, urine studies, and bone marrow. Additional studies that help confirm a diagnosis of multiple myeloma include serum electrophoresis, intravenous pyelography (to investigate kidney involvement), and X-rays of the skull, pelvis, and spine.
How is it treated?
Long-term treatment of multiple myeloma consists mainly of chemotherapy to suppress plasma cell growth and control pain. Local, radiation given in addition to chemotherapy reduces acute lesions, such as collapsed vertebrae, and relieves localized pain.
Other treatments usually include a combination of melphalan and prednisone as well as analgesics for pain. For spinal cord compression, the person may require an operation to remove part of the affected vertebrae; for kidney complications, dialysis.
Because the person may have bone demineralization and may lose large amounts of calcium into the blood and urine, he or she is a prime candidate for kidney stones, nephrocalcinosis, and, eventually, kidney failure due to excessive calcium in the blood. To decrease calcium levels in the blood, the person may be given fluids, diuretics, corticosteroids, oral phosphate, and intravenous mithramycin.
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