Multiple myeloma is one of several diseases that are
collectively known as plasma cell dyscrasias. In general, the term myeloma refers to cancer of special types of white blood cells called plasma cells. Plasma cells are important components of the immune system that help the body fight infections caused by microorganisms such as bacteria, viruses, and fungi. Plasma cells are found primarily in the bone marrow and develop from white blood cells called B- lymphocytes. When microorganisms invade the body, B-lymphocytes respond by transforming into plasma cells which, in turn, produce proteins called antibodies that help to destroy the invading microorganisms and, thereby, eradicate the infection. There are five types (classes) of antibodies (immunoglobulins) produced by plasma cells: IgG, IgM, IgA, IgD, and IgE. Each plasma cell produces a specific class of antibodies. Under normal conditions, the body only produces plasma cells when they are needed to help fight off infections. Once the infection has been eliminated from the body, the old plasma cells die off. Certain genetic mutations can cause plasma cells to become abnormal and continue to divide over and over again and, eventually, form a tumor. These abnormal plasma cells, called myeloma cells are cancer cells that produce a specific type of antibody (monoclonal antibody) called M proteins. The monoclonal antibody that is typically overproduced by the myeloma cells is usually of the IgG or IgA variety. Most commonly, a whole monoclonal antibody is produced, however, in about 20% of cases, only a partial antibody called a light chain is produced by the myeloma cells. Light chains do not remain in the circulation and are found mainly in the urine. The M proteins in patients with multiple myeloma can be detected in the blood and/or urine by specialized techniques known as protein electrophoresis and immunofixation. Since plasma cells originate from the bone marrow, when plasma cells grow out of control, become abnormal myeloma cells, and produce tumors, the tumors usually develop in the bone marrow. If only a single tumor is present, it is called a solitary plasmacytoma. Typically, however, several tumors can be found throughout the bone marrow and, in these cases, the condition is called multiple myeloma. In patients with multiple myeloma, the number of myeloma cells in the bone marrow increases signficantly and usually accounts for more than 20% of the total population of cells found in the bone marrow. The abundance of cancerous plasma cells in the bone marrow can lead to complications including: Anemia - an abnormally low number of red blood cells in the bloodstream that can cause severe fatigue and weakness. Thrombocytopenia - an abnormally low number of platelets in the circulation that can lead to bleeding and/or bruising problems. Leukopenia - an abnormally low number of white blood cells in the circulation that increases the risk for developing severe, life- threatening infections. Myeloma bone disease - myeloma cells produce a variety of substances (mediators) that stimulate cells called osteoclasts to resorb (dissolve) bone at a much faster rate than cells called osteoblasts can produce new bone. This increased rate of bone resorption in patients with myeloma can cause weak, brittle bones (osteoporosis) and, thereby, increase the risk for developing fractures.
Other underlying conditions that may be confused with multiple myeloma because they produce similar signs/symptoms and must be considered in the differential diagnosis of multiple myeloma. How multiple myeloma is diagnosed based on factors such as signs/symptoms, patient history, physical examination, and special laboratory tests such as serum protein electrophoresis and immunofixation The major and minor diagnostic criteria that serve as the basis for confirming the diagnosis of multiple myeloma. A detailed overview of the two major classification systems that are used by doctors for **staging patients with multiple myeloma into specific categories based on the extent of the disease. These 2 classification systems, which play a key role in both planning treatment and predicting the outcome (prognosis) are known as the: Durie-Salmon staging system International staging system Understanding the Standard Treatments...and the Treatment Options Because currently there is no known cure for multiple myeloma, understanding the standard treatments - and the treatment options - is critical in attempting to prolong survival and maintain the patient's overall functional ability and quality of life. As you read through the section of the Guidebook that focuses on the treatments for multiple myeloma, you will specifically learn about: Which patients with multiple myeloma are candidates for an approach known as "watchful waiting", where the progress of the disease is monitored carefully but no specific treatment is required. The various phases in the treatment of multiple myeloma for patients whose disease has progressed to the point where treatment becomes necessary. These treatment phases are grouped into the following categories: Initial or induction chemotherapy Consolidation therapy Maintenance therapy Salvage therapy The role of stem cell transplantation in the management of patients with multiple myeloma, including the risks and benefits of this procedure. The treatment options available to patients with multiple myeloma who experience a relapse or recurrence of the disease after initially having gone into remission. The role of plasmapharesis - the direct removal of abnormal antibody proteins from the bloodstream - in the management of patients with multiple myeloma. A detailed overview of the risk of infections in people with multiple myeloma, including practical recommendations for reducing the risks of developing potentially life- threatening bacterial, viral, and fungal infections. The treatment options that are available for the management of patients with multiple myeloma who develop myeloma bone disease - areas of bone destruction caused by multiple myeloma that significantly increase the risk of developing pathologic fractures. The prognosis (outlook) for people with multiple myeloma and important prognostic factors that have a significant impact in predicting the overall chances of recovery and survival. The role of complementary and alternative therapies in the management of people with multiple myeloma. Quality of life issues such as sleep disorders, fatigue, weight loss, and psychological stress that often confront people with multiple myeloma and tips for how to minimize their impact and better cope with these important issues.
Myeloma is a cancer that affects B cells, the immune cells responsible for the production of antibodies. Normal B cells develop in bone marrow. Myeloma therefore affects bones. Multiple myeloma arises when the cancer cells travel through the body and form tumors in several different bones. Affected bones may become brittle as the malignant cells proliferate and alter the chemical equilibrium in the marrow. Multiple myeloma is rarely diagnosed in individuals under the age of 45.