Multiple Myeloma2

7/27/2019 Multiple Myeloma2

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Multiple MyelomaDefinitionMultiple myeloma is a cancer of your plasma cells. Plasma cells are a type of white blood cellpresent in your bone marrow.In multiple myeloma, a group of abnormal plasma cells (myeloma

cells) multiplies,raising the number of plasma cells to a more than normal level. The result

can beerosion of your bones. The disease also interferes with the function of your bonemarrowand immune system, which can lead to anemia and infection. Multiplemyeloma may also causekidney problems.The disease is called multiple myeloma because myeloma cells can occur in

multiple bone marrow sites in your body.If you have multiple myeloma but don't have symptoms, your doctors

may justmonitor your condition. If you're experiencing symptoms, various treatmentsareavailable.SymptomsAlthough multiple myeloma may not cause symptoms early in the disease, it's likelythat you'll

experience signs and symptoms as the disease progresses.Signs and symptoms of the diseasecan vary from person to person. Common multiplemyeloma symptoms include:

Bone pain.

Presence of abnormal proteinswhich can be produced by myeloma cells in your blood orurine. These proteins which are antibodies or parts of antibodies are called monoclonal, or

M, proteins. Often discovered during aroutine exam, monoclonal proteins may indicate

multiple myeloma, but alsocan indicate other conditions.

High level of calcium in your blood. This can occur when calcium fromaffected bones dissolves

into your blood.If you have a high calcium level in your blood, you may experience signsandsymptoms such as:

Excessive thirst and urination

Constipation

Nausea

Loss of appetite

Mental confusion


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cells are missing all or part of one chromosome

chromosome 13. Cells with amissing or

defective chromosome 13 tend to be more aggressive and harder to treatthan are cells with a

normal chromosome 13.A connection with MGUSMultiple myeloma sometimes develops from a condition called monoclonalgammopathy of

undetermined significance (MGUS). MGUS is more common inadults over age 50. This

condition, like multiple myeloma, is marked by the presenceof M proteins produced byabnormal plasma cells in your blood. However, inMGUS, the amount of the abnormal

proteins isn't high enough to cause harm, and nodamage to the bones occurs.Risk factorsMultiple myeloma isn't contagious. Most people who develop multiple myeloma haveno clearly

identifiable risk factors for the disease.Some factors that may increase your risk of multiplemyeloma include:

Age.The majority of people who develop multiple myeloma are older than 50,with most diagnosed

around age 70. Few cases occur in people younger than40.

Sex.Men are more likely to develop the disease than are women.

Race.Blacks are about twice as likely to develop multiple myeloma as arewhites.

History of a monoclonal gammopathy of undetermined significance.Everyyear 1 percent of the people with MGUS in the United States develop multiplemyeloma.


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Obesity.Your risk of multiple myeloma is increased if you're overweight or obese.Other factors that may

increase your risk of developing multiple myeloma includeexposure to radiation and working in

petroleum-related industries.

When to seek medical adviceIf you're persistently more tired than you used to be, you've lost weight, and youexperience bone

pain, repeated infections, loss of appetite, excessive thirst andurination, persistent nausea,

increased constipation, or weakness or numbness in your legs, your signs and symptoms mayindicate multiple myeloma or other seriousdiseases. See your doctor to determine the underlying

cause.Tests and diagnosisYour doctor may first detect signs of multiple myeloma before you ever havesymptoms through blood and urine tests conducted during a routine physical exam.If you don't yet have

symptoms, these lab tests may be repeated every few months sothat your doctor can track whether your disease is progressing and determine the besttime to starttreatment.Blood and urine testsA blood test called serum protein electrophoresis separates your blood proteins andcan detect

the presence of M proteins, called an "M spike," in your blood. Parts of M proteins may also be

detected in a test of your urinewhen found in urine, they'rereferred to as Bence Jonesproteins.If your doctor discovers M proteins, you'll likely need additional blood tests tomeasure

blood cell counts and levels of calcium, uric acid and creatinine. Your doctor may also conduct

other blood tests to check for beta2-microglobulin another protein produced by myeloma

cellsor to measure the percent of plasma cells inyour bone marrow.Other testsYou may also need other tests. They may include:Imaging.X-rays of your skeleton can show whether your bones have anythinned-out areas, common in

multiple myeloma. If a closer view of your bones is necessary, your doctor may use magneticresonance imaging (MRI)or computerized tomography (CT) scanning.

Bone marrow examination.Your doctor may also conduct a bone marrowexamination by using a needle to remove a small

sample of bone marrowtissue. The sample is then examined under a microscope to check formyelomacells.Staging and classificationThese tests can help confirm whether you have multiple myeloma or another condition. If tests

indicate you have multiple myeloma, the results from these testsallow your doctor to classifyyour disease as stage 1, stage 2 or stage 3. People withstage 3 myeloma are more likely to have

one or more signs of advanced disease,including greater numbers of myeloma cells and kidney

failure.


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ComplicationsMultiple myeloma can result in several complications:

Impaired immunity.Myeloma cells inhibit the production of antibodiesneeded for normal immunity. Having multiplemyeloma may make you morelikely to develop infections, such as pneumonia, sinusitis, bladder orkidneyinfection, skin infections and shingles.

Bone problems.Multiple myeloma also can affect your bones, leading toerosion of bone mass and fractures. The

condition may cause compression of your spinal cord. Signs of this medical emergency include

weakness, or even paralysis, in your legs.

Impaired kidney function.

Multiple myeloma may cause problems withkidney function, including kidney failure. Higher

calcium levels in the bloodrelated to eroding bones can interfere with your kidneys' ability to

filter your

blood's waste. The proteins produced by the myeloma cells can cause similar problems,especially if you become dehydrated.

Anemia.As cancerous cells crowd out normal blood cells, multiple myelomacan also cause anemia and

other blood problems.Treatments and drugsGenerally, if you have multiple myeloma and aren't experiencing symptoms, you don'tneed

treatment. However, your doctors will likely monitor your condition at variableintervals,

checking for signs such as increasing levels of M protein in your bloodor urine that

indicate the disease is progressing. If it is, you may need treatment tohelp prevent symptoms. Inpeople diagnosed with asymptomatic multiple myeloma,the risk of developing symptoms is

about 10 percent a year for the first five years after learning that they have the disease.If you're

experiencing symptoms, treatment can help relieve pain, controlcomplications of the disease,stabilize your condition and slow the progress of thedisease.Standard treatments for myelomaThough there's no cure for multiple myeloma, with good treatment results you canusually returnto near-normal activity. The appropriate multiple myeloma treatmentdepends on your needs,medical status and general health. You may also wish toconsider approved clinical trials as an

option.Standard treatment options include:

Chemotherapy.


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Radiation therapy.This treatment uses high-energy penetrating waves todamage myeloma cells and stop their

growth. Radiation therapy may be usedto target myeloma cells in a specific areafor instance,to more quicklyshrink a tumor that's causing pain or destroying a bone.Initial therapy for myelomaThe initial chemotherapy used to treat multiple myeloma depends on whether you'reconsidered acandidate for stem cell transplantation. Factors such as the risk of your disease progressing, yourage and your general health play a part in determiningwhether stem cell transplantation may be

right for you.

If you're considered a candidate for stem cell transplantation:Your initialtherapy will likely exclude melphalan because this drug can have a toxic effecton

stem cells, making it impossible to collect enough of them. You may begintreatment with themost common initial myeloma therapy in the United States,thalidomide plus dexamethasone.

Or your doctor may instead recommend anewer regimen, lenalidomide plus low-dose

dexamethasone.Your stem cells will likely be collected after you've undergone three tofour months of treatment with these initial agents. Your doctor may recommendundergoing the

stem cell transplant soon after your cells are collected or delaying the transplant until after

a relapse, if it occurs. Your age and your personal preference are important factors that will help

your doctor make hisor her recommendation.

If you're not considered a candidate for stem cell transplantation:Your initial therapy is likely to be a combination of melphalan, prednisone andthalidomide

(MPT). If the side effects are intolerable, melphalan plus prednisone is another option (MP). This

type of therapy is typically given for about 12 to 18 months.Treatments for relapsed or treatment-resistant multiple myelomaMost people who are treated for multiple myeloma eventually experience a relapse of the

disease. And in some cases, none of the currently available, first-line therapiesslow the cancer cells from multiplying. If you experience a relapse of multiplemyeloma, your

doctor may recommend repeating another course of the treatment thatinitially helped you.Another option is trying one or more of the other treatmentstypically used as first-line therapy,

either alone or in combination.Research on a number of promising new treatment options is

ongoing, and these drugsoffer important options for those with multiple myeloma. Talk to yourdoctor aboutwhat clinical trials may be available to you.Treating complicationsBecause multiple myeloma can cause a number of complications, you may also needtreatmentfor those specific conditions. For example:

Back pain.Taking pain medication or wearing a back brace can help relievethe back pain you might

experience with multiple myeloma.


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Kidney complications.People with severe kidney damage may need dialysis.

Infections.

Antibiotics may be necessary to help treat infections or to helpreduce your risk of them.

Bone loss.You may take medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic

acid (Zometa), which bind to the surfaceof your bones and help prevent bone loss. Treatment

with these drugs isassociated with the risk of harm to the jawbone. If you're taking

thesemedications, don't have dental procedures done without consulting your doctor first.

Anemia.

If you have persistent anemia, your doctor may prescribeerythropoietin injections. Erythropoietin

is a naturally occurring hormonemade in the kidneys that stimulates the production of red blood

cells. Researchsuggests that the use of erythropoietin may increase the risk of blood clots insome

people with myeloma.Lifestyle and home remediesThe following tips may help you keep multiple myeloma under control:

Stay active.Exercise helps keep your bones stronger. If pain keeps you from being active, ask your doctor

about ways to lessen the pain.

Drink fluids.Drinking fluids can help keep you from becoming dehydrated.And by drinking plenty of fluids,

you help dilute the Bence Jones proteinfragments in your urine, which may help prevent kidney

damage.

Eat a balanced diet.One way to promote your overall health and cope withany form of cancer is to eat well. Theamount of M protein in your system isn'taffected by how much protein you eat, so there's no

need to limit proteinintake unless told otherwise by your doctor. Don't take vitamins, herbs

or medications without your doctor's approval because they may interfere withyour treatment.Coping and supportA diagnosis of cancer can be extremely challenging. Remember that no matter whatyour

concerns or prognosis, you're not alone. These strategies and resources maymake dealing with

cancer easier:


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Know what to expect.Find out everything you can about your cancerthetype, stage, risks, your treatment options

and their side effects. The more youknow, the more active you can be in your care. In addition to

talking with your doctor, look for information in your local library and on the Internet.The National Cancer Institute will answer questions over the phone from the publicat 800-4-CANCER, or 800-422-6237. Or contact the American Cancer Society at 800-ACS-2345, or -

800-227-2345. Information is also available ontheir Web sites.

Be proactive.Although you may feel tired and discouraged, don't let othersincluding your family or your

doctormake important decisions for you.It's vital that you take an active role in yourtreatment.

Maintain a strong support system.Having a support system and a positiveattitude can help you cope with any issues, pain and

anxieties that mightoccur. Although friends and family can be your best allies, they

sometimesmay have trouble dealing with your illness. If so, the concern andunderstanding of aformal support group or others coping with cancer can beespecially helpful. Although support

groups aren't for everyone, they can be agood source for practical information for you and your

family, too. You mayalso find you develop deep and lasting bonds with people who are goingthrough thesame things you are.

Set reasonable goals.Having goals helps you feel in control and can give youa sense of purpose. But don't choose

goals you can't possibly reach. You maynot be able to work a 40-hour week, for example,

but you may be able to work at least part time. In fact, many people find that continuing to workcan behelpful.

Take time for yourself.Eating well, relaxing and getting enough rest can helpcombat the stress and fatigue of cancer.

Also, plan ahead for the downtimes,when you may need to rest more or limit what you do.

Stay active.Having cancer doesn't mean you have to stop doing the things you enjoy or normally do. For the

most part, if you feel well enough to do something, go ahead and do it. It's important to stay

involved as much as you can.

Multiple Myeloma2

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