What Is It?

Multiple myeloma is cancer of the bone marrow that results from uncontrolled growth of plasma cells, a form of white blood cells. Normally, plasma cells make antibodies called immunoglobulins to fight infections. In multiple myeloma, however, plasma cells multiply uncontrollably and make too much of a single type of immunoglobulin. The level of other types of immunoglobulin drops dangerously low, leaving the patient susceptible to infections. The cancerous plasma cells collect in the bones and bone marrow, and sometimes form tumors that destroy the bone tissue, causing the bones to become weak and possibly break.

Multiple myeloma is a fairly rare form of cancer, affecting only three to four out of every 100,000 people in the United States each year. It tends to occur in older people. The average age that this cancer develops is 60. Other risk factors include exposure to radiation, benzene or pesticides.

There may not be any symptoms early in the illness. However, as multiple myeloma progresses, symptoms can include:

• Pain in the bones, especially in the back, ribs, and, sometimes, the arms — Pain occurs when bone is being destroyed by the myeloma cells.
• Frequent infections
• Fatigue
• A tendency to bleed easily, especially from the nose or gums
• Easy bruising
• A general numbness of the skin
• Severe kidney problems
• Loss of appetite
• Nausea and vomiting
• Confusion

Your doctor will order blood tests to check for anemia, which occurs when plasma cells crowd the bone marrow and prevent the normal production of red blood cells. Blood tests also will reveal unusually high levels of protein, a reflection of the large amounts of immunoglobulin being formed by cancerous plasma cells. You may be asked to collect your urine for 24 hours so that it can be analyzed for abnormal amounts of protein.

Your doctor may order X-rays of the long bones in your body, your skull and chest to help confirm the diagnosis, and to check for bone weakness. A bone-marrow biopsy also will be done to confirm an abnormally high level of plasma cells. This procedure is done under local anesthesia in your doctor’s office. A long needle is used to withdraw a small amount of bone marrow so it can be examined under a microscope. Normally, plasma cells account for less than 5 percent of the cells in the bone marrow. However, in patients with multiple myeloma, this percentage increases to 10 percent to 90 percent. Multiple myeloma is diagnosed if a bone-marrow biopsy shows more than 30-percent plasma cells.

After diagnosis, laboratory tests will determine the extent of the cancer, which is described in terms of stages. Staging is complicated, and is based on protein levels, calcium levels, kidney function and presence of bone lesion.

• Stage I — Few cancer cells have spread through the body, and there may not be any symptoms of the disease.
• Stage II — A moderate number of cancer cells have spread through the body.
• Stage III — A large number of cancer cells have spread through the body. There also can be anemia resulting from a decrease in red blood cells; high levels of calcium in the blood because of damaged bones; more than three bone tumors; or a high level of M-protein in the blood, a reflection of the extent of tumor growth throughout the body.

About 15 percent of patients die within the first three months after diagnosis. In most cases, the illness progresses slowly for two to five years, followed by a relatively brief period when symptoms rapidly worsen.

It may be possible to prevent some cases of multiple myeloma by avoiding exposure to radiation, benzene or pesticides.

If you do not have any symptoms, treatment may be delayed until the disease progresses, depending on your overall health. When treatment is started, it can include:

• Several four- to six-week courses of chemotherapy , given over a period of one to two years. With this treatment, about 70 percent of patients improve, and no evidence of disease remains in about 10 percent of patients.
• Radiation therapy to treat tumors in the bone
• Intravenous infusions of immunoglobulins to prevent serious infections
• Bone-marrow transplant — This may be beneficial for patients under age 65, especially if done early in the course of the illness.

It is not clear that any of these therapies can cure patients, though they often can provide good control of the disease for years.

Call your doctor if your experience any of the symptoms of multiple myeloma, especially frequent infections, bone pain, frequent nosebleeds, prolonged bleeding after minor cuts, easy bruising or unusual fatigue. Older people over age 50 should be especially alert to these symptoms.

Overall, about 29 percent of patients diagnosed with multiple myeloma live more than five years after diagnosis. The average five-year survival rate varies depending on the stage of their illness:

• Stage I — 25 percent to 40 percent
• Stage II — 15 percent to 30 percent
• Stage III — 10 percent to 25 percent

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.