WEB WATCH - MULTIPLE MYELOMA

By Shirley Butler

MULTIPLE MYELOMAS are cancers of the bone marrow, which result from uncontrolled growth of plasma cells (a form of immune-protective white blood cells). Under normal circumstances, plasma cells make antibodies or "immunoglobulins" (defensive immune proteins) to fight infections. In multiple myeloma, however, plasma cells multiply uncontrollably and make too much of a single type of immunoglobulin. Levels of other types of immunoglobulin drop dangerously low, leaving the patient susceptible to infections. Further, the cancerous plasma cells collect in the bones and bone marrow, sometimes forming tumors that destroy the bone tissue, causing structural weakness and fractures.

Multiple myeloma is a fairly rare form of cancer, striking only 3-4 out of every 100,000 Americans annually. Age is an important risk factor for the illness, with an average onset at age 60. Other risk factors include exposure to radiation, asbestos, benzene, or pesticides.

SYMPTOMS

There may be no symptoms early in the illness. However, as multiple myeloma progresses, symptoms may include:

Pain in the bones, especially in the back, ribs, and (sometimes) the arms. Pain results when the number of myeloma cells increases to the point where bone is being destroyed. Some symptoms can be:

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

DIAGNOSIS

Your doctor may suspect multiple myeloma based on your age, your medical history, and your current symptoms. The next step will be blood tests to check for anemia, which occurs when plasma cells crowd the bone marrow and prevent the normal production of red blood cells.

X-rays of the long bones in the body, skull and chest may be used to support a myeloma diagnosis, as well as to detect bone weakness. A bone marrow biopsy will also be done to confirm an abnormally high level of plasma cells. Normally, plasma cells account for less than 5% of the cells in the bone marrow; however, in patients with multiple myeloma this percentage increases to 10%-90%. For diagnostic purposes, a bone marrow biopsy that reveals plasma cells at greater than 30% indicates multiple myeloma.

There are three stages of myeloma:

Stage I - Few cancer cells have spread through the body, and there may be no 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 may also be anemia due to a decrease in the number of red blood cells; high levels of calcium in the blood, due to 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).

EXPECTED DURATION

About 15% of patients die within the first 3 months after diagnosis. In most cases, the illness progresses slowly for 2 to 5 years, followed by a relatively brief period when symptoms rapidly worsen.

PREVENTION

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

TREATMENT

If there are no symptoms, treatment may be delayed until the disease progresses, depending on the overall health of the patient. When treatment is begun, it may include:

Several 4 - 6 week courses of chemotherapy, given over a period of 1-2 years. This produces improvement in about 70% of patients, and complete remission in about 10%.

Radiation therapy to treat tumor involvement at specific bone sites

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.

WHEN TO CALL YOUR DOCTOR

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 individuals over age 50 should be especially alert to these symptoms.

PROGNOSIS

Overall, about 29% of patients diagnosed with multiple myeloma live more than 5 years after detection. However, for any specific patient, the average 5-year survival rate depends on their stage of illness:

Stage I - 25%-40%

Stage II - 15%-30%

Stage III - 10%-25%

For more information about multiple myeloma, contact:

National Cancer Institute (NCI)

Telephone: 1-800-4-CANCER

www.nci.nih.gov

American Cancer Society

1599 Clifton Road, N.E.

Atlanta, GA 30329-4251

Telephone: 1-800-ACS-2345