Malignant plasmacytoma

Definition

Multiple myeloma is a cancer of the plasma cells in bone marrow.

Alternative Names

Causes

Plasma cells help the body's immune system fight disease. Multiple myeloma occurs when plasma cells grow out of control. Excessive plasma cells can form a tumor in the bone marrow called a myeloma. Many tumors are called multiple myeloma.

The growth of the excess plasma cells interferes with the production of red blood cells, white blood cells, and platelets. This causes anemia and makes a person more likely to get infections and have abnormal bleeding.

As the cancer cells grow in the bone marrow, they cause pain and destruction of the bones. If the bones in the spine are affected, it can put pressure on the nerves, resulting in numbness or paralysis.

Renal failure (kidney failure) is a frequent complication.

Multiple myeloma mainly affects older adults. A history of radiation therapy raises your risk for this type of cancer.

Symptoms

• Bone or back pain
• Unexplained fractures
• Bleeding problems
• Increased susceptibility to infection
• Symptoms of anemia (such as tiredness, shortness of breath, and fatigue)

Exams and Tests

Blood tests can help diagnose this disease.

• A newer blood test called the Freelite diagnostic assay can be used to diagnose and monitor multiple myeloma.
• A blood chemistry test shows increased levels of calcium, total protein, and abnormal kidney function.
• A complete blood count (CBC) reveals low hematocrit (anemia) and a low number of red and white blood cells and platelets.
• Serum protein electrophoresis, a test to measure various types of protein part of the blood, is abnormal.

Bone x-rays show fractures or hollowed out areas of bone. If your doctor suspects this type of cancer, a bone marrow biopsy will be performed.

• Bone lesion biopsy
• Serum globulin electrophoresis
• Quantitative immunoglobulins (nephelometry)
• Serum immunoelectrophoresis
• ESR
• Cryoglobulins
• Blood differential
• Ionized calcium
• Protein in urine
• Urine immunofixation
• Urine immunoelectrophoresis
• Calcium in urine
• Bence-Jones protein (quantitative)
• 24-hr urine protein

Treatment

The goal of treatment is to relieve symptoms.

People who have mild disease or have a doubtful diagnosis are usually carefully monitored without treatment. Some people have a slow-developing form of multiple myeloma that takes years to cause symptoms.

Treatment begins when the disease becomes worse or causes symptoms.

Chemotherapy and radiation therapy may be performed to relieve bone pain or treat a bone tumor

Bone marrow transplantation in younger patients has been shown to increase disease-free and overall survival, but it has significant risks.

Newer therapies for multiple myeloma include thalidomide, lenalidomide (Revlimid ), and bortezomib (Velcade).

Patients with multiple myeloma should drink plenty of fluids to prevent dehydration

Chemotherapy and transplants rarely lead to a permanent cure. Complete remission is unusual.

Support Groups

The stress of illness may be eased by joining a support group whose members share common experiences and problems. See cancer - support group.

Outlook (Prognosis)

Survival of people with multiple myeloma depends on the patient's age and the stage of disease. Some cases are very aggressive, while others take years to get worse.

Possible Complications

• Renal failure
• Increased susceptibility to infection (especially pneumonia)
• Paralysis from tumor or spinal cord compression
• Bone fractures

When to Contact a Medical Professional

Call your health care provider if you experience decreased urine output.

Call your provider if you have multiple myeloma and infection develops, or numbness, loss of movement, or loss of sensation develops.