Multiple Myeloma and Plasmacytoma

Multiple myeloma is a cancer that affects white blood cells called plasma cells. Each year, an estimated 13,000 Americans are diagnosed with the disease. Plasma cells and other white blood cells are part of the immune system, which helps protect the body from infection and disease. (Read about "The Immune System") According to the National Cancer Institute (NCI), when cancer involves plasma cells, the body keeps producing more and more of these cells. The unneeded plasma cells are called myeloma cells. They tend to collect in the bone marrow and in the hard, outer part of bones.

When myeloma cells collect in only one bone and form a single mass, or tumor, it is called a plasmacytoma. In most cases, however, according to NCI, the myeloma cells collect in many bones, forming many tumors and causing other problems. When this happens, the disease is called multiple myeloma. Although plasmacytoma and multiple myeloma affect the bones, they begin in the cells of the immune system. Cancers are classified according to where they start (Read about "Cancer: What It Is"); therefore, these cancers are different from bone cancer, which actually begins in cells that form the hard, outer part of the bone. (Read about "Bone Cancer")

Plasma cells normally produce antibodies. Because people with multiple myeloma have an abnormally large number of identical plasma cells, they also have too much of one type of antibody. These myeloma cells and antibodies can cause a number of serious medical problems, according to NCI:

• myeloma cells can damage and weaken bones, causing pain and sometimes fractures
• when bones are damaged, calcium is released into the blood, which can lead to hypercalcemia - too much calcium in the blood - which in turn can cause loss of appetite, nausea, thirst, fatigue, muscle weakness, restlessness, and confusion (Read about "Hypercalcemia")
• there can be problems with the immune system, so that patients cannot fight infection and disease
• there can be problems with the growth of new red blood cells, causing anemia, weakness and fatigue (Read about "Anemia")
• there can be serious problems with their kidneys (Read about "Kidney Disease")

Diagnosis and Treatment

According to NCI, doctors sometimes find multiple myeloma after a routine blood test. (Read about "Complete Blood Count") A doctor may also suspect multiple myeloma after an x-ray for a broken bone. (Read about "X-rays") Or the patient may go to the doctor because he or she is having other symptoms.

To find out whether such problems are from multiple myeloma or some other condition, there may be additional blood tests or urine tests. The doctor may also want a biopsy, obtaining bone marrow through one or both of the following:

• Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
• Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Treatment is complex. If the myeloma is inactive or not producing symptoms, it may not require active treatment. You will, however, be monitored regularly to make sure the disease is not progressing. This is called watchful waiting.

If you are experiencing symptoms, treatment will depend on several factors, including the stage of the disease and whether you have been treated previously. Options include:

Proteasome inhibitor - A class of drugs called proteasome inhibitors can block the action of proteasomes. Proteasomes are a complex of enzymes that may be needed by certain cancer cells in order to grow.

Corticosteroids - Corticosteroids such as prednisone can be used alone or in combination with other therapies.

Chemotherapy - Chemotherapy (Read about "Cancer Treatments") is the use of drugs to kill cancer cells. Chemotherapy drugs may be used alone or in combination with other drugs and/or therapies.

Bone marrow transplantation - NCI says high dose chemotherapy followed by bone marrow transplantation provides is an option. Since higher doses of chemotherapy and/or radiation also cause damage to healthy bone marrow, this approach also involves treatments that help the healthy marrow, such as treatment with colony-stimulating factors (substances that stimulate the production of blood cells) or bone marrow transplantation. (Read about "Transplants") Bone marrow transplantation is a procedure to replace bone marrow destroyed by treatment with high doses of anticancer drugs or radiation. Transplantation may be autologous (an individual's own marrow saved before treatment), allogeneic (marrow donated by someone else), or syngeneic (marrow donated by an identical twin).

Radiation - Radiation therapy involves the use of high energy rays to damage cancer cells. (Read about "Radiation Therapy") Radiation therapy can be used for people who have a single plasmacytoma. It can also be used for patients with multiple myeloma. For those who have multiple myeloma, NCI says treatment can improve the quality of a patient's life by controlling the symptoms and complications of the disease. Patients who have a plasmacytoma may be free of symptoms for a long time after treatment, but may eventually develop multiple myeloma, according to NCI.

Thalidomide - Thalidomide, a controversial drug withdrawn from the market in the 1960's after reports that linked its use with the occurrence of severe birth defects (Read about "Birth Defects"), has been approved as a treatment for some cases of multiple myeloma. Thalidomide can be combined with other therapies. Other drugs, similar to the thalidomide class of drugs, can also be used.

Because multiple myeloma can cause many complications, treatment may also be needed for these other conditions. Pain medications can be prescribed. Antibiotics can help to reduce your risk of infections. (Read about "Antibiotics") You may also need medications to help prevent bone loss and/or anemia. (Read about "Osteoporosis" "Anemia")

More Cancer Information:

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is

Related Information:

    Blood Disorders Glossary