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Cancer InDepth: Multiple Myeloma

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Multiple myeloma is a relatively rare cancer of the plasma cells. Plasma cells normally produce proteins, or antibodies, to help the immune system fight infection. Myeloma occurs when the body produces too many abnormal plasma cells, which are called myeloma cells.

These extra myeloma cells produce excess proteins in the blood. This can cause health problems. Myeloma cells also collect and grow in the bone marrow, the soft interior of the bone. This often results in decreased production of blood cells. The types of blood cells include:

  • Red blood cells—carry oxygen to the body
  • White blood cells—help fight off infection
  • Platelets—help the blood to clot

When myeloma cells grow in more than one site, the disease is called multiple myeloma. A single tumor of abnormal plasma cells is called a solitary plasmacytoma.

Causes

The cause of multiple myeloma is not known. Doctors think exposure to toxins, radiation, or a virus may play a role. Inherited gene mutations may also lead to multiple myeloma. In nearly all cases, doctors have no idea why a particular person develops the disease.

According to the American Cancer Society, about 20,580 Americans are diagnosed with multiple myeloma each year. Slightly more men than women are affected. And 10,580 people with the disease die from it annually. Multiple myeloma affects older adults. The average age of people with this disease is 65 years. It is uncommon for myeloma to occur in people younger than 35.

Symptoms

Symptoms of early stage multiple myeloma include:

  • Persistent bone pain, often severe—Pain is most commonly in the back. But, it can also be in the limbs or ribs.
  • Fatigue

When the disease progresses, symptoms may include:

  • Weakness
  • Broken bones
  • Repeated infections
  • Nausea and vomiting
  • Constipation
  • Difficulty urinating
  • Abnormal bleeding
  • Headache
  • Visual problems
  • Confusion

Complications

Complications of multiple myeloma typically relate to problems with blood function. These complications include the following:

  • Anemia —This is characterized by a lack of red blood cells, which carry oxygen to the body’s cells. Anemia causes fatigue because the cells do not receive enough oxygen. It can also aggravate a heart condition in a person with angina or other heart disease, in which the heart is already suffering from insufficient blood supply. The additional lack of oxygen in the blood from anemia compounds the problem.
  • Increased risk of infection—Because there are not enough white cells to fight bacteria, viruses, and other microbes, infection is more likely.
  • Easy bleeding—Decreased production of platelets impairs blood-clotting ability. This leads to bleeding easily and for a long time.
Abnormal Antibodies

As malignant plasma cells multiply, they produce enormous quantities of abnormal antibodies. These abnormal antibodies accumulate in the blood and urine. This can cause kidney damage and a weakened immune system. About 20% of patients with the disease develop kidney problems. Most find themselves more susceptible to infections. The antibodies can also cause the blood to thicken. This can, in turn, decrease circulation to the brain, which can result in stroke . Decreased circulation to other organs can cause death of tissues in those organs, as well.

Bone Problems

The growing tumor may destroy the surrounding bone, which leads to bone pain. Bones may break as they weaken. The bones in the spine may collapse and put pressure on the spinal cord, creating a medical emergency. Destruction of the bone also leads to high levels of calcium in the blood. Too much calcium can cause weakness and confusion, which can mimic stroke or dementia .

Amyloidosis

Myeloma is also associated with amyloidosis . This is a rare condition in which abnormal proteins accumulate in various organs of the body. The accumulation of these proteins causes the involved organs (usually heart, muscle, nervous system, and intestines) to malfunction. Amyloidosis is the result of a malfunction in the plasma cells that make antibodies. It is sometimes associated with myeloma. Anyone diagnosed with amyloidosis probably needs to be evaluated for the presence of myeloma. Patients with myeloma will sometimes experience complications as a result of amyloidosis.

Revision Information

  • Alan R. Multiple myeloma. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated November 2009. Accessed February 22, 2010.

  • Cancer Medicine . 5th ed. Hamilton, Ontario: BC Decker Inc; 2000.

  • Multiple myeloma. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/multiple-myeloma/DS00415 . Accessed February 22, 2010.

  • Multiple myeloma/other plasma cell neoplasms. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/myeloma . Accessed March 4, 2010.

  • Rakel R, Bope E, eds. Conn's Current Therapy 2002 . 54th ed. St. Louis, MO: WB Saunders Company; 2002: 439-443.

  • What are the key statistics about multiple myeloma? American Cancer Society website. Available at: http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-key-statistics . Updated May 2009. Accessed March 4, 2010.

  • What are the risk factors for multiple myeloma? American Cancer Society website. Available at: http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors . Updated May 2009. Accessed March 4, 2010.