Multiple Myeloma: The Facts

What is it?

Multiple Myeloma is cancer of the plasma cells, which are part of the immune system that helps the body fight off infection. Usually bone marrow contains about two percent plasma cells. When a person has Multiple Myeloma, however, the body keeps making more and more abnormal plasma cells, called myeloma cells, which produce more and more antibodies. These extra cells do not help fight off infection; instead, they stop the body from making normal infection-fighting antibodies and crowd out normal cells. Because the myeloma cells crowd out the normal cells, the bone marrow cannot produce enough healthy cells. This causes low red blood cell counts, a condition called anemia, and low white cell counts, called neutropenia, which weakens the body's defenses against infection. The cancer cells collect in the bone marrow and slowly destroy the bone. Because they destroy bone, myeloma cells can cause the release of stored calcium from the bone into the bloodstream. This can lead to a potentially dangerous condition called hypercalcemia (elevated calcium levels in the blood). Hypercalcemia can affect the functioning of many parts of the body, including the heart, nerves, and kidneys. Myeloma cells produce an abnormal protein (M-proteins) which can affect the kidneys and other organs.

The development of Multiple Myeloma may be described in stages:

• Stage I: Relatively few cancer cells have spread throughout the body, calcium level in blood is normal, and there are no symptoms of the disease.
  
  
• Stage II: A moderate number of cancer cells have spread throughout the body.
  
  
• Stage III: A relatively large number of cancer cells have spread throughout the body. One or more of the following may be present: more than 3 bone tumors are found, high levels of M-proteins are present in the blood or urine, anemia may have developed, the bones may be damaged, resulting in a high calcium level in the blood.
  

Who Gets It?

Of the 1.2 million Americans told they have cancer this year, more than 14,600 people will be diagnosed with Multiple Myeloma. Most people who get Multiple Myeloma are between the ages of 50 and 70. It is rarely seen in people younger than age 40. More men get Multiple Myeloma than do women, and more African-American people get the disease than do white people. Most people with Multiple Myeloma have no known risk factors at all. Risk factors include:

• Family history of Multiple Myeloma
  
• Chemical exposure
  
• Radiation exposure
  
• People who suffer from chronic infections
  

Symptoms

There are often no symptoms in the early stages of Multiple Myeloma. When present, the symptoms depend on the extent of the disease. These symptoms include:

• Bone pain or fractures
  
• Weakness and fatigue
  
• Nausea or vomiting
  
• Anemia
  
• Constipation
  
• Problems with urination
  
• Numbness in the legs
  
• Confusion
  
• History of infection
  

Although these are symptoms of Multiple Myeloma, they may also be caused by other, less serious medical problems. People who have these symptoms should talk to their doctor.

How Is It Detected?

There is no standard screening procedure for Multiple Myeloma. Those who feel they are at risk for this disease should consult their physician. A physician may perform multiple tests, however, when symptoms of Multiple Myeloma are recognized. These tests include:

• Physical Examination and Family History
  
• X-Rays
• Blood and Urine Tests: These tests monitor the level of M-protein, a monoclonal protein which is a type of antibody produced by myeloma cells.
  
• Computerized Tomography (CT) Scan: A scan that shows early stages of bone involvement.
  
• Bone Scan: This scan helps to determine the extent of bone involvement.
  
• Bone Marrow Aspiration: In an aspiration, the doctor places a needle into the hip bone to remove a sample of blood and cells from the bone marrow.
  
• Biopsy: A needle is used to remove a small piece of bone or bone marrow in order to look for cancer cells under a microscope.
  

Is It Curable?

Studies of myeloma patients have reported the following range of 5-year survival rates and median survival times.

• Stage I: 5-year survival rate about 50%; median survival time over 60 months.
  
• Stage II: 5-year survival rate about 40%; median survival time about 41 months.
  
• Stage III: 5-year survival rate 10% - 25%; median survival time about 23 months.
  

Of course, each person's survival depends on more than their stage. Although a patient's stage helps in estimating their prognosis, it is impossible to predict anyone's outlook for certain.

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