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 can not 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")

Myeloma can be diagnosed using x-rays, blood tests, MRI (Magnetic Resonance Imaging) or bone marrow aspiration. (Read about "Complete Blood Count" "X-rays" "MRI - Magnetic Resonance Imaging")

Once multiple myeloma is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for multiple myeloma, according to NCI:

• Stage I

  Relatively few cancer cells have spread throughout the body. The number of red blood cells and the amount of calcium in the blood are normal. No tumors (plasmacytomas) are found in the bone. The amount of M-protein in the blood or urine is very low. (Read about "The Urinary System") There may be no symptoms of disease.

• Stage II

  A moderate number of cancer cells has spread throughout the body.

• Stage III

  A relatively large number of cancer cells has spread throughout the body. There may be one or more of the following:

  • There is a decrease in the number of red blood cells, causing anemia.
  • The amount of calcium in the blood is very high, because the bones are being damaged.
  • More than three bone tumors (plasmacytomas) are found.
  • High levels of M-protein are found in the blood or urine.

Treatment is complex. (Read about "Cancer Treatments") Chemotherapy and corticosteroids are is the main treatment for multiple myeloma, according to NCI. In chemotherapy, doctors may prescribe two or more drugs that work together to kill myeloma cells. Many of these drugs are taken by mouth; others are injected into a blood vessel. Corticosteroids such as prednisone are typically given as pills. NCI says high dose chemotherapy followed by bone marrow transplantation provides an added therapeutic benefit. Since higher doses of chemotherapy and/or radiation also cause greater 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). 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.

Radiation therapy is the main treatment 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 many eventually develop multiple myeloma, according to NCI.

The Multiple Myeloma Research Foundation says there are some other promising therapies. There are newer drugs that work with the immune system to control the condition and extend the survival rate. Vaccines to help stimulate the body's immune system are also under study.

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")

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

Related Information:

    Blood Disorders Glossary