Multiple Myeloma - Symptoms & Treatment

Multiple myeloma is also known as malignant plasmacytoma, plasma cell myeloma, and myelomatosis. It's a disseminated neoplasm of marrow plasma cells that infiltrates bone to produce osteolytic lesions throughout the skeleton (flat bones, vertebrae, skull, pelvis, ribs); in late stages, it infiltrates the body organs (liver, spleen, lymph nodes, lungs, adrenal glands, kidneys, skin, and GI tract). Multiple myeloma strikes about 9,600 people yearly-mostly men over age 40.

The prognosis is usually poor because the disease is commonly diagnosed after it has already infiltrated the vertebrae, pelvis, skull, ribs, clavicles, and sternum. By then, skeletal destruction is widespread and, without treatment, leads to vertebral collapse; about 52% of patients die within 3 months of diagnosis and 90% within 2 years. Early diagnosis and treatment prolong the lives of many patients by 3 to 5 years. Death usually follows complications, such as infection, renal failure, hematologic disorders, fractures, hypercalcemia, hyperuricemia, or dehydration.

Causes

The exact cause of myeloma bone disease is not known, but theories and associations have been suggested as risk factors.

Signs and symptoms

The earliest symptom of multiple myeloma is often back pain. This disease should be considered in diagnosis or treatment of elderly patients with new onset of low back pain. Arthritic symptoms may also occur: achiness, joint swelling, and tenderness, possibly from vertebral compression. Other effects include fever, malaise, slight evidence of peripheral neuropathy (such as peripheral paresthesia), pathologic fractures, and easy bruising.

As multiple myeloma progresses, symptoms of vertebral compression may become acute, accompanied by anemia, weight loss, thoracic deformities (ballooning), and loss of body height-5" (13 cm) or more-due to vertebral collapse.

Renal complications such as pyelonephritis (caused by tubular damage from large amounts of Bence Jones protein, hypercalcemia, and hyperuricemia) may occur. Severe, recurrent infection such as pneumonia may follow damage to nerves associated with respiratory function.

Diagnosis

Diagnosis is made by testing the blood and urine for evidence of an abnormal protein that is secreted by myeloma cells, performing x-rays of the bones, and by performing a bone marrow aspiration and biopsy in which the abnormal cells can often be seen under the microscope.

Treatment

Long-term treatment of multiple myeloma consists mainly of chemotherapy to suppress plasma cell growth and control pain. Some combinations include cyclophosphamide, doxorubicin, and prednisone; and carmustine, doxorubicin, and prednisone. Also, adjuvant
local radiation reduces acute lesions, such as collapsed vertebrae, and relieves localized pain.

Other treatment usually includes a melphalan-prednisone combination in high intermittent doses or low continuous daily doses, and analgesics for pain. For spinal cord compression, the patient may require a laminectomy; for renal complications, dialysis.

Because the patient may have bone demineralization and may lose large amounts of calcium into blood and urine, he's a prime candidate for renal calculi, nephrocalcinosis and, eventually, renal failure due to hypercalcemia. Hypercalcemia is managed with hydration, diuretics, corticosteroids, oral phosphate, and I.V. mithramycin to decrease serum calcium levels.

Prevention

The following tips may help you keep multiple myeloma under control:

• Stay active. Exercise helps keep your bones stronger. If pain keeps you from being active, ask your doctor about ways to lessen the pain.
• Drink fluids. Drinking fluids can help keep you from becoming dehydrated. And by drinking plenty of fluids, you help dilute the Bence Jones protein fragments in your urine, which may help prevent kidney damage.
• Eat a balanced diet. One way to promote your overall health and cope with any form of cancer is to eat well. The amount of M protein in your system isn't affected by how much protein you eat, so there's no need to limit protein intake unless told otherwise by your doctor. Don't take vitamins, herbs or medication without your doctor's approval because they may interfere with your treatment.