Introduction about Multiple Myeloma
Roughly 16,000 Americans develop this illness each year. It is more frequent in men than in women and is more commonly seen after age 60. This disease is due to an overproduction of plasma cells from the bone marrow. Under normal circumstances, these cells are in charge of producing immune globulins, the immune proteins that our body needs to fight infection. In the case of multiple Myeloma, the abnormal plasma cells produce abnormal and dysfunctional immune globulins.
One indicator of the disease is a blood test known as Beta 2 microglobulin. This disease is basically diagnosed by detecting these abnormal immune globulins in the blood or, alternatively, by observing the abnormal plasma cells in the bone marrow.
Causes
The cause of this illness is unknown.
Signs and Symptoms
Patients may not show any signs for quite sometime and Myeloma can present itself in many different ways. Approximately 20 percent of patients are diagnosed incidentally and during workup on an unrelated problem. As the disease progresses, it can cause any of the following problems:
- Bone pain
- High calcium levels
- Kidney failure
- Anemia
- Low platelet count
- Hyperviscosity Syndrome
- Frequent infections
- Fever
- Weight loss
Diagnosis
The diagnosis is established by certain blood tests and also taking a biopsy of the bone marrow.
Staging
Staging refers to determination of the extent of the disease and is a very good guideline as to the treatment plans and outcome of Multiple Myeloma. The extent of the disease depends on the presence or absence of any of the following:
- Bone Disease
- High calcium levels
- Kidney failure
- Anemia
- Low platelet count
Lower stages of the illness are indicated by very minimal problems, and higher stages with the presence of most of the above problems.
Treatment
Multiple Myeloma involves almost all of the bone marrow space in the body. As a result, the disease can only be treated with systemic therapies. Any patient, who is under the age of 70, and in otherwise good health, should be considered and offered a bone marrow transplantation.
Following are the two of the most commonly used regimens for treatment of multiple Myeloma:
- Thalidomide, Dexamethasone known as ThalDex regimen which is treatment of choice for previously untreated patients.
- Velcade
- Melphalan, Prednisone, known as MP regimen: The two drugs are given orally for 4-7 days and are repeated every month
- Vincristine, Adriamycin, Decadron, known as VAD regimen. This is an intravenous treatment, whereby Vincristine and Adriamycin are given intravenously by way of continuous infusion over a period of four days. The infusion is repeated every month. Decadron is given orally. This is a more aggressive regimen with more side effects, as opposed to MP.
If the disease causes a local problem in the bones, like bone pain or fractures, etc., radiation can be used to alleviate the problem. Other drugs that can also be used are: Cytoxan, VP-16, Interferon, BiCNU
Remission
Refers to the response of any cancer to treatment.
Complete remission refers to the situation where the disease disappears completely with the treatment.
Partial remission refers to the situation where the disease shrinks but does not disappear completely with the treatment
Measuring the immune globulin levels in the blood, as well as repeating the bone marrow tests determine the remission status. When and if patients enter a remission, they are best maintained on a treatment regimen with Interferon.
Prognosis
Patients with lower stages have a better prognosis. Low Stage Multiple Myeloma may remain silent for years. It may, however, gradually progress into higher stages. Prognosis of High Stage Multiple Myeloma depends on the response to chemotherapy.
Special Situations
Patients with advanced Multiple Myeloma may develop any of the following complications.
- Spinal cord compression
- Bone destruction and metastasis
- High Calcium level
- Pain
- High Uric acid
Survival
Survival of patients with Multiple Myeloma, in whom a cure is not possible, may vary from months to years, depending on the extent of the cancer, overall condition of the patient, as well as his/her response to treatment and the duration of the response. Those treated with bone marrow transplant have a 30% chance of cure.
Follow-up
After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for the possibility of a recurrence of cancer. Follow-up should be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. In each follow-up visit, patients are examined and normally a blood test and evaluation of immune globulins and Beta 2 microglobulin is done.
Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy using the same agents mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas to which the cancer has spread. If patients experience pain, various pain medications can be used to alleviate pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from Hospice.
Multiple Myeloma
Multiple Myeloma
Multiple Myeloma
Multiple Myeloma
