Multiple myeloma is a type of cancer that occurs when plasma cells in the blood grow abnormally and out of control.
Multiple myeloma does not cause symptoms in everyone. Bone pain, commonly in the back, hips, and skull is usually the first symptom of multiple myeloma.
Other symptoms of multiple myeloma may include:
- Other bone problems: These may include osteoporosis, bone weakness where there is a plasmacytoma, and fractures.
- High blood levels of calcium (hypercalcemia). Symptoms include:
- Extreme thirst
- Increased urination
- Loss of appetite
- Kidney problems and kidney failure
- Severe constipation
- Abdominal pain
- Coma (if calcium levels are extremely high)
- Low counts of red blood cell (anemia), white blood cells (leukopenia), or plasma cells (thrombocytopenia)
- Nervous system symptoms: Spinal bones may weaken and result in spinal cord compression, which is a medical emergency. See a doctor right away if you experience:
- Sudden severe back pain
- Numbness or muscle weakness, usually in the legs
- Loss of bladder or bowel control
- Nerve damage: This can cause weakness, numbness, and a “pins and needles” sensation.
- Thickened blood that slows blood flow to the brain: This may also cause the person to feel confusion, dizziness, or stroke symptoms (such as weakness on one side of the body and slurred speech).
- Kidney problems. Symptoms include leg swelling, itching, shortness of breath, and weakness.
- Infections, such as pneumonia
How Is Multiple Myeloma Diagnosed?
Multiple myeloma is diagnosed with a patient history and physical examination, and tests such as:
- Blood tests
- Complete blood count (CBC)
- Blood chemistry
- Levels of blood creatinine, albumin, calcium, and other electrolytes
- Beta-2 microglobulin
- Lactic dehydrogenase (LDH) levels
- Quantitative immunoglobulins
- Serum free light chains
- Imaging tests
- Bone X-rays
- Magnetic resonance imaging (MRI) scans
- Computed tomography (CT) scan
- Positron emission tomography (PET) scans
- Echocardiogram (“echo”) of the heart
- Urine tests
A diagnosis of multiple myeloma requires:
- A plasma cell tumor (proven by biopsy) OR at least 10% plasma cells in the bone marrow, AND
- At least one of the following:
- High blood calcium level
- Low red blood cell counts (anemia)
- Poor kidney function
- Holes in the bones from a tumor noted on imaging studies
- Increase in one type of light chain in the blood so that one type is 100 times more common than the other
- 60% or more plasma cells in the bone marrow
What Is the Treatment for Multiple Myeloma?
Multiple types of treatments are available for multiple myeloma. Treatment may be systemic (affecting the entire body) or local (directed at the tumor without affecting the entire body).
Systemic treatments for multiple myeloma reach cancer cells throughout the body. Drug therapies commonly used to treat multiple myeloma include:
- Proteasome inhibitors
- Immunomodulating drugs
- Steroids such as dexamethasone and prednisone
- Histone deacetylase (HDAC) inhibitors
- Monoclonal antibodies
- Nuclear export inhibitor
While sometimes a single drug may be used to treat multiple myeloma, using at least 2 or 3 different kinds of drugs in combination is preferred because the cancer responds better. The combination of a proteasome inhibitor and an immunomodulatory agent plus the steroid dexamethasone is the standard treatment for newly diagnosed patients.
Other systemic treatments for multiple myeloma include:
- Bisphosphonate medications for bone disease
- Stem cell transplant
- Supportive treatments
- Intravenous immunoglobulin (IVIG) to help prevent infections
- Treatment for low blood cell counts
- Plasmapheresis is used to remove myeloma protein from the blood
Local treatments for multiple myeloma are often used to treat earlier-stage cancer, though they are sometimes used in other situations, and may include:
- Radiation therapy
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