CanCer-666: Multiple Myeloma

Treatment Options for Multiple Myeloma

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The treatment of multiple myeloma (MM) is complex because of rapid advances in stem cell transplantation, medications, and better supportive care, which have led to improved survival for patients with multiple myeloma over the past thirty years. After multiple myeloma is found and staged, your cancer care team will discuss treatment options with you. 
 
Treatment Options for Multiple Myeloma 
 
The treatment options for multiple myeloma may include: 
 
1. Initial Therapy for Multiple Myeloma 
 
The initial chemotherapy used to treat multiple myeloma depends on whether you're considered a candidate for stem cell transplantation and your individual risk profile. Factors such as the risk of your disease progressing, your age and your general health play a part in determining whether stem cell transplantation may be right for you. 
 
- If you're considered a candidate for stem cell transplantation, your initial therapy will likely exclude melphalan because this drug can have a toxic effect on stem cells, making it impossible to collect enough of them. Your first treatment will typically be lenalidomide or bortezomib combined with low-dose dexamethasone. 
 
Your stem cells will likely be collected after you've undergone three to four months of treatment with these initial agents. You may undergo the stem cell transplant soon after your cells are collected or the transplant may be delayed until after a relapse, if it occurs. Your age and your personal preference are important factors in determining when to do the transplant. 
 
- If you're not considered a candidate for stem cell transplantation, your initial therapy is likely to be a combination of melphalan, prednisone and thalidomide — often called MPT — or melphalan, prednisone and bortezomib (Velcade) — often called MPV. If the side effects are intolerable, melphalan plus prednisone (MP) or lenalidomide plus low-dose dexamethasone are additional options. This type of therapy is typically given for about 12 to 18 months. 
 
2. Standard Treatments for Multiple Myeloma 
 
Though there's no cure for multiple myeloma, with good treatment results you can usually return to near-normal activity. You may wish to consider approved clinical trials as an option. Standard treatment options include: 
 
Bortezomib (Velcade). Bortezomib was the first approved drug in a new class of medications called proteasome inhibitors. It is administered intravenously. It causes cancer cells to die by blocking the action of proteasomes. It is approved for people with newly diagnosed and previously treated myeloma. 
 
Chemotherapy. Chemotherapy involves using medicines — taken orally as a pill or given through an intravenous (IV) injection — to kill myeloma cells. Chemotherapy is often given in cycles over a period of months, followed by a rest period. Often chemotherapy is discontinued during what is called a plateau phase or remission, during which your M protein level remains stable. You may need chemotherapy again if your M protein level begins to rise. Common chemotherapy drugs used to treat myeloma are melphalan (Alkeran), cyclophosphamide (Cytoxan), vincristine, doxorubicin (Adriamycin) and liposomal doxorubicin (Doxil). 
 
Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, have been used for decades to treat multiple myeloma. They are typically given in pill form. 
 
Lenalidomide (Revlimid). Lenalidomide is chemically similar to thalidomide, but because it appears to be more potent and cause fewer side effects, it is currently used more often than thalidomide. Lenalidomide is given orally. It is approved for people with previously treated myeloma, but is also often used in people with newly diagnosed disease. 
 
Radiation therapy. This treatment uses high-energy penetrating waves to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells form a tumor (plasmacytoma) that's causing pain or destroying a bone. 
 
Stem cell transplantation. This treatment involves using high-dose chemotherapy — usually high doses of melphalan — along with transfusion of previously collected immature blood cells (stem cells) to replace diseased or damaged marrow. The stem cells can come from you or from a donor, and they may be from either blood or bone marrow. 
 
Thalidomide (Thalomid). Thalidomide, a drug originally used as a sedative and to treat morning sickness during pregnancy in the 1950s, was removed from the market after it was found to cause severe birth defects. However, the drug received approval from the Food and Drug Administration (FDA) again in 1998, first as a treatment for skin lesions caused by leprosy. Today thalidomide is FDA approved for the treatment of newly diagnosed multiple myeloma. This drug is given orally. 
 
3. Treatments for Relapsed or Treatment-resistant Multiple Myeloma 
 
Most people who are treated for multiple myeloma eventually experience a relapse of the disease. And in some cases, none of the currently available, first line therapies slow the cancer cells from multiplying. If you experience a relapse of multiple myeloma, your doctor may recommend repeating another course of the treatment that initially helped you. Another option is trying one or more of the other treatments typically used as first line therapy, either alone or in combination. Research on a number of new treatment options is ongoing, and these drugs offer important options for those with multiple myeloma. Talk to your doctor about what clinical trials may be available to you. 
 
Treatment of Multiple Myeloma Complications 
 
Because multiple myeloma can cause a number of complications, you may also need treatment for those specific conditions. For example: 
 
Anemia. Anemia (low red blood cell count) that is causing symptoms may require blood transfusions or treatment with erythropoietin (EPO), a substance that stimulates the production of red blood cells. Erythropoietin is usually given by injection one to three times per week. This treatment effectively increases levels of hemoglobin (the protein in red blood cells that helps carry oxygen to the tissues), improves symptoms, and reduces the need for blood transfusion. 
 
Bone pain and fractures. Physical activity, with careful avoidance of injury, can promote bone strength in individuals with multiple myeloma. The bone pain associated with multiple myeloma can be controlled with chemotherapy, analgesics (pain relieving drugs), radiation, and bone strengthening drugs such as zoledronic acid (Zometa) or pamidronate (Aredia) (commonly referred to as bisphosphonates) that can also reduce the likelihood of fractures. 
 
In individuals who have early signs of bone erosion, bisphosphonates reduce the risk of fractures and reduce bone pain. Therefore, bisphosphonates are recommended for all individuals who have early signs of bone erosions on x-rays. Bisphosphonates are usually given by intravenous infusion every four weeks; this treatment is continued for approximately two years. These medications may affect kidney function, which should be monitored on a regular basis to avoid this complication. Dental procedures, such as root canal or extraction of teeth, may be associated with infection or destruction of the jaw (osteonecrosis) in patients treated with intravenous bisphosphonates. Accordingly, patients should avoid such procedures, if possible, while taking these agents; any needed dental procedures should be performed before these agents are started. 
 
High blood calcium levels. High blood calcium levels develop as bone is lost. Individuals with MM should remain as active as possible because physical activity helps counter bone loss. The treatment of high blood calcium levels usually includes the use of intravenous fluids and prednisone. If this treatment is not effective, treatment with drugs that act against bone loss, such as zoledronic acid (Zometa) or pamidronate (Aredia), a class of drugs called bisphosphonates, may be recommended. 
 
Impaired kidney function. Kidney function becomes impaired in about one half of individuals with multiple myeloma. The treatment of impaired kidney function is aimed at the specific underlying cause. Treatment usually includes intravenous fluids; it may also include dialysis (a type of blood filtration used for kidney failure), prednisone (a steroid that can indirectly lower blood calcium levels), and allopurinol, a drug that can lower blood levels of uric acid, a waste product from the increased turnover of the malignant plasma cells, which can damage the kidneys. 
 
Patients are advised to stay well-hydrated and should drink enough fluid to produce three liters of urine daily if they have Bence Jones proteinuria (increased light chains in the urine). They should also avoid using any nonsteroidal anti-inflammatory drugs (NSAIDs, such as Advil, Motrin, Aleve) because these drugs might worsen kidney function. If impaired kidney function has progressed to kidney failure, the treatment options include hemodialysis or peritoneal dialysis. Advanced degrees of kidney failure are usually not reversible even if the multiple myeloma later responds to treatment. 
 
Infection. Bacterial infections, often indicated by the presence of fever, require prompt treatment with antibiotics. Daily use of the antibiotic trimethoprim-sulfamethoxazole (Bactrim) can help prevent infections. Individuals who get frequent infections may be advised to take penicillin daily or rarely to have periodic intravenous infusions of gamma globulin. All individuals with multiple myeloma should receive the pneumococcal vaccine (which reduces the likelihood of pneumonia) and the influenza vaccine (which reduces the likelihood of flu). 
 
Spinal cord compression. Spinal cord compression is a medical emergency that requires prompt treatment to prevent irreversible damage, such as paralysis. Initial treatment may consist of radiation and dexamethasone (a steroid) to reduce swelling around the spinal cord; if these measures are not effective, surgery is needed to relieve pressure on the spinal cord. Patients should call their doctor immediately if they have severe back pain; weakness, numbness, or tingling in the legs; or new problems with control over their 
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bladder or bowel (incontinence). 
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Thickening of the blood. Thickening of the blood (called hyperviscosity syndrome) rarely occurs in individuals with multiple myeloma. This complication is treated with plasmapheresis, a type of blood filtration that removes the excess monoclonal proteins responsible for the increased viscosity. 
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Treatment Options for Multiple Myeloma

The treatment of multiple myeloma (MM) is complex because of rapid advances in stem cell transplantation, medications, and better supp...

Multiple Myeloma Stages

ancorez Multiple Myeloma 4:52 AM

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Staging is a way of describing where a cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer. 
 
For myeloma, it is important to begin with whether the patient is experiencing symptoms. It is common to classify patients with newly diagnosed myeloma as being either symptomatic from the disease (having symptoms and signs) or asymptomatic (without any symptoms). Patients without symptoms are generally watched closely without treatment, which is called active surveillance (see the Treatment Options section). Patients with symptoms need treatment. 
 
Multiple myeloma may be staged using the Durie-Salmon system. Although some doctors use this system, its value is becoming limited because of newer diagnostic methods. Recently, a new staging system called the International Staging System for Multiple Myeloma has been developed. It relies mainly on levels of albumin and beta-2-microglobulin in the blood. Other factors that may be important are kidney function, platelet count and the patient's age. 
 
1. The Durie-Salmon staging system 
 
This system is based on 4 factors: 
<ul>
<li>The amount of abnormal monoclonal immunoglobulin in the blood or urine: Large amounts of monoclonal immunoglobulin indicate that many malignant plasma cells are present and are producing that abnormal protein.</li>
<li>The amount of calcium in the blood: High blood calcium levels can be related to advanced bone damage. Because bone normally contains lots of calcium, bone destruction releases calcium into the blood.</li>
<li>The amount of hemoglobin in the blood: Hemoglobin carries oxygen in red blood cells. Low hemoglobin levels mean you are anemic and can indicate that the myeloma cells occupy much of the bone marrow and that not enough space is left for the normal marrow cells to make enough red blood cells.</li>
<li>The severity of bone damage based on x-rays: Multiple areas of bone damage seen on x-rays indicate an advanced stage of multiple myeloma.</li>
</ul>
This system uses these factors to divide myeloma into 3 stages. Stage I indicates the smallest amount of tumor, and stage III indicates the largest amount of tumor: 
 
Stage I 
Many patients with stage I myeloma show no symptoms because there are fewer cancer cells in the body. If the cancer has affected kidney function, the prognosis may be worse regardless of the stage. Factors characteristic of stage I include: 
<ul>
<li>Bone x-rays appear normal or show only 1 area of bone damage</li>
<li>Calcium levels in the blood are normal (less than 12 mg/dL)</li>
<li>Hemoglobin level is only slightly below normal (still above 10 g/dL)</li>
<li>Only a relatively small amount of monoclonal immunoglobulin is in blood or urine</li>
</ul>
Stage II 
More cancer cells are present in the body in stage II. Again, if kidney function is affected, then the prognosis worsens regardless of the stage. Criteria for stage II are defined as those that fit neither stage I nor stage III. 
 
Stage III 
Many cancer cells are present in the body at stage III. Factors characteristic of this stage are: 
<ul>
<li>3 or more areas of bone destroyed by the cancer</li>
<li>High blood calcium level (above 12 mg/dL)</li>
<li>Large amount of monoclonal immunoglobulin in blood or urine</li>
<li>Low hemoglobin level (below 8.5 g/dL)</li>
</ul>
The International Staging System 
 
Another classification system called the International Staging System (ISS) is now used more commonly. It defines the factors that influence patient survival. The ISS is based on data collected from patients with multiple myeloma from around the world. The system has three stages based on the measurement of serum albumin and the levels of serum β2 microglobulin. Recent efforts involve further classifying myeloma based upon patterns of gene expression in myeloma cells; this is an ongoing area of research. 
 
Stage I 
Serum beta-2 microglobulin is less than 3.5 (mg/L) and the albumin level is above 3.5 (g/L) 
 
Stage II 
Neither stage I or III, meaning that either: 
<ul>
<li>The albumin is below 3.5 while the beta-2 microglobulin is less than 3.5, or</li>
<li>The beta-2 microglobulin level is between 3.5 and 5.5 (with any albumin level).</li>
</ul>
Stage III 
Serum beta-2 microglobulin is greater than 5.5. 
 
Recurrent or relapsed myeloma. Myeloma that returns after a period of being in control after treatment is called recurrent myeloma or relapsed myeloma. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above. 
 
 
Other Classifications 
 
Age: Age is also important. In the studies of the international staging system, older people with myeloma do not live as long. 
 
Chromosome Studies: The bone marrow may be sent for tests to look at the chromosomes in the malignant cells. Certain chromosome changes can indicate a poorer outlook. For example, changes in chromosome 13 will lower a person’s chances for survival. Another genetic abnormality that predicts a poor outcome is an exchange of material from chromosomes 4 and 14. This is called a translocation. 
 
Kidney Function: The blood creatinine (Cr) level shows how healthy the kidneys are. Kidneys eliminate this chemical from the body. When they are damaged by the monoclonal immunoglobulin, blood creatinine levels rise, predicting a worse outlook. 
 
Labeling Index: The myeloma cell labeling index, sometimes called the plasma cell labeling index, indicates how fast the cancer cells are growing. This test is done in specialized labs, using myeloma cells from bone marrow samples. A high labeling index can predict a more rapid accumulation of cancer cells and a worse outlook. 
 
Monoclonal Gammopathy of Unknown Significance (MGUS): This condition occurs when people have a low level of M protein (meaning there are small quantities of abnormal plasma cells), but they do not have any other evidence of myeloma, such as bone damage, excessive plasma cells, or low numbers of red blood cells. People with MGUS have a 1% chance per year of developing myeloma or lymphoma. For this reason, doctors monitor the health of people with MGUS on a regular basis. 
 
Prognosis: The International Staging System (ISS) of myeloma gives information about prognosis and predicts the person’s chance of recovery. Researchers are also looking at other ways to predict prognosis for patients with multiple myeloma. Some of these ways of evaluating prognosis include: 
<ul>
<li>A plasma cell labeling index can be done in a specialized laboratory using bone marrow samples to find out how fast the cancer cells are growing.</li>
<li>Abnormalities of chromosomes in the cancer cells may show how aggressive the cancer is.</li>
<li>High levels of β2-M may indicate a large number of myeloma cells are present and kidney damage has occurred. The level of this protein increases as myeloma becomes more advanced.</li>
<li>Lactase dehydrogenase (LDH) is an enzyme; higher blood levels of LDH indicate a poorer prognosis.</li>
<li>Lower amounts of serum albumin may indicate a poorer prognosis.</li>
</ul>
Smoldering Multiple Myeloma (SMM) or Asymptomatic Myeloma: People who are diagnosed with SMM have slightly higher levels of M protein and more plasma cells in the bone marrow than people with MGUS. There is still no evidence of symptoms or signs of myeloma, such as bone disease or anemia. But, a person with SMM may be prescribed bisphosphonates for symptoms of osteoporosis or osteopenia (a low density of bone minerals). Most people with SMM eventually develop myeloma. For this reason, doctors closely monitor the health of people with smoldering myeloma. 
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Multiple Myeloma Stages

Staging is a way of describing where a cancer is located, if or where it has spread, and whether it is affecting other parts of the bod...

How is multiple myeloma diagnosed?

ancorez Multiple Myeloma 1:35 AM

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Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy (the removal of a small amount of tissue for examination under a microscope) is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test: 
<ul>
<li>Age and medical condition</li>
<li>Type of cancer suspected</li>
<li>Signs and symptoms</li>
<li>Previous test results</li>
</ul>
The following tests may be used to diagnose multiple myeloma: 
 
1. Bone Marrow Biopsy 
 
People with multiple myeloma have too many plasma cells in their bone marrow. The procedure to check the bone marrow is called a bone marrow biopsy and aspiration. It can be either done at the doctor's office or at the hospital. In this procedure, the back of the pelvic bone is numbed with local anesthetic. Then, to do the bone marrow aspiration, a needle is inserted into the bone, and a syringe is used to remove a small amount of liquid bone marrow. This causes a brief sharp pain. Then for the biopsy, a needle is used to remove a tiny sliver of bone and marrow, about 1/16-inch across and 1-inch long. Patients may feel some pressure during the biopsy, but it usually isn’t painful. There is some soreness in the biopsy area when the numbing medicine wears off. Most patients can go home immediately after the procedure. 
 
A doctor will use a microscope to look at the bone marrow tissue to see the appearance, size, and shape of the cells, how the cells are arranged and to determine if there are myeloma cells in the bone marrow and, if so, how many. The aspirate may also be sent for other tests, including immunohistochemistry and flow cytometry, and chromosome analyses, including karyotype and fluorescent in situ hybridization (also known as FISH). 
 
Cytogenetics. This technique lets doctors evaluate the chromosomes (long strands of DNA) in normal bone marrow cells and myeloma cells. Some myeloma cells may have too many chromosomes, too few chromosomes, or other chromosome abnormalities. The cells are looked at under a microscope to see if the chromosomes have any changes, such as translocations (where part of one chromosome has broken off and is now attached to another chromosome) or deletions (where part or all of a chromosome is missing), as can happen in some cases of multiple myeloma. Finding these changes can sometimes help in predicting a person’s prognosis. Cytogenetic testing usually takes about 2 to 3 weeks because the cells must grow in lab dishes for a couple of weeks before their chromosomes are ready to be seen under the microscope. 
 
Flow Cytometry. Like the immunohistochemistry test, the flow cytometry test looks for certain substances on the outside surface of cells that help identify what types of cells they are. But this test can look at many more cells than immunohistochemistry. For this test, a sample of cells is treated with special antibodies that stick to the cells only if certain substances are present on their surfaces. The cells are then passed in front of a laser beam. If the cells now have antibodies attached to them, the laser will cause them to give off light, which can be measured and analyzed by a computer. Groups of cells can be separated and counted by these methods. 
 
This is the most commonly used test for immunophenotyping — classifying cells according to the substances (antigens) on their surfaces. Different cells and cell types have different antigens on their surface. These antigens may also change as each cell matures. Flow cytometry can help determine if there are abnormal cells in the bone marrow and if they are myeloma cells, lymphoma cells, some other cancer, or a non-cancerous disease. 
 
Fluorescent In Situ Hybridization (FISH). Fluorescent in situ hybridization (FISH) is similar to cytogenetic testing. It uses special fluorescent dyes that only attach to specific parts of chromosomes. FISH can find most chromosome changes (such as translocations and deletions) that can be seen under a microscope in standard cytogenetic tests, as well as some changes too small to be seen with usual cytogenetic testing. 
 
FISH can be used to look for specific changes in chromosomes. It can be used on regular blood as well as bone marrow samples. It is very accurate and because the cells don’t have to grow in a dish first, results are often available within a couple of days. 
 
Immunohistochemistry. In this test, a part of the biopsy sample is treated with special antibodies (man-made versions of immune system proteins) that attach only to specific molecules on the cell surface. These antibodies cause color changes, which can be seen under a microscope. This test may be helpful in telling different types of cells apart and in finding myeloma cells. 
 
2. Imaging Studies 
 
Bone X-rays. Bone destruction caused by the myeloma cells can be detected with x-rays. Often doctors will do a series of x-rays that includes most of the bones. This is called a bone survey or skeletal survey. 
 
Computed Tomography (CT) Scans. The computed tomography (CT) scan (also known as a CAT scan) is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures of the part of your body being studied as it rotates around you. A computer then combines these pictures into an image of a slice of your body. Sometimes, this test can help tell if your bones have been damaged by myeloma. A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken. 
 
You might be asked to drink 1 to 2 pints of a solution of contrast material before the test. This helps outline the intestine so that it is not mistaken for tumors. You might also receive an intravenous (IV; in the vein) line through which a different contrast dye is injected. This helps better outline structures in your body. The injection can cause a feeling of warmth throughout the body (flushing). Some people are allergic to the IV contrast and get hives. Rarely, more serious reactions like trouble breathing and low blood pressure can occur. Medicine can be given to prevent and treat allergic reactions. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays. If IV contrast is being used, it is important you tell the radiology people that you have myeloma. Some of these contrast agents can damage the kidneys of people with myeloma. 
 
CT scans can also be used to guide a biopsy needle precisely into a suspected tumor. For this procedure, called a CT-guided needle biopsy, the patient remains on the CT scanning table while a radiologist advances a biopsy needle toward the location of the tumor. CT scans are repeated until the doctors are confident that the needle is within the mass. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about ½-inch long and less than 1/8 inch in diameter) is removed and examined under a microscope. 
 
Magnetic Resonance Imaging (MRI) scans. MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross-sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of your body. A dye (contrast material) might be injected just as with CT scans but is used less often. 
 
MRI scans are very helpful in looking at bones, the brain, and the spinal cord. They might be able to find plasmacytomas that cannot be seen on regular x-rays. MRI can also be used to look at the bone marrow in patients with multiple myeloma. MRI scans are a little more uncomfortable than CT scans. First, they can take an hour or longer. Also, you have to be placed inside tunnel-like equipment, which is confining and can upset some people. The machine also makes a thumping noise that could be disturbing. Some places provide headphones with music to block this out. 
 
Positron Emission Tomography (PET) Scans. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that produce the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. 
 
3. Laboratory Tests 
 
If symptoms suggest that a person might have multiple myeloma, lab tests on blood and/or urine, x-rays of the bones, and a bone marrow biopsy are usually done. 
 
Beta-2 Microglobulin. This is another protein produced by the malignant cells. Although this protein itself doesn't cause problems, it can be a useful indicator of a patient's prognosis (outlook). High levels indicate more advanced disease and maybe a worse prognosis. 
 
Blood Chemistry Tests. Levels of blood urea nitrogen (BUN) and creatinine, albumin, calcium, and other electrolytes will be checked. 
<ul>
<li>Albumin is a protein found in the blood. Low levels can be a sign of more advanced myeloma.</li>
<li>BUN and creatinine (Cr) levels show how well your kidneys are working. Higher levels mean that kidney function is impaired. This is common in people with myeloma.</li>
<li>Calcium levels may be higher in people with advanced myeloma. High calcium levels can cause severe symptoms of fatigue, weakness, and confusion.</li>
<li>Levels of electrolytes such as sodium and potassium may be affected as well.</li>
</ul>
Blood Counts. The complete blood count (CBC) is a test that measures the levels of red cells, white cells, and platelets in the blood. If myeloma cells occupy too much of the bone marrow, levels of some of these blood cells will be low. The most common finding is a low red blood cell count (anemia). 
 
Electrophoresis. The immunoglobulin produced by myeloma cells is abnormal because it is monoclonal (all the exact same antibody). Serum protein electrophoresis (SPEP) is a test that measures the immunoglobulins in the blood and can find a monoclonal immunoglobulin. Then, another test, such as immunofixation or immunoelectrophoresis, is used to determine the exact type of abnormal antibody (IgG or some other type). Finding a monoclonal immunoglobulin in the blood may be the first step in diagnosing multiple myeloma. This abnormal protein is known by several different names, including monoclonal immunoglobulin, M protein, M spike, and paraprotein. 
 
Immunoglobulins are made up of protein chains: 2 long (heavy) chains and 2 shorter (light) chains. Sometimes the kidneys excrete pieces of the M protein into the urine. This urine protein is the part of the immunoglobulin called the light chain. It is also known as Bence-Jones protein. The tests used for finding a monoclonal immunoglobulin in urine are called urine protein electrophoresis (UPEP) and urine immunofixation. These are most often done on urine that has been collected over 24 hours. 
 
Free Light Chains. This test measures the amount of light chains in the blood. This is most helpful in the rare cases of myeloma in which no M protein is found by SPEP. Since the SPEP measures the levels of intact (whole) immunoglobulins, it cannot measure the amount of light chains. 
 
Quantitative Immunoglobulins. This test measures the blood levels of the different antibodies. There are several different types of antibodies in the blood: IgA, IgD, IgE, IgG, and IgM. The levels of these immunoglobulins are measured to see if any are abnormally high or low. In multiple myeloma, the level of one type may be high while the others are low. 
 
4. Other Biopsy Tests 
 
If an area looks abnormal on an x-ray, a biopsy may be needed to confirm that it is a plasmacytoma. Most often, a needle biopsy is used. 
 
Core Needle Biopsy. This test is similar to FNA, but a larger needle is used and a larger tissue sample is removed. 
 
Fine Needle Aspiration Biopsy. Fine needle aspiration (FNA) uses a very thin needle and an ordinary syringe to withdraw a small amount of tissue from a tumor or lymph node. The doctor can aim the needle while feeling an enlarged node near the surface of the body. If the abnormal area (tumor) is deep inside the body, the needle can be guided while it is viewed on a computed tomography (CT) scan (see discussion of imaging tests later in this section). The main advantage of FNA is that it does not require surgery. The disadvantage is that in some cases the thin needle cannot remove enough tissue for a definite diagnosis. FNA can be useful in diagnosing cancers that have spread to nodes from other organs. 
 
After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer.</div>
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How is multiple myeloma diagnosed?

Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments m...

Symptoms and Signs of Multiple Myeloma

ancorez Multiple Myeloma 12:48 AM

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Signs and symptoms of multiple myeloma can vary from person to person. Early in the disease, the condition may not cause any symptoms (smoldering multiple myeloma). As the disease progresses, it's likely that you'll experience at least one of the four major problems common to multiple myeloma, which include: 
 
A high level of calcium in your blood. When the myeloma cells dissolve bone, calcium is released. This can lead to high levels of calcium in the blood (called hypercalcemia). Symptoms include feeling very thirsty, drinking a lot of fluids, and urinating (peeing) a lot. This can cause dehydration and even kidney failure. High calcium can also cause severe constipation, abdominal (belly) pain, and loss of appetite. It can make people feel weak, drowsy, and confused. If the level of calcium gets high enough, it can even cause you to lapse into a coma. 
 
Anemia-related fatigue. This fatigue occurs as myeloma cells replace oxygen-carrying red blood cells in your bone marrow. 
 
Blood clots, nosebleeds, bleeding gums, bruising, and hazy vision caused by hyperviscosity (thickened blood) 
 
Bone damage, a common symptom, is caused by local bone damage and osteoporosis (general thinning of the bone), which makes the bone more likely to break. The back or ribs are the most common sites of bone pain, but any bone can be affected. Pain is usually worse with movement and at night. If cancer is in the spine, the vertebrae (individual bones that make up the spine) can collapse (known as a compression fracture) and sometimes pinch the nerve, causing pain. In advanced multiple myeloma, a patient may lose inches from his or her height due to compressed vertebrae. 
 
Hypercalcemia. Resulting in symptoms of drowsiness, constipation, and kidney damage. 
 
Infections. Myeloma patients are much more likely to get infections. This happens because the body is unable to make the proper antibodies that help fight infection. When someone with myeloma gets an infection, they may be slow to respond to treatment. That person may stay sick for a long time. Pneumonia is a common and serious infection seen in myeloma patients. 
 
Kidney (renal) failure. Myeloma protein can damage the kidneys. Early on, this doesn't cause any symptoms, but signs of kidney damage can be seen on a blood test. As the kidneys start to fail, they lose the ability to dispose of excess salt, fluid, and body waste products. This can lead to symptoms like weakness, shortness of breath, itching, and leg swelling. 
 
Your doctor will ask you questions about the symptoms you are experiencing, if any, to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often. 
 
If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. 
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Symptoms and Signs of Multiple Myeloma

Signs and symptoms of multiple myeloma can vary from person to person. Early in the disease, the condition may not cause any symptoms (s...

Multiple Myeloma Risk Factors

ancorez Multiple Myeloma 12:26 AM

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A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. 
 
The causes of myeloma are not known or well understood, and there are currently no known ways to prevent it. There are also no strong risk factors for myeloma. Mutations (changes) in plasma cells are acquired, not inherited, so having a relative with the disease usually does not mean another family member is at higher risk for developing it. There appears to be a very slight increase in the incidence of the disease in first-degree relatives (parents or siblings) of people with multiple myeloma, but this link has not been shown to be genetic at this time. 
 
Some factors that may increase your risk of multiple myeloma include: 
 
Age 
The risk of multiple myeloma goes up with age. The majority of those diagnosed are over 65 years old. Only 2% of cases occur in people under 40. 
 
Family history 
Multiple myeloma seems to run in some families. Having a sibling or a parent who's had multiple myeloma may increase the likelihood of developing the disease as much as four times when compared to people who have no family history of multiple myeloma. However, this has only been found in a small number of cases. 
 
Gender 
Men are slightly more likely to develop multiple myeloma than women. 
 
Obesity 
Your risk of multiple myeloma is increased if you're overweight or obese. 
 
Other plasma cell diseases 
Some people who have a condition known as monoclonal gammopathy of undetermined significance (MGUS) may be at increased risk for multiple myeloma. In MGUS, an abnormal line of antibody-producing plasma cells will begin to produce monoclonal antibody proteins (M-proteins). Over time, the proliferation of the “M-protein” may crowd out the normal plasma cells that are capable of producing functional antibodies. The American Cancer Society has reported that every year approximately 1 percent of all people with MGUS develop a more severe disease, including multiple myeloma. It is not known why some people with MGUS develop multiple myeloma and others do not. 
 
Race 
For unknown reasons, the incidence of multiple myeloma is twice as high in African Americans as compared to white Americans. 
 
Radiation 
People who were exposed to radiation from an atomic bomb blast had a higher risk of multiple myeloma. Exposure to lower levels of radiation may also increase the risk of multiple myeloma. At most, this accounts for a very small number of cases. 
 
Workplace exposures 
A small number of cases may be linked to exposure to high doses of radiation. Studies looking at workplace exposures and multiple myeloma risk have found no clear links.</div>
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Multiple Myeloma Risk Factors

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development o...

Definition and Description of the Multiple Myeloma

Gaptek_ancorez Multiple Myeloma 11:41 AM

<div dir="ltr" style="text-align: left;" trbidi="on"><h1>Definition of Multiple Myeloma</h1><div style="text-align: justify;"> 
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAhQx9yT4mIfWxkQFh1JJnR2f2SHk1_093PHvS1YoF7AEFPgr5bNEHDRgSdwwDV67rytE7CDcGEJGtKhIb-ATASkQoJqq5FzIRyH-Vy68dcv0rqh2TnY2P1XtmQYSxfVbLoEv03yGaOl0I/s1600/Definition+and+Description+of+the+Multiple+Myeloma.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAhQx9yT4mIfWxkQFh1JJnR2f2SHk1_093PHvS1YoF7AEFPgr5bNEHDRgSdwwDV67rytE7CDcGEJGtKhIb-ATASkQoJqq5FzIRyH-Vy68dcv0rqh2TnY2P1XtmQYSxfVbLoEv03yGaOl0I/s320/Definition+and+Description+of+the+Multiple+Myeloma.png" width="192" /></a></div><div style="text-align: justify;">Multiple myeloma is a <a href="http://cancer-666.blogspot.com/">cancer</a> of your plasm cells; a character of the white blood corpuscle gives in your marrow. Plasma cells generally built proteins called antibodies to help oneself you battle infections.</div><div style="text-align: justify;"> 
</div><div style="text-align: justify;">In multiple myeloma, a grouping from plasma cells (myeloma cells) converts malignant and multiplies, advancing the count of plasma cells to a more in high spirits than regular stage. Because these cells normally build proteins (antibodies), the stage from abnormal proteins in your blood also might go up. Unhealthiness had of multiple myeloma can pretend your bones, resistant scheme, kidneys and red blood cell count.</div><div style="text-align: justify;"> 
</div><div style="text-align: justify;">Whenever you've multiple myeloma just do not accept symptoms, your repair could just now reminder your check. Whenever you're feeling symptoms, a number of discussions are usable to assist ascendance multiple myeloma.</div><div style="text-align: justify;"> 
</div><div style="text-align: justify;"><h2>Description of Multiple Myeloma</h2></div><div style="text-align: justify;"> 
</div><div style="text-align: justify;">Multiple myeloma, alias plasmacyte myeloma, are the second-most basic leukemia. They are the more common typecast of plasmacyte tumor. Multiple myeloma accounts as around 1% by totally cancers and 2% of all deceases from cancer. Multiple myeloma are a disease in which malignant plasmacyte's cattle farm by the marrow and hard external allots of the big bones of the body. These myeloma cells could anatomy neoplasms called plasmacytomas. Finally, multiple fontanelles or cake holes, called osteolytic wounds, anatomy inward the bones.</div><div style="text-align: justify;"> 
</div><div style="text-align: justify;">Marrow is the spongelike tissue inside the bones. The sternum, backbone, ribs, skull, pelvic bones, and the is long of the second joint totally is specially ample in marrow. Marrows are an identical physical tissue that's responsible acquiring the cells that broadcast in the blood. This let in the erythrocytes that acquit oxygen, the leucocytes that develop into resistant system cells, and thrombocytes, which case blood to curdle.</div><div style="text-align: justify;"> 
</div><div style="text-align: justify;">Multiple myelomas are a haematological (blood) Cancer the Crab that makes grows in the marrow, the easy, spongelike center on by almost bones. Face anatomy. Myeloma commonly comes in marrow on the most action, which are the marrow successful the back, pelvic bones up; rib bands surface at area of the berms and coxae. A lot, corpuscle is acquired in the marrow; myeloma affects plasmacytes, cells that polyimmunoglobulin (antibodies) that assist agitate contagion and disease. In multiple myeloma, normal plasmacytes metamorphose into malevolent myeloma cells and acquire big amounts by an antidromic immune gamma globulin called monoclonal (M) protein. The malevolent cells as well gang away and conquer the product of convention corpuscles and antibodies in the marrow. Additionally, groups of myeloma cell's case additional cells in the marrow to take away the hearty break of the bone and case fontanelles in the bone. This fontanels, besides called osteolytic wounds, and additional auguries of bone departure is basic, although they don't come altogether humans on myeloma.</div></div>

Definition and Description of the Multiple Myeloma

Definition of Multiple Myeloma Multiple myeloma is a cancer of your plasm cells; a character of the white blood corpuscle gives in your m...

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