Multiple Myeloma

Overview

What is multiple myeloma?

Multiple myeloma (say: my-a-low-ma) is a kind of cancer in the bone marrow. Bone marrow is the tissue inside the bones where new blood cells are made. Multiple myeloma is caused when your body makes too many of a certain blood cell, called a plasma cell. When this happens, the abnormal plasma cells group together and form tumors. They kill the bone cells around them and keep other blood cells that your body needs from being made.

Symptoms

What are the symptoms of multiple myeloma?

The symptoms of multiple myeloma include:

  • Bone pain, especially in the back, ribs and hips

  • Frequent bone fractures

  • Constipation and/or increased urination

  • Weakness and fatigue

  • Feelings of confusion

Causes & Risk Factors

What causes multiple myeloma?

The cause of multiple myeloma is currently unknown. This cancer usually occurs in people older than 60 years of age. It is slightly more common in men than in women. It can often run in families. Multiple myeloma is also more common in blacks than in whites. Some studies suggest that workers in agriculture or petroleum-based industries may be at greater risk due to exposure to chemicals.

Diagnosis & Tests

How does my doctor know if I have multiple myeloma?

Several tests can help your doctor tell if you have multiple myeloma. An X-ray can identify areas of bone loss. Your doctor might take some blood tests. These tests can tell if you’re anemic (have too little iron in your blood), if your calcium level in your blood is too high and how well your kidneys are working.

If the multiple myeloma is in a later stage, you may need more tests. Your doctor might want you to have a magnetic resonance imaging scan of your bones (also called an MRI scan). This scan can show if the multiple myeloma is in your spine.

The only way for your doctor to be sure you have multiple myeloma is by using a needle to take a very small sample of the tissue inside your bone. This is called a bone marrow aspiration. It can be done in your doctor’s office. This procedure hurts a little, but no special care is needed afterward.

Treatment

How is multiple myeloma treated?

There is currently no cure for multiple myeloma. Treatment includes medicine to relieve pain, and chemotherapy to destroy abnormal cells and to slow the development of the disease. You will also need treatment if you have broken bones, a low blood count, infection or kidney damage. Even with treatment, sometimes your symptoms will be better and sometimes they’ll be worse. The 2 medicines most often used together to treat multiple myeloma are melphalan (a chemotherapy drug) and prednisone (a steroid medicine).

If you have multiple myeloma, you should try to stay active. Staying active helps keep the calcium in your bones instead of in your blood, which helps keep your bones strong. You should also eat a balanced diet and drink plenty of fluids.

Are there side effects of medicines used to treat multiple myeloma?

Yes, like most cancer medicines, these medicines have side effects. Your doctor will probably give you blood tests once a month. When melphalan kills the cancer cells, it also kills some of your body’s "good" cells. You may lose some of your hair, but it will grow back after you stop chemotherapy. However, if you have a fever, bleeding (such as nosebleeds, bleeding gums or severe bruising), a skin rash or a cough that doesn’t go away, call your doctor right away. These are some of the more serious side effects of melphalan. While you’re taking melphalan, you must not get pregnant because melphalan might be harmful for the baby.

If the cancer doesn’t respond to a combination of melphalan and prednisone, your doctor may talk with you about other treatments. These may include other medicines, radiation treatments or a bone marrow transplant.

Questions to Ask Your Doctor

  • What can I do to keep myself as healthy as possible?

  • I’m in a lot of pain. Is there anything I can take to stop the pain?

  • How long can I live with multiple myeloma?

  • I’m having frequent nosebleeds. What can I do to stop them?

  • Is multiple myeloma something my children may be prone to?

  • I worked around a lot of chemicals when I was younger. Do I need to be screened for multiple myeloma?

Citations

  • Multiple Myeloma: Recognition and Management by ED George, R Sadovsky( 04/01/99, http://www.aafp.org/afp/990401ap/1885.html)