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Return to Myeloma/Multiple Myeloma Overview

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Cancer (Oncology)

Myeloma/Multiple Myeloma

Myeloma is a cancer formed by malignant plasma cells. Plasma cells are found in the bone marrow and are an important part of the immune system. When plasma cells become cancerous, they can produce a single tumor called a solitary plasmacytoma (found most often in the bone), or multiple plasma cell tumors in different areas. The latter – occurring far more frequently than a solitary plasmacytoma – is referred to as multiple myeloma.

In multiple myeloma, the myeloma cells crowd out the normal plasma cells, which can lead to anemia (a shortage of red blood cells) and reduction in the level of blood platelets. Additionally, multiple myeloma can lead to leukopenia, a shortage of normal white blood cells. Fortunately, multiple myeloma is a relatively uncommon cancer and treatment continues to improve.

Risk Factors and Prevention

There is no real way to prevent this disease and there is no reliable screening test. The risk of multiple myeloma goes up with age, with most people diagnosed after age 65. Men are slightly more likely to develop multiple myeloma than women. In the U.S., African-Americans are at a much higher risk of developing myeloma than people of other ethnic groups.

Exposure to radiation may slightly increase the risk of multiple myeloma. Family history can account for a small increase in risk; being overweight or obese also increases the risk. People with other plasma cell diseases, including monoclonal gammopathy of undetermined significance (MGUS) or solitary plasmacytoma, are at risk for developing multiple myeloma and should be closely monitored.

Signs and Symptoms

Multiple myeloma is difficult to diagnose early, as it rarely causes symptoms until it has reached an advanced stage. When symptoms do occur, they are likely to include intense nerve and/or bone pain and muscle weakness as bone is broken down by the cancerous cells. Bone fractures are common in people suffering from multiple myeloma; the bones in the back, hips, and skull are most affected.

Anemia caused by multiple myeloma can result in weakness, shortness of breath, and dizziness. The increased bleeding and bruising that comes with a low level of platelets can make even minor scrapes serious. Leukopenia lowers resistance to certain infections, including pneumonia. The cancer can also result in high calcium levels as bones dissolve, causing excessive thirst and urination, constipation and loss of appetite. These symptoms may progress to dehydration and kidney failure.

Treatment

Multiple myeloma is most often treated by chemotherapy. Radiation is also used, particularly when the cancer has not responded to chemotherapy; radiation is the most common treatment for solitary plasmacytomas. Surgery may be used to remove single plasmacytomas or to repair spinal cord compression caused by the disease. Stem cell transplants are becoming a standard treatment for younger patients. Since the beginning of the twenty-first century, newer drugs have significantly improved the prognosis of Myeloma. In addition research is yielding better drugs with lesser side effects, including:

Revlimid (lenalidomide)
FDA approved for multiple myeloma June 2006
Lenalidomide, taken daily as a pill, is approved for use in patients with multiple myeloma who have had at least one prior treatment. The precise way in which the drug works is unclear, but it appears to boost the immune system and to prevent the development of new blood vessels that tumors need to grow. This drug causes severe, life-threatening birth defects or death to an unborn child and is only available under strict guidelines. To get lenalidomide, you must be registered in the RevAssist program. Your healthcare provider will explain the program to you and have you sign an agreement form. You will only receive up to a 28 day supply of the medicine at one time. You will need a new prescription for each refill.

Thalomid (thalidomide)
FDA approved for multiple myeloma May 2006
Thalidomide, taken daily as a pill, is approved for use in patients newly diagnosed with multiple myeloma. The precise way in which it works is unclear, but it appears to boost the immune system and to prevent the development of new blood vessels that tumors need to grow. This drug causes severe, life-threatening birth defects or death to an unborn child and is only available under strict guidelines. Both women and men must commit to strict guidelines when receiving thalidomide. To receive thalidomide, you, your physician, and your pharmacy must be registered in the System for Thalidomide Education and Prescribing Safety (STEPS) Program. You may only receive up to a 28-day supply of thalidomide at a time, and you will need a new prescription for each refill. Your prescription must be filled within seven days of your doctor's office visit.

Velcade (bortezomib)
FDA approved May 2003
This drug, given as an injection, approved for the treatment of patients with multiple myeloma. Velcade is the first in a new class of anticancer agents known as proteasome inhibitors.

Zometa (zoledronate)
FDA approved February 2002
This drug, given as an IV injection, helps slow the action of cells called osteoclasts, which break down bone. It is approved for use in people with multiple myeloma. This drug also reduces the release and breakdown of calcium from bone. It is used when you have a high amount of calcium in your blood to lower the blood calcium levels. High blood calcium levels can make you confused and tired and cause stomach pain and muscle weakness. Zoledronic acid helps to relieve these symptoms.

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