Multiple Myeloma

A bone marrow cancer in which abnormal antibody-producing white blood cells multiply in an uncontrolled manner

  • Increasingly common over the age of 40; most common around the age of 70
  • Gender, genetics, and lifestyle are not significant factors

Multiple myeloma is one of the commonest cancers of the bone marrow and affects plasma cells, the white blood cells that produce antibodies against infection. A plasma cell undergoes a cancerous change, multiplies excessively, and disrupts the production of normal red and white blood cells and platelets. These abnormal, cancerous plasma cells are known as myeloma cells.

The myeloma cells produce abnormal antibodies, and fewer normal antibodies are produced, increasing the risk of infection. The myeloma cells also destroy bone tissue, leading to bone pain, fractures, and release of excess calcium into the bloodstream.

Low numbers of red blood cells may reduce the oxygen-carrying capacity of the blood (see Anaemia) and reduced numbers of platelets may lead to abnormal bleeding (see Thrombocytopenia).

What are the symptoms?

The symptoms of myeloma include:

  • Tiredness, pale skin, and shortness of breath on exertion due to anaemia.

  • Bone pain, most often in the spine, as myeloma cells multiply in the bone marrow and spread within the skeleton.

  • Repeated infections.

  • Easy bruising without injury.

  • Thirst, frequent need to pass urine, and constipation due to high calcium levels in the blood.

The loss of calcium from bone tissue may lead to brittle bones that fracture easily. Increased levels of calcium and abnormal antibodies in the blood may lead to kidney failure.

Skull bone loss in multiple myeloma

This X-ray shows the skull of a person with multiple myeloma. The abnormal “pepper-pot” appearance results from areas of localized bone loss.

What might be done?

You may have blood tests to measure levels of blood cells and look for abnormal antibodies. Your urine may also be tested for abnormal antibodies and you may have a bone marrow aspiration and biopsy. You may have X-rays to look for skeletal damage.

There is no cure for multiple myeloma. The aim of treatment is to control the disease so that it goes into remission; that is, so that there are no signs of active disease in your body. There are various treatment options for multiple myeloma and the treatment that will be recommended for you will depend on factors such as your age, general health, symptoms, and how far the disease has progressed. If you have no symptoms, your doctor may suggest simply close monitoring. For people who do have symptoms, the initial treatment is usually with a combination of chemotherapy and corticosteroid drugs. Other treatment options include new drugs for multiple myeloma, such as thalidomide and bortezomib. For people who are fit enough, further intensive treatment with high-dose chemotherapy and a stem cell transplant may be suggested.

Radiotherapy may be given for severe bone pain. You may need blood transfusions for severe anaemia, although the anaemia may be improved and the need for transfusions reduced by injections of erythropoietin (a hormone that stimulates red blood cell production). Infections may be treated with antibiotics. You may be given bisphosphonates (see Drugs for bone disorders) to treat high calcium levels; these drugs also slow the progress of skeletal damage. Drinking plenty of fluids will also help to lower calcium levels and reduce the risk of kidney damage.

The outlook varies according to the age of the person affected and the severity of the disorder. Survival has improved in recent years and most people live for up to 5 years after diagnosis, while some have survived for more than 10 years.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

The subjects, conditions and treatments covered in this encyclopaedia are for information only and may not be covered by your insurance product should you make a claim.

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