Multiple Myeloma

Roughly 13,000 Americans develop this illness every year. It is more frequent in men than in women. It is more commonly seen after age of 60. This disease is due to overproduction of Plasma cells from the bone marrow. Under normal circumstances, these cells are in charge of producing immune globulins, the immune proteins that our body needs to fight infections. In case of Multiple Myeloma, the abnormal plasma cells produce abnormal and dysfunctional immune globulins.

One that is used as an indicator of the disease is known as Beta 2 microglobulin. This disease is basically diagnosed by detecting these abnormal immune globulins in the blood, or alternatively, by observing the abnormal plasma cells in the bone marrow.

Causes: The cause of this illness is unknown.

Signs and Symptoms Patients may not show any signs for quite sometime. This illness can present itself in many different fashions. 20% of patients are diagnosed incidentally, and during work up on another problem. As the disease progresses, it can cause any of the following problems:

• Bone pain
• High calcium levels
• Kidney failure
• Anemia
• Low platelet count
• Hyperviscosity Syndrome
• Frequent infections
• Fever
• Weight loss

Diagnosis The diagnosis is established by certain blood tests and also taking a biopsy of the bone marrow.

Staging Refers to the extent of the disease and is a very good guideline as to the treatment plans and outcome of Multiple Myeloma. The extent of disease depends on the presence or absence of any of the following:

• Bone Disease
• High calcium levels
• Kidney failure
• Anemia
• Low platelet count

Lower stages of the illness are indicated by very minimal problems, and higher stages with presence of most of the above problems.

Treatment Multiple Myeloma involves almost all of the bone marrow space in the body. As a result, the disease can only be treated with chemotherapy. Any patient who is under the age of 70, and otherwise in good health, should be considered and offered a bone marrow transplantation. Multiple Myeloma can not be cured by any methods other than a transplant. This procedure can cure up to 30% of the patients. For individuals who are older or can not tolerate the transplant, chemotherapy is most appropriate.

If the disease causes a local problem in bones, like bone pain, or fractures, etc., radiation can be used to alleviate that problem.

Following are the two most commonly used chemotherapy regimens for treatment of Multiple myeloma:

1. Melphalan , Prednisone, known as MP regimen: The two drugs are given orally for 4-7 days and are repeated every month
2. Vincristine, Adriamycin , Decadron, known as VAD regimen. This is an intravenous treatment, whereby Vincristine and Adriamycin are given intravenously, by way of continuos infusion over 4 days. The infusion is repeated every month. Decadron is given orally. This is a more aggressive regimen with more side effects, as opposed to MP.

Other drugs that can also be used are: Cytoxan, VP-16, Interferon, BiCNU

Remission: Refers to the response of any cancer to the treatment.

Complete remission refers to the situation where the disease disappears completely with the treatment

Partial remission refers to the situation where the disease shrinks but does not disappears completely with the treatment

The remission status is determined by measuring the immune globulin levels in the blood, as well as repeating the bone marrow tests. When and if patients enter a remission, they best be maintained on a treatment regimen with Interferon.

Prognosis: Patients with lower stages have a better prognosis. Low Stage Multiple Myeloma may remain silent for years. They may, however, gradually transition into higher stages. Prognosis of High Stage Multiple Myeloma depends on the response to chemotherapy.

Special Situations Patients with advanced Multiple Myeloma may develop any of the following complications.

• Spinal cord compression
• Bone destruction and metastasis
• High Calcium level
• Pain
• High Uric acid

Survival Survival of patients with Multiple Myeloma, in whom cure is not possible, could vary from months to years, depending on the extent of cancer, overall condition of the patient as well as their response to treatments and the duration of their response. Those treated with bone marrow transplant have a 30% chance of cure.

Follow up After completion of treatment, and in any combination that might have taken place, patients need to remain under surveillance for possibility of recurrence of cancer. Follow up shall be scheduled on a regular basis and initially every 1-3 months for 1-2 years. The frequency of follow up will depend on the condition of the patient and their disease. In each follow up visits, patients are examined and normally a blood test and evaluation of immune globulins and Beta 2 microglobulin should be done.

Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy with same agents as mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas, where the cancer has spread to. If patients experience pain, different pain medications could be used to alleviate the pain. For patients with advanced disease, where most treatments have failed, once could consider assistance from hospice.