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Category: Hematology | Oncology

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Multiple myeloma overview

Published: July 07, 2009. Updated: July 27, 2009

Multiple myeloma (also known as myeloma or plasma cell myeloma) is a hematologic cancer, meaning it develops in the blood. It is a cancer of the plasma cell, an important part of the immune system that produces immunoglobulins (antibodies) to help fight infection and disease.

Incidence of multiple myeloma

There are approximately 45,000 people in the United States living with multiple myeloma, and the American Cancer Society estimates that approximately 14,600 new cases of myeloma are diagnosed each year in the United States.

Multiple myeloma is the second most prevalent blood cancer (10%) after non-Hodgkin's lymphoma. It represents approximately 1% of all cancers and 2% of all cancer deaths. Although the peak age of onset of multiple myeloma is 65 to 70 years of age, recent statistics indicate both increasing incidence and earlier age of onset.

Multiple myeloma affects slightly more men than women. African Americans and Native Pacific Islanders have the highest reported incidence of this disease and Asians the lowest. Results of a recent study found the incidence of myeloma to be 9.5 cases per 100,000 African Americans and 4.1 cases per 100,000 Caucasian Americans. Among African Americans, myeloma is one of the top 10 leading causes of cancer death.

Symptoms and diagnosis of multiple myeloma

Symptoms can include: malaise, anemia, infections (decreased immunity) and fractures (due do breakdown of bone by malignant cells). Often, the diagnosis of multiple myeloma is often made incidentally during routine blood tests for other conditions.

The existence of unexplained anemia and a high serum protein (especially raised globulin) may suggest further testing. A doctor will then order protein electrophoresis, on which a paraprotein band can be noticed. Quantitative measurements of the paraprotein are necessary to determine the seriousness of the disease.

Pathology of multiple myeloma

There are at least two forms of myeloma:

  • Secretory - where enzymes are released that allow blood testing for diagnosis and progression monitoring.
  • Non-secretory - where enzymes are not released and are thus not available for blood testing. Progression in these cases in monitored through bone marrow byopsies and looking for elevated levels of bone marrow plasma cells.

Treatment of multiple myeloma

Treatment for multiple myeloma is focused on disease containment and suppression, as no reliable cure has been found.

Modes of therapy include:

  • Thalidomide with steroids.
  • Low-dose chemotherapy with melphalan
  • Chemotherapy with vincristine, adriamycin and dexamethasone (abbreviated VAD).
  • High-dose chemotherapy (melphalan) with stem cell transplant.

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