A B C D E F G H I J K L M N O P R S T U V W

MULTIPLE MYELOMA

What is a Multiple Myeloma ?

Multiple myeloma is a cancer of particular cells in the bone marrow called plasma cells. It differs from leukaemia in that the abnormal plasma cells do not usually spill over into the bloodstream. Myeloma usually occurs in people over the age of 60, but can affect younger people.

How does a Multiple Myeloma occur ?

Plasma cells are found in the bone marrow and in many other tissues. Their function is to produce proteins called immunoglobulins which fight infections. In myeloma the abnormal plasma cells continue to produce immunoglobulins. Although increased in amount, these abnormal immunoglobulins are ineffective in fighting infection. The excess abnormal immunoglobulins can also produce symptoms, for example by damaging the kidneys. There are three main groups of symptoms: pain in the bones, anaemia, and (in some patients) symptoms due to failure of kidney function. Pain in the bones is due to the myeloma cells eroding the bone. Anaemia (lack of red blood cells) is due to crowding out of the normal bone marrow cells which make the red cells. Anaemia causes tiredness and shortness of breath, especially on exercise. Failure of kidney function may occur and can lead to loss of appetite and nausea. As well as these problems, infection is also common because of the lack of normal immunoglobulins.

Why does a Multiple Myeloma occur ?

Exposure to excessive radiation can cause myeloma. However, in most cases the cause is not known.

Treatment Involved for a Multiple Myeloma

Treatment has two parts. First, there is treatment to control the symptoms of the disease. Blood transfusion may be necessary to correct anaemia. Painkilling drugs are used to help bone pain and antibiotics to treat infections. The kidneys are protected by drinking plenty of fluid 5 to 6 pints (3 litres) daily. Secondly, there is specific treatment to control the growth of the myeloma cells. Anti-cancer drugs are used (chemotherapy) and x-ray treatment may be given to sites where the tumour is causing pain (radiotherapy). Chemotherapy can be given in different ways. Tablets may be given for a few days every few weeks. A combination of tablets and intravenous chemotherapy may be used, again on an intermittent basis. This type of therapy is normally given as an outpatient treatment. Steroid drugs like prednisolone are often given with the chemotherapy. They help destroy the myeloma cells. Interferon is a substance normally produced by the body in response to virus infections. It has been found to reduce the growth of several types of cancer, including myeloma. There is some evidence that patients with myeloma benefit from a group of drugs called interferons. Interferon is given by injection under the skin, usually three times a week. It affects the way that abnormal cells behave. Interferon may be given by a district or practice nurse, but many patients learn to give their own injections. Other drugs called bisphosphonates may be given to reduce the bone damage caused by myeloma. The response of the myeloma to treatment is assessed by measuring the abnormal immunoglobulin in the blood and by examining the bone marrow. When the disease appears to be controlled, treatment is usually stopped. A close watch is kept on the progress of the disease. Treatment is restarted if there is evidence that the myeloma cells are growing again. Some younger patients with myeloma may also be treated by bone marrow transplantation. They may also be treated with cells extracted from their own bone marrow, called stem cells. These are the starting point of all bone marrow cells and have the ability to develop into more normally behaving cells.

During Treatment for a Multiple Myeloma

Side-effects of the treatment will depend on the type of treatment given. Oral chemotherapy usually causes few or no side-effects. Mild nausea and loss of appetite can occur. This can be helped with drugs. Nausea is commoner with intravenous therapy and some degree of hair loss may also occur. The hair will regrow normally when treatment is finished. Chemotherapy will also affect the normal bone marrow cells to some extent and may cause anaemia or a drop in the white blood cell count. If the white cells are low, it makes catching an infection more likely. The doctor should be told immediately if there are any symptoms of infection, such as fever or cough. Steroids are usually given only for short periods and so side-effects are uncommon. They may however cause a gain in weight, an increase in appetite, and a change in mood. Some people feel more energetic, others feel low. Interferon may cause headache and flu-like symptoms especially in the early stages of treatment. This can usually be prevented by taking paracetamol an hour or two before the injection. Usually these symptoms disappear after 2 to 3 weeks. In rare cases, other side-effects can occur: any unusual symptoms should be reported to the doctor.

After Treatment for a Multiple Myeloma

As described above, treatment may be stopped when the disease is controlled. The doctor will keep a close watch on things by doing blood tests regularly and by doing x-rays and bone marrow tests every few months. The doctor should be told if any new symptoms occur, like pain in the bones or backache. This may mean that treatment needs to be started again. At present the disease cannot be cured permanently with chemotherapy. Bone marrow transplant is a new approach which is being tried in younger patients with myeloma.

If a Multiple Myeloma is Left Untreated

The progress of the disease is variable. It may progress slowly in some patients even if untreated. In others there is more rapid progression, and this can lead to severe anaemia or kidney failure. Erosion of the bones can lead to fractures. In general, the more advanced the disease when treatment is started, the less responsive it is to treatment.

Effects on Family of a Multiple Myeloma

People should see the improvement in your health as the myeloma responds to treatment. Sometimes, however, the symptoms of the disease and the need for frequent visits to hospital may mean some changes in your usual activities. Myeloma is not inherited or infectious. It cannot be passed on to family or friends.