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Multiple Myeloma

more about Multiple Myeloma


  • Multiple Myeloma refers to cancer of the plasma cells normally involved in the production of antibodies.  When this type of serious cancer occurs, it invades bone marrow and metastasizes (spread) to other bones, while secreting abnormal Proteins called paraproteins (abnormal antibodies).
  • Paraproteins may be abnormally deposited in organs and tissues, causing a severe disease known as Amyloidosis (see section on Amyloidosis).
  • Multiple Myeloma damages the immune system, making those affected more susceptible to infection.
  • It usually occurs in older adults, with the average age of onset around 60.

  • Most common:
    1. Back pain
    2. Rib pain
    3. Hip pain/fractures
  • Less common:
    1. Leg swelling
    2. Paralysis
    3. Bleeding gums
    4. Room spinning
    5. Nausea
    6. Visual changes
    7. Altered mentation

  • Examination:
    1. Pale skin
    2. Tenderness over the rib and back bones
    3. Soft tissue masses
    4. Paralysis
    5. Leg pain
    6. Lung crackles if Heart Failure is present
    7. Enlarged liver
    8. X-Rays of the skull, ribs, back, hip, or other long bones show destructive lesions
  • Laboratory:
    1. Anemia
    2. Elevated serum protein level
    3. Elevated serum globulin level
    4. Monoclonal spike on serum electrophoresis
    5. Bence Jones Proteins in the urine
    6. Abnormal urine electrophoresis -- prognosis and response to treatment are followed by the grams/deciliter of antibody spike present
    7. Bone marrow biopsy is often performed
    8. Other findings that may be present include elevated sedimentation rate, elevated BUN and Creatinine, hypercalcemia, normal Alkaline phosphatase (in spite of extensive bony lesions).

  • Mild disease -- observation without treatment
  • Symptomatic disease (usually bone pain) -- Melaphan plus Prednisone, or combination chemotherapy
  • Patients under 60 -- autologous stem cell transplant
  • Treatment failures -- chemotherapy combination of Vincristine, Adriamycin, and Dexamethasone (called VAD).
  • Allogenic bone marrow transplants can be curative, but have a death rate of 40-50% associated with treatment.
  • Radiation treatment for bone pain
  • Hypercalcemia (elevated Calcium levels in the blood) is treated with immobilization and hydration.
  • Bisphosphonate pamidronate reduces pathologic bone fractures.
  • Pneumovax (Pneumonia vaccine) should be given every 5-7 years.

  • See your physician as soon as possible.




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