What is Multiple Myeloma?

Myeloma is cancer of the plasma cells in the bone marrow. Blood contains both red and white blood cells. The white blood cells generate the antibodies that fight infection. There is one type of white blood cell (plasma cell) that is located in the soft centers of human bones.

Because there are frequently multiple areas in the bones where tumors or lesions can develop, this form of myeloma is called "multiple." Plasma cell tumors can form, appearing in the hip bones, spine, ribs and skull.

In myeloma, one of the plasma cells becomes cancerous and multiplies. Because of this multiplication, certain antibodies are made in too great an amount. Patients become anemic because the growth of plasma cells interferes with the making of platelets and red and white blood cells. They can also suffer from infections and may have a tendency to bleed. Abnormal antibodies are dangerous because if they accumulate in the kidneys, kidney failure can result.

Multiple Myeloma has an estimated frequency of 5 to 6 new cases per 100,000 persons each year. There are currently more than 50,000 people living with Multiple Myeloma in the United States.

What are the Common Symptoms?

Because Myeloma destroys bone, pain is caused or bones can collapse. Symptoms may include:

• Anemia, due to a lack of iron in the blood
• Fatigue and weakness
• Recurrent infections
• Problems with the kidneys
• Severe bone pain, especially in the back
• Sudden bone fractures, usually in the back, ribs, arms or legs
• Too much calcium in the blood from the breakdown of the bones
• Bleeding problems
• Confusion, vision difficulties and headaches (caused by blood not getting to the skin, fingers, toes and nose)

What are the Risk Factors?

Research is still being performed, as the cause of myeloma is not yet known. Men tend to be affected slightly more than women, and people 40 or older are more at risk.

Research has suggested possible associations between Multiple Myeloma and certain occupations. Those in agricultural occupations, workers in the petroleum and leather industries, and cosmetologists all seem to have a higher than average incidence of developing Multiple Myeloma.

Diagnosis and Treatment

A diagnosis can be based on the symptoms and the results of the following tests:

• Blood test
• Urine test
• X-rays of the bones
• Magnetic resonance imaging (MRI)
• Bone marrow biopsy

Because multiple myeloma worsens over time, managing the condition can extend the quality of life. Treatment options may include:

• Bone marrow transplantation
• Chemotherapy
• Drugs, including antibiotics to control infections, prevent kidney problems or to control anemia
• Radiation therapy
• Transfusions to prevent systemic anemia

A spine specialist can help deal with the pain caused by this disease.

If you are diagnosed with Multiple Myeloma, who are the people who will care for you?

• Oncologists
• Infusion Area Nurses
• Radiation Area Nurses
• Exam Area Nurses
• Pharmacists
• Research Coordinators
• Nursing Assistants
• Social Workers
• Nutritionists
• Schedulers
• Financial Counselors

Treatment Goals

Individualized therapeutic goals are the basis of treatment regimens. These goals may include:

• Eradication of all evidence of disease, which may necessitate the patient's accepting greater levels of toxicity
• Controlling activity of the disease so that damage to other organs of the body may be prevented by using a toxicity level acceptable to the patient
• Preserving the patient's quality of life for as long as possible with minimal intervention
• Offering intervention for the management of pain and other disease symptoms
• Managing myeloma over the long-term for those patients in remission

Management Options for Myeloma

Myeloma therapy is customized for each patient. There is no standard therapy for active Myeloma. There are, however, therapies that have been traditionally used for the treatment of Myeloma and these have a track record that have been documented in scientific journals.

Many factors must be taken into account in the treatment of Myeloma, such as the patient's general state of health, other medical diseases or issues, how effectively the disease is being controlled, as well as the patient's response to therapy in the past. Many variables must be considered in the diagnosis of Myeloma and in determining its prognosis. There is no single test for Myeloma.

It is recommended that eligible patients participate in clinical trials so that therapies for Multiple Myeloma may be further advanced. Clinical trials are designed to be at least as effective as traditional therapies, especially Phase II and Phase III trials.

The patient's disease classification and disease status determine the scope of management options.

Disease Classification

There are two disease classifications for patients with Multiple Myeloma, active and inactive.

Asymptomatic in nature, inactive disease does not require immediate treatment nor do patients present with any myeloma-related organ or tissue impairment. Inactive disease includes the following classification subtypes:

• Monoclonal gammopathy of undetermined significance (MGUS)
• Smoldering myeloma (SMM)
• Indolent myeloma (IMM)
• Stage I disease

Symptomatic or active disease requires treatment. Patients with Myeloma in Stage II or Stage III disease fall into this category.

Disease Status

Treatment options for those who have already received therapy are different than for those who have not. A patient's disease status is fully taken into account.

Those patients with newly diagnosed disease have myeloma that has not yet been treated.

Patients who have received therapy fall into the following categories:

• Responsive disease is the term used to describe myeloma that is responding to therapy. A decrease in M protein of at least 50 percent has been documented. There are Myeloma specialists who consider a decrease in M protein between 25 percent and 50 percent to be minimal response while other medical authorities consider this to fall within the range of stable disease.
• Stable disease is the term used to describe Myeloma that has not responded to treatment. While the decrease in M protein has not reached 50 percent, the disease has not gotten worse. There are Myeloma specialists who consider a decrease in M protein between 25 percent and 50 percent to fall within minimal response.
• Progressive disease is the term used to describe active Myeloma that is becoming worse. M protein is increasing with accompanying organ or tissue impairment. Relapsed and/or refractory disease can also be considered progressive disease.
• Relapsed disease is the term used to describe Myeloma that first responded to therapy but began progressing again at a later time. Patients may be more specifically categorized as having relapsed after initial therapy began or after therapy that followed.
• Refractory disease is the term used to describe Myeloma that has not responded to initial therapy. Myeloma that does not respond to subsequent treatment is referred to as relapsed Myeloma. For this type of Myeloma, the condition is also described as relapsed and refractory disease.

There are two types of refractory disease:

• Refractory disease that is progressing is referred to as non-responding progressing refractory disease. Because treatment of this type of Myeloma may be difficult, innovative therapy is recommended as an option for treatment.
• Refractory disease that is not worsening is referred to as non-responding non-progressing refractory disease. Often patients with this condition do as well as patients who have responsive disease.

Approaches to Treatment

Interventions will vary depending on whether the patient has active or inactive disease.

Active Disease

Initial therapy is administered to patients with newly-diagnosed, active and symptomatic myeloma. These patients also receive bisphosphonates and the supportive care needed to treat bone disease and other complications. After prior treatment and outcomes have been reviewed, subsequent treatment options are decided. Patients have the opportunity to participate in a clinical trial at every step of this intervention.

Inactive Disease

Unless their disease begins to progress, patients with inactive and asymptomatic disease are observed and not treated unless their disease progresses. Where there is evidence of active disease with end organ damage, a clinical trial may be recommended without therapy. For some patients with smoldering or indolent Myeloma or Stage 1 disease, bisphosphonates and other forms of supportive care may be recommended. For patients with inactive disease, Thalidomide and other agents are being tested.

During your treatment for Multiple Myeloma, patient safety is a priority at TCCC.

It is the responsibility of all health care workers to ensure that all patients are treated in a safe, effective, appropriate and efficient manner. Your caregivers follow a strict set of guidelines to protect your safety, including:

• Improving the accuracy of patient identification. It is mandatory to use at least two patient identifiers whenever administering medications, taking blood samples and other specimens for clinical testing, or providing any other treatments or procedures.
• Improving the effectiveness of communication among caregivers.
• Utilizing a list of drugs with look-alike/sound-alike names, abbreviations, acronyms and symbols to prevent errors involving the interchange of these drugs.
• Reducing the risk of health care-associated infections.
• Reducing the risk of patient harm or injuries resulting from falls.
• Obtaining and documenting an accurate and complete list of the patient's current medications and communicating this list to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization.

You should always feel that you have the opportunity to ask questions and that you are given ample time by the caregiver to respond to your questions.

If something is bothering you, tell your team. Don't be shy about asking for help with controlling pain, depression or any other concern. Keep a diary so you can keep a record of issues and concerns, and then follow up with a phone call or visit to your doctor.