MULTIPLE MYELOMA

WHAT IS MULTIPLE MYELOMA?

An estimated 20,180 people diagnosed in the United
States in 2010
A type of blood cancer in which plasma cells grow
uncontrollably, usually inside the bone marrow
Associated with bone lesions that cause structural
damage and/or fractures from overproduction of
myeloma cells
Referred to as multiple myeloma because about 90% of
patients have multiple bone lesions
Solitary plasmacytoma: a mass of myeloma cells in one
site in the bone or another organ
Extramedullary plasmacytoma: myeloma that begins in
other tissues, such as skin, muscle, or lungs
What is the Function of Plasma Cells?
Found inside the bone
marrow (spongy, red
tissue in the inner part of
large bones)

Part of the body’s

immune system that
produce antibodies to
help the body fight
infection
What are the Risk Factors for Multiple
Myeloma
Age
Race
Exposure to radiation and chemicals
History of solitary plasmacytoma
Monoclonal gammopathy of unknown significance
(MGUS): a low level of a protein called monoclonal
immunoglobulin (M protein)
 What are the Symptoms of Multiple Myeloma?

Hypercalcemia (high
General calcium levels in the
Weight loss
blood)
Easy bruising Nausea and vomiting
Hazy vision Increased urination
Bleeding gums Excessive thirst

Bones
Pain
Fractures
 Symptoms of Multiple Myeloma

Kidney Failure Amyloidosis (build-up of

proteins)
Nausea and vomiting Peripheral neuropathy
(nerve damage)
Fatigue
Edema (swelling caused

Weakness by build-up of fluid in the

body)

Enlargement of organs
 What are the Symptoms of Multiple Myeloma?

Bone Marrow/Immune Blood and Circulation

System Disorders

Anemia (low red blood Shortness of breath

cell count)
Bleeding Blood clots
Infections
Pneumonia Bleeding
 Multiple Myeloma Staging

Staging is a way of describing a cancer, such as the size of a

tumor and if or where it has spread

Staging is the most important tool doctors have to determine a

patient’s prognosis

Durie-Salmon system (D-S)

The International Staging System (ISS)

Recurrent cancer is cancer that comes back after treatment

 How is Multiple Myeloma Diagnosed

Blood test for anemia, kidney function, and calcium levels

Blood and urine tests to measure M protein levels

Bone marrow biopsy

Diagnosis is confirmed with a bone marrow biopsy

X-ray

Magnetic resonance imaging (MRI)

Computed tomography (CT or CAT) scan

Positron emission tomography (PET) scan or PET-CT

 Treatment for Multiple Myeloma

Treatment depends on many factors

More than one treatment may be used
Active Surveillance: close observation without
treatment for patients with no symptoms
Chemotherapy
Radiation therapy
Surgery
Stem cell transplantation
 Cancer Treatment: Chemotherapy

Use of drugs to kill cancer cells

A combination of medications is often used
Typical medications include cyclophosphamide (Cytoxan,
Neosar), doxorubicin (Adriamycin), Doxorubicin
liposome injection (Doxil), melphalan (Alkeran),
vincristine (Oncovin), cisplatin (Platinol) and
dexamethasone (Decadron).
Newer drugs include: thalidomide (Thalomid),
lenalidomide (Revlimid), and bortezomib (Velcade)
Side effects may include fatigue, risk of infection, nausea
and vomiting, loss of appetite, and diarrhea
 Cancer Treatment: Radiation Therapy

The use of high-energy x-rays to destroy cancer cells

External beam: outside the body

May be used to control pain when chemotherapy is

not effective
Not used to control bone pain due to structural
damage
Side effects may include fatigue, mild skin reactions,
upset stomach, and loose bowel movements
 Stem Cell/Bone Marrow Transplantation

High-dose chemotherapy used to kill cancer cells

New stem cells are introduced from the patient

(autologous) or a donor (allogeneic) to form new blood
cells
Autologous stem cell transplantation is considered the
standard treatment
Allogeneic stem cell transplantation is only recommended
for patients with high-risk or recurrent myeloma
 Supportive Therapy for Myeloma

Used to reduce symptoms and complications from myeloma

Treatment of anemia

Antibiotics and rarely intravenous immunoglobulins to treat

and prevent infection
Bisphosphonate medications (drugs that increase bone
density) to alleviate bone pain, reduce the risk of fractures,
and prevent hypercalcemia
Balanced diet high in calories, protein, and healthy fluids

Exercise to maintain bone strength and reduce calcium loss

The Role of Clinical Trials for the Treatment of Multiple Myeloma

Clinical trials are research studies involving people

They test new treatment and prevention methods to

determine whether they are safe, effective, and better than
the standard treatment

The purpose of a clinical trial is to answer a specific

medical question in a highly structured, controlled process

Clinical trials can evaluate methods of cancer prevention,

screening, diagnosis, treatment, and/or quality of life
 Clinical Trials: Patient Safety

Informed consent: participants should understand

why they are being offered entry into a clinical trial
and the potential benefits and risks; informed
consent is an ongoing process

Participation is always voluntary, and patients can

leave the trial at any time

Other safeguards exist to ensure ongoing patient

safety
 Clinical Trials: Phases

Phase I trials determine the safety and dose of a new

treatment in a small group of people

Phase II trials provide more detail about the safety of the

new treatment and determine how well it works for treating
a specific type of cancer

Phase III trials take a new treatment that has shown

promising results when used to treat a small number of
patients with cancer and compare it with the standard
treatment for that disease; phase III trials involve a large
number of patients