Multiple myeloma

What is the difference between myeloma and multiple myeloma?

There is no difference. The terms are used interchangeably. Myeloma is derived from the Greek words "myel" (meaning marrow) and "oma" (meaning tumor). Because malignant plasma cells almost always occur in more than one location, it is often referred to as multiple myeloma.

Multiple myeloma begins in the bone marrow—the soft, spongy tissue that fills the center of bones. The bone marrow is where blood cells such as red blood cells, white blood cells, and platelets are made.

Patients with multiple myeloma develop an excessive number of abnormal plasma cells in their bone marrow. The cancerous plasma cells multiply, building up in the marrow and crowding out normal, healthy blood cells. This buildup of myeloma cells can lead to various medical problems and complications, like a reduction in blood cell production, damage to the surrounding bones, organ damage, and problems with blood clotting and circulation.

There is currently no cure for the majority of multiple myeloma patients. However, it is a treatable disease and many patients are able to live fulfilling lives for 10 years or more after being diagnosed if treated with the best available therapies.

Multiple myeloma causes and risk factors

There is no known cause of multiple myeloma, but we know myeloma starts with an abnormal plasma cell that multiplies and eventually crowds out healthy cells in the bone marrow.

There are certain factors that make a person more likely to have this disease, like age, sex, race, obesity, and the presence of other plasma cell disorders.

• Age. Growing older increases the chances of developing multiple myeloma.
• Sex. Men are 50% more likely to develop multiple myeloma than women.
• Race. Myeloma is twice as common in African Americans than in Caucasians, and the risk of developing multiple myeloma is lowest among Asian Americans.
• Obesity. If a person is overweight or obese, he or she is at increased risk of developing multiple myeloma.
• Plasma disorders like MGUS. some people with plasma disorders like MGUS (Monoclonal Gammopathy of Unknown Significance) or a solitary plasmacytoma can eventually develop multiple myeloma.

Potential causes of multiple myeloma

In addition, some studies have noted that exposure to toxic chemicals—like agricultural chemicals, Agent Orange and petroleum products—or radiation can trigger myeloma. Other factors thought to increase the risk of developing myeloma include frequent use of hair dye and breast implants, but the data to support these claims is very weak, so this has not been proven.

Research into whether or not multiple myeloma runs in families strongly suggests that hereditary forms do exist.

Multiple myeloma symptoms

In the early stages of multiple myeloma, symptoms may be vague and resemble other conditions. Many cases of multiple myeloma are now discovered during a routine blood test, when protein levels are found to be elevated and myeloma is suspected.

As the disease progresses, some of the following symptoms can occur:

Bone Disease

Tiny fractures in the bones resulting from an accumulation of plasma cells and bone-dissolving cells called osteoclasts are common in people with multiple myeloma. Bones may become weak and prone to breaking. Pain is often felt in the lower back, pelvis, ribs, and skull.

Spinal cord compression, which causes nerve damage, is one of the most severe effects of myeloma. About 70% of myeloma patients have disease-related bone lesions. Magnetic Resonance Imaging, or MRI, and PET/CT scans can determine whether or not bone tumors or lesions exist and where in the body they are located.

To manage skeletal symptoms, patients are usually asked to take calcium supplements and bone-strengthening medications, such as pamidronate (Aredia) or zoledronic acid (Zometa) and avoid straining the spine by not carrying heavy weight. Injections of a cement-like substance into the spine, known as vertebroplasty or kyphoplasty, may be needed to prevent further collapse of spine bodies.

Hypercalcemia

As a result of increased bone destruction, excess calcium can build up in the blood, causing a condition called hypercalcemia. This condition calls for urgent treatment. Raised calcium levels can take a toll on the kidneys and cause fatigue, muscle weakness, loss of appetite, nausea, and confusion.

Kidney damage

If left untreated, excess amounts of myeloma protein can cause kidney damage or even renal failure. A kidney biopsy might be performed to determine the exact cause of the kidney damage.

To manage kidney problems, patients should stay hydrated and avoid non-steroidal anti-inflammatory drugs and intravenous contrast agents.

Anemia

In myeloma patients, it is common that the growth of red blood cells—which carry oxygen throughout the body—is inhibited. If the development of red blood cells is depressed, anemia can result. Anemia causes extreme tiredness, weakness, and dizziness. It can also cause shortness of breath. The vast majority of myeloma patients develop anemia.

To manage anemia, patients receive growth factors that stimulate the growth of red blood cells, such as Procrit or Aranesp, and may also need to receive blood transfusions.

Infections

Myeloma patients have reduced white blood cell counts, meaning their bodies are less likely to produce the lymphocytes and antibodies necessary to fight infection. Therefore, patients are at significant risk of contracting infections, like pneumonia, urinary tract infections, and shingles. Receiving chemotherapy can further reduce white blood cell counts, putting a patient at even greater risk.

Patients will often be given antibiotics to manage infections. If infections are recurrent and life-threatening, intravenous immunoglobulin therapy may be necessary.

Nervous system complications

Collapsing bone structures can impede on nerves, causing severe pain, numbness, tingling, and muscle weakness. Polyneuropathy, which occurs when peripheral nerves throughout the body malfunction simultaneously (typically starting in the feet), can be caused by amyloidosis, a rare complication of myeloma, and also by medications such as Thalidomide, Velcade, and Vincristine.

Thickening of the blood

The abnormal proteins produced by myeloma cells can cause a dangerous thickening of the blood, also known as hyperviscosity. When blood is resistant to flowing properly and becomes thick and sticky, the result can be bruising, nose bleeding, gastrointestinal bleeding, hazy vision, confusion, numbness in the extremities, chest pain, and shortness of breath. Plasmapheresis, a procedure by which the thick blood is replaced by other fluids, may be needed in such cases.