About Multiple Myeloma

Multiple myeloma is a cancer of the plasma cells. These are the cells that normally make antibodies to fight infections. Antibodies are also called immunoglobulins. In multiple myeloma the plasma cells grow out of control, causing several problems. When uncontrolled cell growth occurs, the abnormal cells in the bone marrow effectively squash the normal marrow cells that make the red cells, white cells and platelets that make up healthy blood. Anemia, or lack of red cells, is the most common problem in myeloma.

In multiple myeloma, plasma cells can grow in clumps in the bone marrow and erode the bone. It does this by abnormally stimulating osteoclasts, which play a critical role in bone remodeling. When osteoclasts are over-stimulated, the normal process of bone remodeling — in which the destruction of old cells and growth of new cells occurs essentially in balance — goes awry, leading to the creation of holes in the bone, or lytic lesions. These holes or lesions may occur in places where they cause no problems (such as the skull) or they can occur in places where they severely weaken the bones and cause fractures. The most common areas for fractures are the spine, ribs, femurs or humeri. In addition to lytic lesions, some patients have a generalized loss of bone, or osteopenia, which can also cause fracture, especially in the spine. When bone is dissolved calcium is released; this can cause abnormal levels of calcium in the blood and lead to nausea, dehydration, constipation or confusion.

Treatment for Multiple Myeloma

As with all diseases, treatment depends on the individual and the individual’s disease. If there are no symptoms, treatment may not be needed. In such cases, the doctor may choose simply to follow the patient closely so treatment can be started as soon as symptoms develop. If there are symptoms, treatment will probably be chemotherapy and sometimes radiation therapy.

At the Bone Marrow Transplant Center at Rush University Medical Center in Chicago, Illinois, patients meeting specific criteria with standard risk multiple myeloma (normal cytogenetics) who are 75 years of age or younger may be eligible for an autologous bone marrow transplant as part of their initial therapy. Some younger patients and those with cytogenetic abnormalities (who have a matched donor) may be eligible for immunotransplantation.