Alternate Names: Plasma cell dyscrasia; Plasma cell myeloma; Malignant plasmacytoma; Plasmacytoma of bone; Cancer - multiple myeloma

Causes and Risks: Multiple myeloma is characterized by the overgrowth and malfunction of plasma cells in the bone marrow. The growth of the plasma cells interferes with the growth of red blood cells, white blood cells and platelets; therefore anemia, susceptibility to infection, and tendencies toward bleeding develop. As the cells grow and expand in the bone marrow, they cause pain and destruction of the bones. If the bones in the spine are affected, compression of the nerves may result causing numbness or paralysis. Renal failure is a frequent complication caused by the excess calcium related to bone destruction. Multiple myeloma affects older adults. Other risk factors are unknown. This disease is rare with about 3 new cases per 100,000 people a year.

Prevention: The specific cause is unknown, therefore prevention is unknown.

Symptoms:

• bone pain
• unexplained fractures
• back pain
• bleeding problems
• increased susceptibility to infection
• symptoms anemia such as: tiredness, shortness of breath, and fatigue

Signs and Tests:

• A bone marrow biopsy is performed.
• Serum protein electrophoresis is abnormal.
• Bone X-rays show fractures, hollowed out bone lesions.
• Chemistry profile shows increased serum calcium, total protein, and abnormal kidney function.
• CBC reveals low hematocrit (anemia), low red blood cell count, low platelets and low white blood cell count.

• bone lesion biopsy
• T (thymus derived) lymphocyte count
• serum globulin electrophoresis
• quantitative immunoglobulins (nephelometry)
• immunoelectrophoresis - serum
• ESR
• febrile/cold agglutinins
• cryoglobulins
• blood differential
• calcium (ionized)
• protein, urine
• immunofixation - urine
• immunoelectrophoresis - urine
• calcium; urine
• Bence-Jones protein (quantitative)
• 24 hr. urine protein

Treatment: The goal of treatment is to relieve symptoms, but there is no curative therapy. Complete remission is unusual. People who have mild disease or in whom the diagnosis is in doubt are usually observed without treatment.

Chemotherapy with alkylating agents and localized radiation therapy for relief of bone pain or treating a bone tumor may be useful. Bone marrow transplantation in younger patients is experimental, but the long-term results of this treatment are not known.

Symptoms of high serum calcium levels are treated, and dehydration is avoided to optimize kidney function.

Support Groups: The stress of illness can often be helped by joining a support group where members share common experiences and problems. See cancer - support group.

Prognosis: Median survival of people with multiple myeloma is 3 years.

Complications:

• renal failure
• increased susceptibility to infection (especially pneumonia)
• paralysis from tumor or spinal cord compression
• fractures of bones

Call your health care provider if you experience decreased urine output.

Call your health care provider if you have multiple myeloma and infection develops, or numbness or loss of movement or loss of sensation develops.