What is multiple myeloma?

Multiple myeloma occurs when plasma cells in the bone marrow multiply to excess. Plasma cells are white blood cells that produce antibodies to fight infections. Bone marrow is the soft, fatty tissue inside bones. As a result of the disease, bone marrow does not produce the parts of the blood as it normally does, bones are weakened, and the few normal plasma cells are less able to fight infection.

Other complications of this life-threatening cancer include anemia, paralysis, blood clotting problems, nerve damage, and kidney failure. This disorder affects mainly people over age 50.

How does it occur?

For reasons doctors don't yet fully understand, multiple myeloma occurs when abnormal plasma cells multiply quickly and disturb the number of red blood cells, white blood cells, and platelets being made. The rapidly multiplying plasma cells generally all produce the same defective, inactive antibody. Your body then produces fewer working antibodies, which lowers your resistance to infections. Also, fewer blood platelets are produced, so your blood clots more slowly than normal.

These changes in the chemical makeup of blood often cause serious kidney damage or kidney failure. If undetected and untreated, this condition can spread throughout the body and become life-threatening.

What are the symptoms?

The main symptom of multiple myeloma is pain in your bones, particularly in your vertebrae (backbones). Other symptoms include:

• frequent infections

• feeling weak and tired

• a tendency to bleed easily

• paralysis or numbness

• severe kidney problems.

How is it diagnosed?

Your doctor will ask about your symptoms. He or she will give you a physical exam. To gain more information, your doctor may order one or more of the following tests:

• bone marrow biopsy (a procedure used to take a sample of bone marrow to be examined for cancer cells)

• an x-ray exam or bone scan (a procedure that uses radioactive materials to view the bone)

• blood and urine tests

• other special x-rays such as CT scans or magnetic resonance imaging (MRI) scans. (CT scan is a special kind of x-ray that gives more detailed information than regular x-rays. MRI is a technique that produces a detailed picture of the internal organs and structures of the body by using magnets and radio waves instead of x-rays.)

What is the treatment?

Your doctor will determine your treatment plan based on the stage of the disease when it is diagnosed. He or she may recommend a combination of the following therapies:

• anticancer drugs (chemotherapy) to destroy cancer cells and slow their growth

• radiation treatments to relieve the pain and help control the growth of the cancer

• antibiotics to treat infections, which can occur more frequently during chemotherapy

• blood transfusions, if appropriate, for anemia

• pain-relieving medicines

• corticosteroid drugs (steroids) to treat some side effects of radiation therapy.

These steps may slow or temporarily stop the growth of the cancer and ease the symptoms (for up to 4 or 5 years and sometimes longer).

How long will the effects of multiple myeloma last?

The effects of multiple myeloma will vary depending on the stage of the disease when detected and when treatment begins. Your age and physical condition are important factors as well. Some treatments are not recommended for frail or elderly people, who may be more susceptible to infections due to lower immunity that can result from radiation or chemotherapy.

You may enjoy periods of normal health, though relapses of multiple myeloma occur. About 20% of people live more than 4 years after it is detected.

How can I take care of myself?

Follow these guidelines:

• See your doctor if you have pain in your bones (especially the vertebrae) that continues for a week or longer or gets worse.

• Avoid using tobacco in any form.

• Avoid heavy use of alcoholic beverages.

• Complete the full course of radiation, chemotherapy, medication, and other treatments recommended by your doctor.

• Learn about the side effects you may have from radiation or chemotherapy. It may help to be prepared for severe or distressing side effects, such as baldness. Usually your hair will grow back when therapy ends.

• If possible, join a cancer support group during your illness and recovery.

• Avoid unproven cancer treatments without discussing these with your doctor. Besides costing money, 'quack cures' may delay possible life-saving treatment.

• Maintain a hopeful and positive outlook throughout your treatment and recovery.

• Eat well-balanced meals that are low in fat and high in fiber, exercise regularly, and observe overall good health practices.

For more information contact national and local self-help organizations such as:

• AMC Cancer Information 1-800-525-3777

• Cancer Information Center 1-800-4-CANCER, or in Alaska 1-800-638-6070, or collect from Hawaii 1-808-524-1234

What can be done to help prevent multiple myeloma from spreading or recurring?

You may be able to reduce the risk of recurrence or spread of multiple myeloma by:

• completing the full course of radiation, chemotherapy, and medications ordered by your doctor

• avoiding use of all tobacco products

• avoiding heavy use of alcoholic beverages

• seeing your doctor right away if you notice a return of any previous symptoms or if you develop new ones.