Multiple Myeloma
Understanding Multiple Myeloma
Multiple myeloma (MM) is a cancer of certain white blood cells (WBC) in the bone marrow that are responsible for making immune globulin, which is the same as antibodies, and help fight infection. Myeloma most often grows in the bone marrow of the spine, skull, pelvis, rib cage, shoulders, and hips. The only time that myeloma is not "multiple" are in rare cases of single areas being affected.
Exposure to toxic chemicals, atomic radiation, anything that interferes with the immune system, or infection with cancer-causing viruses have all been implicated as causes or triggers of myeloma. Toxic chemicals include dioxins (such as those found in Agent Orange), agricultural chemicals (such as defoliants and pesticides), fuels, engine exhausts and cleaning products. Several viruses have been identified as potential triggers, including HIV and AIDS, hepatitis, and several herpes viruses. Approximately 5% - 7% of myeloma diagnoses occur in individuals who have a close relative previously diagnosed with myeloma or monoclonal gammopathy of undetermined significance (MGUS). Those who have a family member (mother, father, brother, sister, son, or daughter) with myeloma or MGUS should inform their primary care physician, so it is in the permanent medical record.
Symptoms of Multiple Myeloma
In 70% of patients, the most common symptoms of MM are back or bone pain, fatigue, and recurrent or persistent infections. Other symptoms include swelling of the extremities and shortness of breath.
Diagnosing Multiple Myeloma
MM tests are diverse and complex and are used at various times, including for initial diagnosis, determining the type of myeloma, staging of the disease, and for monitoring response to treatment. Testing includes blood tests and urine tests, bone marrow tests, and imaging studies.
Treating Multiple Myeloma
MM is a highly treatable disease. Many patients live long and productive lives after diagnosis. Both survival and quality of life for myeloma patients are improving steadily. Treatment varies depending on the stage of the disease and may include watch and wait. If active MM with symptoms or smoldering myeloma without symptoms, treatment is usually started. A combination of medications (proteasome inhibitor and an immunomodulatory agent plus the steroid dexamethasone) is the standard of care for newly diagnosed patients. Another treatment option is chemotherapy. Stem cell transplant should be considered early in all transplant-eligible patients.
Role of Immune Globulin Therapy
Immune globulins are found naturally in the body and help fight infection. Although patients with MM may have elevated or normal levels of antibodies, the antibodies do not function normally and may cause recurrent infections. Patients with recurrent infections may receive immune globulin replacement therapy administered into the blood stream intravenously (IVIG) or under the skin subcutaneously (SCIG). Immune globulin is extracted from a large pool of human plasma and contains all the important antibodies present in the normal population.
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