Multiple Myeloma

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Information written by:
John Garton, MD

Multiple Myeloma

BACKGROUND

Multiple myeloma is a malignancy caused by the unregulated proliferation of a population of plasma cells in the bone marrow. Plasma cells are part of the normal immune system. Their primary purpose is the production of normal immunoglobulins or antibodies which are produced in response to infections, inflammation, and even malignancies. These plasma cells are normally well regulated and can be thought of as small factories for immunoglobulins. The typical signs and symptoms of multiple myeloma relate to the loss of normal bone marrow function and weakening of the bone itself.

Epidemiology

Multiple myeloma represents approximately 1% of all new cases of cancer identified annually. It does account for approximately 13% of all blood related malignant disorders in the United States. There is a slightly higher incidence rate in African-Americans and in males. The average age of patients presenting at diagnosis is 63 years. There is a slight increased incidence as age increases. Studies have shown an increased prevalence in patients who have been exposed to fuel oil products, agricultural workers, miners and sheet metal workers. The specific etiologic factors regarding multiple myeloma are unknown.

Signs and Symptoms

The most common presenting complaint in multiple myeloma is bone pain relating to the destruction of the bone by the myeloma plasma cells. Other common symptoms include: fatigue, increased incidence of infection and bruising or easy bleeding. Signs of the disease include: anemia, abnormal bone x-rays, abnormal findings of protein in the blood or urine, and kidney dysfunction.

Diagnostic tests

Studies which are indicated in patients who have multiple myeloma should include: Complete blood counts, blood chemistry studies, uinalysis, specific immunoelectrophoretic studies of blood and urine, x-rays of the spine, skull and long bones, and a bone marrow aspirate and biopsy examination. Other studies may be taken from the bone marrow which may be used to help identify certain prognostic categories in myeloma patients. Further imaging studies such as MRI or CT scans may be indicated to identify causes of atypical pain or neurologic symptoms.