Information About Myeloma

John Han-Chih Chang, MD
Last Modified: November 1, 2001

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Question
Dear OncoLink "Ask the Experts,"
Please tell me what myeloma cancer is? My lifelong friend has myeloma at the 1st lumbar spine. They operated and removed the tumor, but could not reach all of the cancer cells. He is now getting radiation treatments to his abdomen.

He experiences great pain. He has commissioned me to find out if there is any hope of eradicating the remaining cancer cells in this manner. He wants to know if there is any hope of him recovering a normal life style?

Are there any statistical records of survivors of this dreaded disease? My job is to give him encouragement so that he might keep his spirits up. Is there any information that you can provide, or point me to so that I can give him a hope for the future?  
Thank you,
J.E.


Answer
John Han-Chih Chang, MD, OncoLink Editorial Assistant, responds:

Dear J.E.,
Thank you for your interest and question.

Myeloma is often called multiple myeloma (MM) because of its diffuse involvement and nature. This cancer has an occurrence rate of 2-3 per 100,000. It is a disease seen mostly in the 6th and 7th decades of life and involves the bones and soft tissues.

The cell of origin in multiple myeloma is the plasma cell or the B-lymphocytes that make antibodies. The malignancy is the result of abnormal growth of one plasma cell line. This disease is usually found in the bone but can be found in the soft tissues. Symptoms of MM include bone pain, infection, bleeding and/or increased fatigue. These symptoms are due to the decrease in white blood cells (infection fighting cells), platelets (clotting cells) and red blood cells (oxygen carrying cells) caused by replacement of the bone and bone marrow with the cancerous plasma cells. The pain associated with MM is a result of bone and marrow being replaced by cancer cells.

Most of the bony lesions are lytic, meaning that there is bone being reabsorbed causing an increased risk of fracture. The lesion can be solitary (only one focus of tumor) and termed a plasmacytoma (tumor of plasma cells). It can be just a solitary bone plasmacytoma or an extramedullary plasmacytoma (NOT in bone, but soft tissues of the head/neck, lungs, lymph nodes, spleen and gastrointestinal tract).

The solitary lesions do better than MM, since by definition MM is diffuse in nature. Most solitary bone plasmacytomas, unfortunately, progress to MM, while extramedullary disease is less likely to do so (but still can). Thus, MM patients have a much worse outcome than solitary bone plasmacytoma patients, who have a grimmer outlook than extramedullary disease.

For solitary lesions, treatment to the primary tumor is usually with radiation therapy. It can be very effective in controlling and eradicating the painful lesion in bone or soft tissue. Chemotherapy to prevent progression to MM has not really been effective. For MM, treatment is usually with chemotherapy and/or radiation therapy with good initial response, but poor durability of control. Chemotherapy is usually with a drug called melphalan along with a steroid called prednisone. Other chemotherapy can be used. Some have advocated using bone marrow or peripheral stem cell transplant, but results are preliminary and are currently under testing in a major clinical trial. Total body or hemibody radiation has been used in cases of chemotherapy resistant MM with some limited success and high toxicity. Local field radiation has been used to treat areas of pain to help make the person comfortable, but is not curative. The outlook is not promising for MM, though there have been some long term survivors with stabilized disease for a number of years (with treatment MM can have a prolonged clinical course).