Multiple Myeloma

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Original Editors - Jill Jones from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Multiple myeloma is a primary malignant neoplasm, or cancer, caused by uncontrolled growth of plasma cells in the bone marrow.  The excessive growth of plasma cells that originate in the bone marrow destroys bone tissue and is associated with widespread osteolytic lesions (decreased areas of bone density) . 

According to Goodman and Fuller, tumors of this type initially affect the bones and bone marrow of the vertebrae, ribs, skull, pelvis, and femur. These regions are most often affected because of their high concentrations of bone marrow.  The progression of this disease can cause damage to the kidney, lead to recurrent infections, and often affects the nervous system .  To date, multiple myeloma is an incurable disease with a poor prognosis. Most individuals die within 1 to 3 years after the diagnosis is made .

 

 File:MRI bones.jpg

      FDG PET scan of a patient with multiple myeloma with severe diffuse and focal disease 

Prevalence

·         Annual incidence of approximately 16,570 cases of the multiple myeloma in the United States

·         11,310 deaths from multiple myeloma in the United States in 2006

·         Occurs less often than the most common cancers (e.g. breast, lung, or colon)

·         Disease can develop at any age, but most commonly seen in persons between the ages of 50 and 70 years

         o    Median age of diagnosis is 69 years for men and 71 years for women

         o    Only 5% of clients with multiple myeloma are younger than 40 years old

·         Multiple myeloma is more common in men and African Americans 

Characteristics/Clinical Presentation

Multiple Myeloma presence and pain :<o:p></o:p>

·         Location: skeletal pain, especially in the spine, sternum, rib, leg, or arm<o:p></o:p>

·         Referral: according to the location of the tumor<o:p></o:p>

·         Description: sharp, knifelike<o:p></o:p>

·         Intensity: moderate to severe<o:p></o:p>

·         Duration: intermittent, progressing to constant<o:p></o:p>

·         Associated signs and symptoms: <o:p></o:p>

o    Hypercalcemia – dehydration (vomiting), polyuria, confusion, loss of appetite, constipation<o:p></o:p>

o    Bone destruction with spontaneous bone fracture<o:p></o:p>

o    Neurologic – Carpal tunnel syndrome; back pain with radicular symptoms; spinal cord compression (motor or sensory loss, bowel/bladder dysfunction, paraplegia)<o:p></o:p>

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When to see a doctor, according to Mayoclinic.com:<o:p></o:p>

If you're persistently more tired than you used to be, you've lost weight, and you experience bone pain, repeated infections, loss of appetite, excessive thirst and urination, persistent nausea, increased constipation, or weakness or numbness in your legs, your signs and symptoms may indicate multiple myeloma or other serious disease. See your doctor to determine the underlying cause .<o:p></o:p>

Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports

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Resources

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Recent Related Research (from Pubmed)

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References

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