Multiple Myeloma
Original Editors - Jill Jones from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
Multiple myeloma is a type of cancer formed by cancerous plasma cells. Normal plasma cells are found in the bone marrow and are an
important part of the body's immune system.
The immune system is made up of several types of cells that work together to fight infections. Lymph cells (called lymphocytes) are the main type of cell in the immune system. There are 2 types of lymph cells: T cells and B cells.
When B cells respond to an infection, they change into plasma cells. The plasma cells are mainly in the bone marrow—the soft, inner part of some bones. The plasma cells make proteins called antibodies that attack and help kill germs.
When plasma cells grow out of control, they can form a tumor, usually in the bone marrow. This type of tumor is called a myeloma, and if there are many tumors they are called multiple myeloma..[1]
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 [2]. 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 [3].
[Image courtesy of University of Arkansas for Medical Sciences http://www.uams.edu/radiology/info/clinical/pet/images.asp]
Prevalence[edit | edit source]
The American Cancer Society's most recent estimates for multiple myeloma in the United States are for 2009:
- 20,580 new cases of multiple myeloma (about 11,190 in
men and about 8,730 in women)
- 10,580 deaths from multiple myeloma
In the United States, the lifetime risk of getting multiple myeloma is 1 in 161.
Scientists have found a few risk factors that may make a person more likely to get multiple myeloma. These are the known risk factors for multiple myeloma:
Age and gender: Age is the biggest risk factor for multiple myeloma. Very few cases are found in people younger than 35. Most people with this cancer are over 65 years old. Men are slightly more likely to get multiple myeloma than women.
Race: Multiple myeloma is almost twice as common among black Americans as white Americans. The reason is not known.[1]
Characteristics/Clinical Presentation[edit | edit source]
Multiple Myeloma presence and pain [2]:
· Location: skeletal pain, especially in the spine, sternum, rib, leg, or arm
· Referral: according to the location of the tumor
· Description: sharp, knifelike
· Intensity: moderate to severe
· Duration: intermittent, progressing to constant
· Associated signs and symptoms:
o Skeletal – Hypercalcemia: symptoms include dehydration (vomiting), polyuria, confusion, loss of appetite, constipation
o Bone destruction with spontaneous bone fracture
o Neurologic – Carpal tunnel syndrome; back pain with radicular symptoms; spinal cord compression (motor or sensory loss, bowel/bladder dysfunction, paraplegia)
When to see a doctor, according to Mayoclinic.com:
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 [4].
Associated Co-morbidities[edit | edit source]
Excerpt from the International Myeloma Foundation website [5]:
TABLE 2: MEDICAL PROBLEMS RELATED TO MYELOMA
Image:TABLE_2_MEDICAL_PROBLEMS_RELATED_TO_MYELOMA.jpg
Medications[6][edit | edit source]
-Cytoxan is an antineoplastic. It works by stopping or slowing the growth or spread of certain cancer cells.
-Revlimid affects the immune system. It helps promote immune responses to prevent inflammation in the body.
-Adriamycin is an antineoplastic antibiotic. It works by killing cancer cells.
-Velcade interferes with the growth of some cancer cells and keeps them from spreading in your body.
-Thalomid affects the immune system. It helps promote immune responses to prevent inflammation in the body. It is used together with another medicine called Dexamethasone to treat multiple myeloma (bone marrow cancer).
-Doxil is an antineoplastic antibiotic. It works by killing cancer cells.
-Alkeran is an alkylating agent. It works by destroying resting and rapidly dividing tumor cells in certain types of cancer.
-Oncovin (Vincristine) is cancer medication that interferes with the growth of cancer cells and slows their spread in the body.
-Mozobil works by helping your bone marrow release stem cells into your bloodstream so they can be collected and transplanted back into the body.
-Neosar is an antineoplastic. It works by stopping or slowing the growth or spread of certain cancer cells.
-Cyclophosphamide is a cancer (chemotherapeutic) medication. Cyclophosphamide interferes with the growth of cancer cells and slows their growth and spread in the body.
-Cyclophosphamide is a cancer (chemotherapeutic) medication. Cyclophosphamide interferes with the growth of cancer cells and slows their growth and spread in the body.
-BiCNU is an antineoplastic. It works by blocking the growth of cancer cells.
-Bisphosphonates can be used to prevent fractures.
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
diagnose this disease. They may include [7]:
- Blood chemistry (CHEM 20) may show increased levels of
calcium, total protein, and abnormal kidney function
- Complete blood count (CBC) reveals low numbers of red
and white blood cells and platelets
- Serum protein electropheresis (SPEP)
- Urine protein electrophoresis (UPEP) or Bence-Jones
protein analysis
- Quantitative immunoglobulins (nephelometry)
[Image courtesy of Mayo Foundation for Medical Research http://www.mayoclinic.com/health/multiple-myeloma/DS00415]
Bone x-rays show fractures or hollowed out areas
of bone. If this type of cancer is suspected, a bone marrow biopsy might be performed in order diagnose.
Major and minor criteria were created to distinguish multiple myeloma from asymptomatic myeloma and monoclonal gammopathies of undetermined significance (MGUS). Individuals must have at least one major and one minor or three minor criteria to be diagnosed with multiple myeloma.
Criteria for the Diagnosis of Multiple Myeloma [3]:
Image:Multiple_myeloma_diagnostic_criteria.jpg
Causes[edit | edit source]
The exact cause of multiple myeloma is unknown. It has been reported that the beginning of multiple myeloma begins with the presence and multiplication of an abnormal plasma cell in the bone marrow. Exposure to ionizing radiation and occupational hazards (i.e. petroleum, leather, lumber, and agricultural industries) may be linked to the presence of this abnormal plasma cell formation. Abnormal cells do not behave as normal cells do, with maturation and death. These abnormal cells accumulate and thus eventually overwhelm the number and production of healthy cells. Statistically, in healthy bone marrow less than 5 percent of the cells are plasma cells. Individuals with multiple myeloma display a presence of more than 10 percent of the cells in bone marrow being plasma cells. Multiple myeloma is a malignancy that increases the rate of abnormal cell division. Uncontrolled plasma cell growth can damage bones and surrounding tissue. It can also interfere with your immune system's ability to fight infections by inhibiting your body's production of normal antibodies [3][4].
Systemic Involvement[edit | edit source]
Multiple myeloma systemic involvement list excerpt from Goodman and Snyder [2]:
· Immune system:
o Recurrent bacterial infections (especially pneumococcal pneumonias)
· Circulatory system:
o Anemia with weakness and fatigue
o Bleeding tendencies
· Skeletal system:
o Bone destruction
§ Skeletal/bone pain (especially pelvis, spine and ribs)
§ Spontaneous fracture
§ Osteoporosis
§ Hypercalcemia (confusion, increased urination, loss of appetite, abdominal pain, vomiting, and constipation)
· Urinary system:
o Renal involvement
§ Kidney stones
§ Renal insufficiency
· Neurological systems:
o Neurologic abnormalities
§ Carpal tunnel syndrome
§ Back pain with radicular symptoms
§ Spinal cord compression (motor or sensory loss, bowel/bladder dysfunction, paraplegia)
Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
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Resources
[edit | edit source]
1. Multiple Myeloma Research Foundation: http://www.multiplemyeloma.org/
2. American Cancer Society: http://www.cancer.org
3. International Myeloma Foundation: http://myeloma.org
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 American Cancer Society website. 2010. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_2_1x_What_Is_Multiple_Myeloma.asp?sitearea=. Accessed April 4, 2010.
- ↑ 2.0 2.1 2.2 3. Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis: Saunders Elsevier; 2007.
- ↑ 3.0 3.1 3.2 Goodman C, Fuller K. Pathology: Implications for the Physical Therapist. St. Louis: Saunders Elsevier; 2009.
- ↑ 4.0 4.1 Mayoclinic.com. 2010. Available at: http://www.mayoclinic.com/health/multiple-myeloma/DS00415. Accessed March 1, 2010.
- ↑ International Myeloma Foundation website. 2010. Available at: http://myeloma.org/ArticlePage.action?tabId=1&menuId=161&articleId=2732&aTab=-1&gParentType=menuitem&gParentId=161&parentIndexPageId=52&parentCategoryId=443. Accessed March 3, 2010.
- ↑ Drugs.com. 2010. Available at: http://www.drugs.com/condition/multiple-myeloma.html. Accessed March 3, 2010.
- ↑ A.D.A.M. Google Health: Multiple Myeloma. 2010. Available at: https://health.google.com/health/ref/Multiple+myeloma. Accessed March 1, 2010.
