Multiple myeloma is a malignancy. It is in some ways more like leukemia than cancer. Cancer, which usually refers to the medical term carcinoma, is a malignancy arising from a certain type of tissue, called epithelial. Carcinomas usually arise in a single site and spread by metastasizing.
Multiple myeloma arises from plasma cells found in the bone marrow, which are not epithelial cells. In the majority of cases, one cannot say where the myeloma started, since it affects all of the bone marrow. In a variant called plasmacytoma, the malignant cells arise in one spot, and radiation may cure the disease.
Plasma cells make antibodies, which are proteins circulating in the blood; in myeloma, this usually results in a excess of a single antibody protein. The diagnosis is made by finding this protein, and by seeing the malignant plasma cells in the bone marrow.
Because the myeloma grows almost exclusively within the bone, bone destruction and pain are often the first symptoms. The X-ray picture, particularly of the skull, may be diagnostic, showing many small areas of bone destruction. Bone destruction elsewhere may lead to fractures or collapse of vertebrae.
Complications of the disease may vary. Large amounts of bone destruction can cause the release of too much calcium into the blood stream, which, if not controlled, can be fatal. Bacterial infections, particularly urinary tract infections, are common, apparently because the excess production of one antibody suppresses the normal production of others necessary to keep bacterial infections under control. Anemia may occur because the tumor cells replace normal bone-marrow cells.
Kidney failure occurs in about 25 percent of myeloma patients and is the common cause of death from this disease. Kidney failure may be caused by several factors, including high calcium levels in the blood, high uric acid levels, and direct damage to the kidney’s filtering units by the large amount of protein passing through.
Chemotherapy is the only treatment in most cases, and about 80 percent of patients have at least a partial remission of their disease. This is not a permanent cure, however, and relapse is common. The disease is usually fatal in two to five years, although about 10 percent of patients have a slow-growing form of the disease and may survive without any treatment for many years.
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