Multiple myeloma---cancer that arises in the plasma cells of the bone marrow---is a relatively rare malignancy. Representing 1 percent of cancers in Caucasians and 2 percent in African-Americans, it strikes more than 20,000 individuals in the United States annually. It is the second most common blood cancer in Americans.
Types
Patients are classified into one of several myeloma categories, which are used to determine treatment options. Treatment may be delayed in patients in the early stages, thus giving their own immune systems a chance to combat the disease, and avoiding the side effects of certain medications, such as chemotherapy.
Early Disease
According to the Mayo Clinic, multiple myeloma may begin as monoclonal gammopathy of undetermined significance (MGUS), a benign, asymptomatic condition that affects 3 percent of people over 50 years old. About one-third of people with MGUS develop multiple myeloma or a related cancer, such non-Hodgkin's lymphoma. Like MGUS, another early disease, known as smoldering myeloma, is an asymptomatic condition with increased plasma cells in the bone marrow and elevated levels of the M-protein in the blood. To appropriately manage both conditions, reports the Multiple Myeloma Research Foundation, patients are observed, with treatment initiated if their diseases progress.
Stage I-III Disease
Active multiple myeloma is classified into three stages. According to the Multiple Myeloma Research Foundation, stage I disease is typically stable or slowly progressing. It should be monitored every 3 months, with treatment initiated if disease progresses. On the other hand, stage II and III myeloma are active and symptomatic, and require immediate treatment.
Complications
Multiple myeloma can cause complications. According to the Mayo Clinic, because the dysfunctional plasma cells interfere with normal immune function, many patients develop repeated infections. These may include shingles, skin infections, pneumonia, and bladder or kidney infections. Because multiple myeloma erodes bones, patients are more likely to experience fractures and, in some cases, compression of the spinal cord. Other complications include decreased kidney function and anemia.
Treatment Strategies
Treatment options for multiple myeloma are traditional chemotherapy, steroids, and immunomodulating agents such as thalidomide and lenalidomide. According to the Mayo Clinic, standard treatment now includes bortezomib, a type of medication known as a proteasome inhibitor. The drugs selected for initial chemotherapy depend on whether the patient is a candidate for stem cell transplantation. Other factors influencing treatment selection are age, health, and symptoms. Also, if there are complications resulting from treatment, specific drugs are added to alleviate them.
