$Unique_ID{BRK04030} $Pretitle{} $Title{Myeloma, Multiple} $Subject{Myeloma, Multiple Plasma Cell Myeloma Myelomatosis Kahler Disease Smoldering Myeloma Plasma Cell Leukemia Nonsecretory Myeloma Osteosclerotic Myeloma Solitary Plasmacytoma of Bone Extramedullary Plasmacytoma Waldenstrom Macroglobulinemia Heavy Chain Disease Primary Amyloidosis Smoldering Myeloma Plasma Cell Leukemia NonSecretory Myeloma Osteosclerotic Myeloma Solitary Plasmacytoma of Bone Extramedullary Plasmacytoma } $Volume{} $Log{} Copyright (C) 1988, 1989, 1990, 1992 National Organization for Rare Disorders, Inc. 566: Myeloma, Multiple ** IMPORTANT ** It is possible that the main title of the article (Multiple Myeloma) is not the name you expected. Please check the SYNONYM listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Plasma Cell Myeloma Myelomatosis Kahler Disease DISORDER SUBDIVISIONS Smoldering Myeloma Plasma Cell Leukemia Nonsecretory Myeloma Osteosclerotic Myeloma Solitary Plasmacytoma of Bone Extramedullary Plasmacytoma Information on the following diseases can be found in the Related Disorders section of this report: Waldenstrom Macroglobulinemia Heavy Chain Disease Primary Amyloidosis Smoldering Myeloma Plasma Cell Leukemia NonSecretory Myeloma Osteosclerotic Myeloma Solitary Plasmacytoma of Bone Extramedullary Plasmacytoma General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Multiple Myeloma is a rare form of bone marrow cancer. Major symptoms may include pain in the bones of the back or chest, weakness, fatigue, anemia and kidney problems. Symptoms Multiple Myeloma starts with pains in the bones of the chest or back which are triggered by movement of the body. Weakness, fatigue, anemia, kidney problems, and/or compressed nerves in the spine may also be present. Paleness of the skin is a common physical finding and there is increased susceptibility to bacterial infections, particularly pneumonia. Sometimes the liver and spleen become enlarged. Causes The exact cause of Multiple Myeloma is not known. Scientists suspect there may be a variety of causes such as the effects of radiation, asbestos, industrial or agricultural toxins, hereditary disposition or viruses. Multiple Myeloma is characterized by excessive new growth (neoplastic proliferation) of the plasma cells in bone marrow. It is initially found in the bones of the spine, skull, rib cage, pelvis or legs. The blood shows an increase in levels of certain immune system cells (suppressor T cells) and abnormally low levels of helper T cells. Affected Population Multiple Myeloma patients account for 1% of all types of cancer and 10% of all blood malignancies. It is found in men twice as often as women. It usually occurs between the fourth and seventh decades of life. Related Disorders Symptoms of the following disorders can be similar to those of Multiple Myeloma. Comparisons may be useful for a differential diagnosis: Amyloidosis refers to a group of diseases characterized by extracellular depositions of a protein-like material (amyloid), in one or more sites of the body. Amyloid deposits, in large amounts, can cause a wide variety of organ abnormalities. The organ can take on a firm, rubbery consistency and have a waxy, pink or gray appearance. Organ enlargement (especially of the liver, kidney, spleen, or heart) may be prominent. (for more information on this disorder, choose "Amyloidosis" as your search term in the Rare Disease Database). Waldenstrom Macroglobulinemia is a lymph and blood cell disorder. Abnormally large quantities of homogeneous protein molecules are present in the blood. The disorder tends to run in families and occurs mainly among older men. An enlarged spleen and liver with abnormalities of the lymph glands are the most frequent symptoms. Weakness, anemia, fatigue and excessive bleeding, especially from the nose and mouth, also occur. (For more information on this disorder, choose "Waldenstrom " as your search term in the Rare Disease Database). Heavy Chain Diseases are characterized by the presence of too many plasma cells, or lymphocytes that resemble plasma cells, in the bone marrow and lymph nodes. This condition includes Gamma, Alpha and Mu Heavy Chain Disease, which are all disorders of the proliferative type. Gamma Heavy Chain Disease is characterized by a deletion of amino acids and anemia. The liver, spleen and lymph nodes are enlarged. Alpha Heavy-Chain Disease occurs most often in men of Mediterranean ancestry. It involves the digestive tract with severe malabsorption of nutrients, loss of weight, diarrhea, and loss of fat (steatorrhea). Symptoms are most often progressive. Mu Heavy-Chain Disease is typified by a form of chronic lymphocytic leukemia or tumors of the lymph gland. Analysis of the blood serum usually reveals excessively low levels of antibodies in the blood (gammaglobulinemia). The following disorders may be associated with Multiple Myeloma as secondary characteristics. They are not necessary for a differential diagnosis: Smoldering Myeloma is characterized by abnormally high levels of atypical plasma cells in the bone marrow without evidence of symptomatic disease. Many patients excrete protein in the urine but have no other evidence of either anemia, bone lesions or kidney failure. Plasma Cell Leukemia is characterized by the presence of excessive amounts of plasma cells in the blood. Most patients initially have leukemia and approximately thirty percent already have well-documented cases of Multiple Myeloma. Non-Secretory Myeloma exists when a patient with Multiple Myeloma does not produce M protein in either the urine or blood serum. Osteosclerotic Myeloma patients usually have five percent or less of the normal amounts of plasma cells in their blood. One or more osteosclerotic lesions are present and lytic lesions develop in some cases. The disease is chronic and inflammatory, usually causing motor disabilities, high protein levels in the spinal fluid and/or low motor nerve conduction. The spleen and liver are usually enlarged, and discoloration of the skin occurs as well as fluid retention and clubbing of the fingers. Solitary Plasmacytoma of Bone is characterized by only one lesion of the bone. Diagnosis relies on cell examination, no evidence of Multiple Myeloma in the bone marrow, and no M protein in the blood serum or urine. Extramedullary Plasmacytoma occurs when plasma cell tumors arise outside the bone marrow. The upper respiratory tract, which includes the nasal cavity and sinuses, nasopharynx, and larynx, is the most frequent site of involvement. However, extramedullary plasmacytomas have been found in virtually every organ of the body, making a confirmed diagnosis of Multiple Myeloma necessary. Therapies: Standard Treatment of Multiple Myeloma usually involves chemotherapy and analgesic drugs for pain. If kidneys are involved, the administration of fluids may be necessary to avoid dehydration. Other treatment may include radiation therapy to reduce bone masses that may develop. The use of the biologic drug, Interferon, combined with chemotherapy drugs may also be recommended. Plasmapheresis may be of benefit in some cases of Multiple Myeloma. This procedure is a method for removing unwanted substances (toxins, metabolic substances and plasma parts) from the blood. Blood is removed from the patient and blood cells are separated from plasma. The patient's plasma is then replaced with other human plasma and the blood is retransfused into the patient. This therapy is still under investigation to analyze side effects and effectiveness. More research is needed before plasmapheresis can be recommended for use in all but the most severe cases. Therapies: Investigational Studies are being conducted in the use of Sandoglobulin as a treatment for Multiple Myeloma. Further investigation is needed to determine it's safety and effectiveness. The orphan product Melphalan (Alkeran for injection) is being studied by the FDA for the treatment of Multiple Myeloma in patients in whom oral therapy is not correct. The product is sponsored by Burroughs Wellcome Company, Research Triangle Park, NC. This disease entry is based upon medical information available through March 1992. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Multiple Myeloma, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 National Kidney Foundation 2 Park Avenue New York, NY 10016 (212) 889-2210 (800) 622-9010 American Kidney Fund 6110 Executive Blvd., Suite 1010 Rockville, MD 20852 (301) 881-3052 (800) 638-8299 (800) 492-8361 (MD) American Cancer Society 1599 Clifton Rd., NE Atlanta, GA 30329 (404) 320-3333 NIH/National Cancer Institute 9000 Rockville Pike, Bldg. 31, Rm. 1A2A Bethesda, MD 20892 1-800-4-CANCER The National Cancer Institute has developed PDQ (Physician Data Query), a computerized database designed to give doctors quick and easy access to many types of information vital to treating patients with this and many other types of cancer. To gain access to this service, a doctor can contact the Cancer Information Service offices at 1-800-4-CANCER. Information specialists at this toll-free number can answer questions about cancer prevention, diagnosis, and treatment. References INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown and Co., 1987. Pp. 1104-1106. EFFECTS OF PLASMAPHERESIS ON THE PLASMA CONCENTRATION OF PROTEINS USED TO MONITOR THE DISEASE PROCESS IN MULTIPLE MYELOMA. A. Wahlin, et al.; Acta Med Scand (1988, issue 223 (3)). Pp. 263-267. INTERFERONS IN THE TREATMENT OF MULTIPLE MYELOMA. M.R. Cooper, et al.; Cancer (February, 1987, issue 59 (3 Suppl)). Pp. 594-600. THE USE OF INTERFERON IN THE TREATMENT OF MULTIPLE MYELOMA. J.J. Costanzi, et al.; Semin Oncol (June, 1987, issue 14 (2 Suppl 2)). Pp. 24-28.