Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, M.D.
13 February 2002

WHAT IS MULTIPLE MYELOMA?

     A cancer can be thought of as a group of cells that don’t know when to stop growing. Many people think of cancers as being rapidly growing structures or cells but in fact this isn’t really necessarily true.  They may be growing at a normal rate but they simply don’t know when to stop.  This  thus leads to an accumulation of cells that have no use and purpose for the benefit of the body.  Yet they are taking up nutrients and space and blood supply which eventually stops the body’s strength.  Cancers can come from many, many different types of cells including the stomach,  the intestine, the lung, the prostate gland, the breast, the brain, etc. etc.

     Multiple myeloma is a cancer of the cells in the bone marrow that make antibodies. Antibodies are a type of protein that are specific for a given kind of infectious agent.  For instance, when a child first develops measles, the measles virus will multiply in the person’s body.  The body’s immune system will mount an immunizing response that will kill off the measles virus and the person will be immuned  to further episodes of measles in the future.  This is because the immune system will manufacture antibodies that are specific for measles and prevent it from ever coming again.  As babies mature and reach adulthood, the individual develops antibodies to measles, mumps, chicken pox, influenza, and a host of other infectious agents that the child meets along the way.  On each occasion, cells in the bone marrow specific for the given infectious agent are stimulated and grow at an appropriate rate to combat the infection.

    In the person that has multiple myeloma, a colony of cells makes antibodies that have no use for the body.  These cells simply begin to grow and don’t know when to stop.  As they continue to grow, they produce more and more antibody which serves no purpose in the person’s body.  This multiple myeloma cell produced antibody is not directed to the pneumococcus or any other infection that might be present, instead it seems to be like wasted effort to produce proteins that the body doesn’t need.

       The bad effects on the person’s health that comes from this problem include fatigue, weakness and weight loss most prominently.  This symptom seems to develop slowly and is frequently difficult to diagnosis.  The second concern is bone pain that seems to result from the tumor slowly eroding the bones.  As the bones become weak, they bend more easily and bending a bone is very painful.  Simply getting out of a chair puts enough strain on the legs and the back to cause severe pain.  Thirdly, the person develops an anemia with low blood counts because the bone marrow spends so much time making protein it doesn’t need that it doesn’t have time to make the red blood cells that the body does need.  As the anemia progresses, weakness becomes more of a problem.  Sometimes, the person’s calcium in their blood becomes too high because cancer cells in the bone marrow melt the bone and release the calcium into the blood stream. This can be a very severe problem.  Lastly, the extra protein that the myeloma cells produce may cause kidney failure and the person will have to be treated with an artificial kidney for the rest of their lives.  Multiple myeloma is a very serious disease that left untreated causes great hardship and eventual mortality.

       Fortunately, there is very effective treatment for many people with this condition.  Two relatively cheap and safe chemicals called Prednisone and Melphalan will effectively stop the condition in about 60% of the people who use these.  The treatment program is relatively simple with a person simply taking the medication for four days at the start of each month.  I have had several patients in whom this treatment program effectively controlled the condition for more than 8 years.  If the Prednisone and Melphalan is ineffective, there are other more complex chemotherapeutic protocols that can be used.  In addition, various other complications that can occur in myeloma can be effectively treated and prevent discomfort or death.

       The condition is relatively easy to diagnose and evaluate.  Actually, the entire evaluation and treatment program can be done through your local clinics.  If complications arise, referral to specialists and the institution of more complex treatment programs would be necessary.