Multiple Myeloma
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Plasma cell neoplasms are diseases in which certain
cells in the blood (called plasma cells) become cancer. Plasma cells are made
by white blood cells called lymphocytes. The plasma cells make antibodies,
which fight infection and other harmful things in the body. When these cells
become cancer, they may make too many antibodies and a substance called M-protein
is found in the blood and urine.
There are several types of plasma cell neoplasms.
The most common type is called multiple myeloma. In multiple myeloma, cancerous
plasma cells are found in the bone marrow. The bone marrow is the spongy tissue
inside the large bones in the body. The bone marrow makes red blood cells (which
carry oxygen and other materials to all tissues of the body), white blood cells
(which fight infection), and platelets (which make the blood clot). The cancer
cells can crowd out normal blood cells, causing anemia (too few red blood cells).
The plasma cells also may cause the bone to break down. The plasma cells can
collect in the bone to make small tumors called plasmacytomas.
Plasma cell neoplasms also can appear only as growths
of plasma cells (plasmacytomas) in the bone and soft tissues, without cancer
cells in the bone marrow or blood.
Macroglobulinemia is a type of plasma cell neoplasm
in which lymphocytes that make an M-protein build up in the blood. Lymph nodes
and the liver and spleen may be swollen.
If there are symptoms, a doctor will order blood and
urine tests. If the tests are not normal, the doctor may do a bone marrow biopsy.
During this test, a needle is inserted into a bone and a small amount of bone
marrow is taken out and looked at under the microscope. The doctor can then
tell what kind of cancer the patient has and plan the best treatment. X-rays
also may be done to see whether the bones are affected.
The chance of recovery (prognosis) depends on the
kind of plasma cell neoplasm, and the patient’s age and general health.
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Once plasma cell neoplasm has been found, more tests
will be done to see how far the cancer has spread. This is called staging.
Plasma cell neoplasms are grouped together depending on the type of plasma
cell cancer that is found. The following stages are used for multiple myeloma:
Relatively few cancer cells have spread throughout
the body. The number of red blood cells and the amount of calcium in the blood
are normal. No tumors (plasmacytomas) are found in the bone. The amount of
M-protein in the blood or urine is very low. There may be no symptoms of disease.
A moderate number of cancer cells have spread throughout
the body.
A relatively large number of cancer cells have spread
throughout the body. There may be one or more of the following:
- A decrease in the number of red blood cells, causing anemia.
- The amount of calcium in the blood is very high, because the bones are being
damaged.
- More than three bone tumors (plasmacytomas) are found.
- High levels of M-protein are found in the blood or urine.
The following groups are used to determine the treatment
of plasma cell neoplasms that don’t involve the bone marrow.
Only a single plasma cell tumor is found in the
bone without any other evidence of cancer. Patients may develop multiple myeloma
at a later time.
Plasma cell tumors are found only outside the bone
and the bone marrow in the soft tissues, usually the tonsils or tissues around
the nose. Patients may develop multiple myeloma at a later time.
Plasma cells that produce a certain type of M-protein
are found in the blood. Patients usually have swollen lymph nodes and spleen
or liver.
M-protein is found in the blood without symptoms
or other signs of cancer. People with this condition may develop plasma cell
neoplasms or cancer of the lymph system (lymphoma) at a later time.
The plasma cells do not decrease even though treatment
is given.
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There are treatments for all patients with plasma
cell neoplasms. Three kinds of treatment are used:
- Chemotherapy (using drugs to kill cancer cells).
- Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer
cells).
- Biological therapy (using the body’s immune system to fight cancer).
Chemotherapy uses drugs to kill cancer cells. Chemotherapy
may be taken by pill, or it may be put into the body by a needle in the vein
or muscle. Chemotherapy is called a systemic treatment because the drug enters
the bloodstream, travels through the body, and can kill cancer cells throughout
the body.
Radiation therapy uses x-rays or other high-energy
rays to kill cancer cells and shrink tumors. Radiation for plasma cell neoplasms
usually comes from a machine outside the body (external radiation therapy).
Biological therapy tries to get the body to fight
cancer. It uses materials made by the body or made in a laboratory to boost,
direct, or restore the body’s natural defenses against disease. Biological
therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.
Bone marrow transplantation is used to replace the
bone marrow with healthy bone marrow. First, all of the bone marrow in the
body is destroyed with high doses of chemotherapy with or without radiation
therapy. Healthy marrow is then taken from another person (a donor) whose tissue
is the same as or almost the same as the patient’s. The donor may be a twin
(the best match), a brother or sister, or an unrelated person. The healthy
marrow from the donor is given to the patient through a needle in the vein
to replace the marrow that was destroyed. A bone marrow transplant using marrow
from a relative or unrelated person is called an allogeneic bone marrow transplant.
Another type of bone marrow transplant, called autologous
bone marrow transplant, is being studied in clinical trials. To do this type
of transplant, bone marrow is taken from the patient and treated with drugs
to kill any cancer cells. The marrow is then frozen to save it. Next, the patient
is given high-dose chemotherapy with or without radiation therapy to destroy
all of the remaining marrow. The frozen marrow that was saved is then thawed
and given back to the patient through a needle in a vein to replace the marrow
that was destroyed.
Another type of autologous transplant is called
a peripheral blood stem cell transplant. The patient’s blood is passed through
a machine that removes the stem cells (immature cells from which all blood
cells develop). The machine then returns the blood back to the patient. This
procedure is called leukapheresis and usually takes 3 or 4 hours to complete.
The stem cells are treated with drugs to kill any cancer cells and then frozen
until they are transplanted back to the patient. This procedure may be done
alone or with an autologous bone marrow transplant.
A greater chance for recovery occurs if a doctor
chooses a hospital which does more than five bone marrow transplantations per
year.
If the spleen is swollen, the doctor may take out
the spleen in an operation called a splenectomy.
If too many M-proteins build up in the blood, the
patient’s blood may need to be filtered through a special machine. This is
called plasmapheresis.
Treatment of plasma cell neoplasms depends on the
type and stage of the disease, and the patient’s age and overall health.
Standard treatment may be considered because of
its effectiveness in patients in past studies, or participation in a clinical
trial may be considered. Not all patients are cured with standard therapy and
some standard treatments may have more side effects than are desired. For these
reasons, clinical trials are designed to find better ways to treat cancer patients
and are based on the most up-to-date information. Clinical trials are ongoing
in most parts of the country for most stages of plasma cell neoplasms.
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If there are no symptoms, treatment may not be needed. A doctor will follow
the patient closely so treatment can be started if symptoms develop. If there
are symptoms, treatment will probably be chemotherapy. Clinical trials are
testing new chemotherapy drugs and dose regimens.
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Treatment will probably be external radiation therapy to the tumor.
If other symptoms appear, patients may receive chemotherapy.
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Treatment may be one of the following:
- External radiation therapy to the tumor.
- Surgery to remove the tumor, usually followed by external radiation therapy.
If other symptoms appear, patients may receive chemotherapy.
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If there are no symptoms, treatment may not be needed. A doctor will
follow the patient closely so treatment can be started if symptoms develop.
If there are symptoms, treatment may be chemotherapy, biologic therapy, or
immunotherapy. Clinical trials are testing new chemotherapy drugs and combinations
of drugs with or without stem cell support or transplant.
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A doctor will follow the patient closely to see if symptoms of plasma
cell neoplasm or lymphoma develop.
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Treatment will probably be chemotherapy. Clinical
trials are testing new drugs and combinations of drugs.
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Ankylosing Spondylitis
