April is Multiple Myeloma Month
By Danny M. Sims, MD

Multiple Myeloma is a cancer that arises from plasma cells, and about 15,000 new cases of Multiple Myeloma occur in the United States each year.

Recently, the incidence of Multiple Myeloma has been slowly, but not dramatically, increasing. The cause of Myeloma remains unknown in the majority of patients. Multiple Myeloma does not usually run in families. The disease typically develops later in life. Its incidence peaks at approximately age 70.

Plasma cells are one of the cells of the immune system, which normally reside in the bone marrow. Myeloma most often begins in the bone marrow, so the early signs of Myeloma are related to the bones or the marrow. These include anemia, fatigue, bone pain, and sometimes fractures.

Normal plasma cells produce antibodies to help fight off infections. Myeloma cells frequently produce a unique antibody protein that can lead to problems with the functioning of other organs, especially the kidneys. This unique antibody protein may be helpful in tracing the course of Multiple Myeloma. As treatment is given, the amount of protein in the blood should decrease, which indicates that the disease is regressing.  An increase in the protein level could indicate a relapse or the need for a change in treatment.

The treatment of Myeloma has improved substantially over the last several years. Chemotherapy has been and remains an important and successful part of Myeloma treatment. Depending on the situation, either oral or intravenous chemotherapies may be used. For those patients who are able to undergo very vigorous treatments, which rely on high doses of chemotherapy, bone-marrow or stem-cell transplants may offer some additional benefit.

Although Myeloma can go into remission with treatment, it, nevertheless, remains an incurable disease. Symptoms usually will recur and require further treatment.

Clinical research in Myeloma has yielded important results over the last few years. Now, Thalidomide, a medicine known to cause terrible birth defects when given during pregnancy, has been shown to be very effective in treating Myeloma. Patient takes the medication orally. Although side effects do occur, they can usually be managed by adjusting the dose.

Research continues to find more effective and better-tolerated drugs similar to Thalidomide. Several of these are undergoing clinical trials presently and hopefully will be available soon.

Velcade is the newest drug approved for the treatment of Myeloma. It is the first drug of its kind and works unlike other treatments. Velcade is given intravenously, and its side effects are generally mild. Initially, excitement regarding Velcade arose when it was found to be effective even in patients whose Myeloma had progressed after multiple other treatments. Now, we are finding it to be very effective when used earlier in the course of the disease, and combined with other treatments such as chemotherapy or Thalidomide.

Other treatments for Multiple Myeloma include radiation therapy, which can help relieve the pain of weakened bones. Bisphosphonates also relieve pain and can prevent fractures by strengthening the bones.

At New Hampshire Oncology-Hematology, we are participating in clinical research in the treatment of Multiple Myeloma. Through such research, we hope to improve even further the quality of the lives of our patients. 

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