Multiple myeloma is a cancer of the bone marrow, also known as plasma cell myeloma or Kahler disease, after Dr Otto Kahler who described it in 1889. In multiple myeloma the bone marrow produces a subtype of white blood cells—plasma cells—that under normal conditions are responsible for production of antibodies (proteins that fight infections). These malignant plasma cells produce a paraprotein (an inactive antibody known also as M protein or Bence Jones protein ) that adversely affects bone marrow, bones, blood, and the kidneys. Multiple myeloma is a somewhat uncommon disease that accounts for 1.1% of all cancers in white persons and 2% in elderly black persons and affects more men than women. For many years it has been known that multiple myeloma can have either a mild or very aggressive course. The December 1, 2010, issue of JAMA includes an article describing conditions that consistently precede the development of multiple myeloma.
As the number of plasma cells increases, the number of red blood cells, white blood cells, and platelets in blood decreases. Also, the amount of paraprotein increases in blood and in bone marrow, destroying bone structures. That is why several seemingly unrelated symptoms are characteristic for multiple myeloma:
Bone pain
Bone fractures in the spine and ribs
Spinal cord compression causing pain, muscle weakness, and urinary difficulties
Anemia (a decreased number of red blood cells in blood), causing fatigue
Repeated infections
Nosebleeds
Multiple myeloma is suspected when a patient with bone pain has tests that reveal bone lesions in the skull, spine, or ribs; anemia; renal failure; and high blood calcium levels that are accompanied by the presence of paraprotein in blood and urine. The diagnosis is made when bone marrow aspiration reveals an increased number of plasma cells. Further analysis of these cells may indicate the prognosis. Recent studies show that multiple myeloma is consistently preceded by precursor states called monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM). At this time, there is evidence that early treatment prevents progression to full-blown multiple myeloma; however, it is unknown if it leads to longer overall survival. Multiple myeloma is a treatable disease and many patients enjoy their lives for many years after diagnosis. Treatment options for multiple myeloma include drugs that affect the immune system (such as thalidomide and lenalidomide), proteasome inhibitors (such as bortezomib), chemotherapy (use of drugs that kill cancer cells), or radiation. Since the mid-1990s, high-dose treatment with the chemotherapy drug melphalan followed by an autologous stem cell transplant (using the patient's own stem cells) has been part of the therapy for newly diagnosed patients younger than 65 to 70 years without other serious diseases.
Grahic Jump Location
National Library of Medicinehttp://www.nlm.nih.gov/medlineplus/multiplemyeloma.html
National Cancer Institutehttp://www.cancer.gov/cancertopics/wyntk/myeloma
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish.
Sources: National Library of Medicine, National Cancer Institute
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
TOPIC: CANCER
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.