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Multiple myeloma

AGE  Increasingly common over the age of 40; most common around the age of 70GENDER  Not significant factors
LIFESTYLE  Not significant factorsGENETICS  Not significant factors

Multiple myeloma ia a bone marrow cancer in which abnormal antibody-producing white blood cells multiply in an uncontrolled manner.

Multiple myeloma
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Multiple myeloma is one of the commonest cancers of the bone marrow and affects plasma cells, the white blood cells that produce antibodies against infection. A plasma cell undergoes a cancerous change, multiplies excessively, and disrupts the production of normal red and white blood cells and platelets.

The abnormal plasma cells produce abnormal antibodies, and fewer normal antibodies are produced, increasing the risk of infection. The abnormal plasma cells destroy bone tissue, leading to bone pain, fractures, and release of excess calcium into the bloodstream.

Low numbers of red blood cells may reduce the oxygen-carrying capacity of the blood (see Anaemia) and reduced numbers of platelets may lead to abnormal bleeding (see Thrombocytopenia).

What are the symptoms of multiple myeloma?

The symptoms of myeloma include:

  • Tiredness, pale skin, and shortness of breath on exertion due to anaemia.
  • Bone pain, most often in the spine, as plasma cells multiply in the bone marrow and spread within the skeleton.
  • Repeated infections.
  • Easy bruising without injury.
  • Thirst, frequent need to pass urine, and constipation d ue to high calcium levels in the blood.

The loss of calcium from bone tissue may lead to brittle bones that fracture easily. Increased levels of calcium and abnormal antibodies in the blood may lead to kidney failure.

What might be done?

You may have blood tests to measure levels of blood cells and look for abnormal antibodies. Your urine may also be tested for abnormal antibodies and you may have a bone marrow aspiration and biopsy. You may have X-rays to look for skeletal damage.

You will probably be treated with a combination of chemotherapy and corticosteroid drugs. The intensity of treatment depends on the person's age and general health. People under 65 may receive oral or intravenous chemotherapy, which may be followed by a stem cell transplant. People older than 65 may receive oral chemotherapy alone.

Radiotherapy may be given for severe bone pain. You may need blood transfusions for severe anaemia, although the anaemia may be improved and the need for transfusions reduced by injections of erythropoietin (a hormone that stimulates red blood cell production). Infections may be treated with antibiotics. You may be given bisphosphonates (see Drugs for bone disorders) to treat high calcium levels; these drugs also slow the progress of skeletal damage. Drinking plenty of fluids will also help to lower calcium levels and reduce the risk of kidney damage.

The outlook varies according to the age of the person affected and the severity of the disorder. Most people live for 2-4 years after diagnosis, but some have survived for 10 years.

Posted 04.05.2011

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