Treatment

Our Approach

Patients who come to the Siteman Cancer Center for treatment of multiple myeloma and other plasma cell neoplasms are seen by a team of Washington University Physicians — surgical, medical and radiation oncologists.  A health psychologist is also available as needed.

Experienced nurses then spend time with you, answering your questions and putting you in touch with resources that may help during this stressful time. These nurses offer patients printed materials on your condition, chemotherapy, radiation therapy, bone marrow transplant and other related issues. As a unique feature of your care, we also offer the services of a palliative care specialist who can help you fit treatment into your own special circumstances, if needed. Because multiple myeloma and other plasma cell neoplasms are blood disorders, radiation, chemotherapy and bone marrow transplant are the mainstays of therapy.

Clinicians at Siteman Cancer Center see more than 300 new multiple myeloma a year and more other plasma cell neoplasms than most other centers in the area and are internationally recognized for their expertise.

Multiple Myeloma is the most common type of a class of conditions called plasma cell neoplasms. Multiple myeloma is a type of cancer that begins in plasma cells (white blood cells that produce antibodies). Abnormal plasma cells build up in the bone marrow, preventing the bone marrow from making healthy blood cells: red cells to carry oxygen, white cells to fight infection and platelets to prevent bleeding. It can damage the bone and make it more prone to breaking. It can also cause kidney malfunction, high blood levels of calcium and put patients at greater risk for infection. Sometimes, however, there are no symptoms and it is found on a routine blood test.

Besides multiple myeloma, there are other types of plasma cell neoplasms:

  • Monoclonal gammopathy of undetermined significance (MGUS) is generally not cancerous but can progress to multiple myeloma.
  • Smoldering myeloma is another inactive form or precursor of multiple myeloma. Patients with smoldering myeloma have more plasma cells in the bone marrow without evidence of organ damage. Although smoldering myeloma has a greater risk of progressing to active multiple myeloma, some patients never do. Patients with smoldering myeloma are generally observed without any therapy, except in clinical trials.
  • Amyloidosis is a rare but serious protein deposition disease caused by an abnormal protein called amyloid that builds up in tissues or organs. As the amount of amyloid protein deposits increase, they interfere with function and may cause organ failure. Systemic amyloidosis is the most common. Amyloidosis may be associated with certain blood cancers like multiple myeloma.
  • Plasmacytoma is cancerous but differs from multiple myeloma in that the abnormal plasma cells (myeloma cells) are in one place and form one tumor. Sometimes it can be cured. Plasmacytomas can either be of the bone or extramedullary, in which the tumor is outside the bone, usually in tissues of the throat, tonsil or paranasal sinuses and can become multiple myeloma.

Several types of treatment are used for plasma cell neoplasms: chemotherapy, corticosteroids, targeted therapy (proteasome inhibitors), high-dose chemotherapy with stem cell transplant, biologic therapy with immune modulators, radiation therapy, surgery to remove the tumor (followed by radiation), and active surveillance. Clinical trials are exploring new combinations of therapy.

Radiation therapy may be indicated to kill cancer cells and shrink tumors, but more often is used for pain control and prevention of fractures. Chemotherapy uses drugs given by mouth or intravenously to kill cancer cells. Bone marrow transplants can restore the normal function of the bone marrow to produce red and white blood cells and platelets.

Siteman cancer physicians are actively involved in clinical trials that investigate new chemotherapy regimens, and other approaches to cure. Having your cancer treated at Siteman gives you access to new therapies that are as good as – or potentially better than – current standard therapies available elsewhere.