Treatment

Symptoms, Risks and Diagnosis

Multiple Myeloma belongs to a class of conditions called plasma cell neoplasms, which are abnormal growths of tissue that form a mass or tumor, some of which are benign and some cancerous. The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide if treatment is needed. Some forms are slow-growing and may initially be handled with active surveillance. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level, so the best treatment options may be identified.

Symptoms of Plasma Cell Neoplasms

  • Bone pain, especially in the back or ribs.
  • Bones that break easily.
  • Fever for no known reason or frequent infections.
  • Easy bruising or bleeding.
  • Trouble breathing.
  • Weakness of the arms or legs.
  • Feeling very tired.
  • Symptoms from hypercalcemia (too much calcium in the blood):
    • Loss of appetite.
    • Nausea or vomiting.
    • Feeling thirsty.
    • Frequent urination.
    • Constipation or diarrhea
    • Muscle weakness
    • Confusion or trouble thinking
  • Symptoms specific to amyloid patients:
    • Purple spots on the skin.
    • Enlarged tongue.
    • Swelling caused by fluid in your body’s tissues.
    • Tingling or numbness in your legs and feet.

Risk Factors

  • Being African-American.
  • Being male.
  • Having a personal history of MGUS or plasmacytoma.
  • Being exposed to radiation or certain chemicals.
  • Family history of plasma cell.

Diagnosis

Determining the condition and specific type often takes more than one approach.

The following tests and procedures may be used:

  1. Physical exam and history to examine the patient’s past illnesses and treatments, and any signs of disease, such as a swollen spleen, lumps or anything else that seems unusual.
  2. Complete blood count (CBC): A sample of blood is drawn to check for the number of red blood cells, white blood cells and platelets, as well as the amount of hemoglobin (the protein that carries oxygen) and the portion of the sample made up of red blood cells.
  3. Blood chemistry studies: These studies test blood samples for the amounts of certain substances released into the blood by organs and tissues in the body in order to look for signs of disease. Tests may include:
  • Serum and urine electrophoresis
  • Quantitative immunoglobulin
  • Beta2 microglobulin
  • Serum free light chain analysis
  1. 24-hr urine test for protein excretion.
  2. Skeletal bone survey: X-rays taken of all bones to look for damage.
  3. Bone marrow biopsy to aspirate bone marrow, blood and a small piece of bone from the hipbone or breastbone to look for microscopic signs of cancer.
  4. Cytogenetic/FISH analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.
  5. CT-PET scan: A procedure that makes a series of detailed pictures of areas inside the body, which are taken from different angles. Contrast dye may be used to reveal swollen lymph nodes or a swollen spleen.
  6. MRI scan of the spine and pelvis in select patients.

Patients with amyloid may need additional testing.

Staging of Plasma Cell Neoplasms

For multiple myeloma, staging is based on the levels of beta-2-microglobulin and albumin in the blood and ranked 1 through 3.

Prognosis

The prognosis and treatment options depend on the following:

  • The type of plasma cell neoplasm.
  • The stage of the disease.
  • The chromosomal features of the disease.
  • Whether there are certain genetic changes.
  • Whether the kidney is damaged.
  • Whether the cancer responds to initial treatment or recurs (comes back).
  • Age and general health.