Plasmacytoma
This disease generally occurs in older adults. Less than 3 percent of cases occur in people younger than 40 years old. Multiple myeloma is more common in men than in women. It is twice as common in African Americans, as it is in Caucasians.
Cause
Multiple myeloma occurs spontaneously. Patients to ionizing radiation and the pesticide dioxin exposure can develop the disease. Infection with some viruses (HIV and human herpesvirus 8) has also been associated with multiple myeloma. No known risk factors are inherited.
Symptoms
Most patients complain of bone pain. Other symptoms are:
* Fatigue
* Feeling sick
* Fever
* Night sweats
Weight loss is not common in the early stages.
Physically, the patients are pale with diffuse bone tenderness, especially around the sternum (breastbone) and pelvis (hip).
Pathological fractures (fractures caused by tumors) are common. Thirty percent of patients have discovered their multiple myeloma first when they develop this type of fracture. The spine is the most common location for a pathological fracture. It can also happen in the ribs and pelvis.
Compression of the spinal cord occurs in 10 to 15 percent of the patients. This causes pain in the back and legs and numbness and weakness in the legs.
Patients with a high level of calcium in the blood may have nausea, fatigue, confusion, constipation, frequent urination, and experience.
In patients with anemia can cause fatigue, weakness and shortness of breath with exercise.
In advanced cases, patients typically have recurrent infections and renal failure have.
Diagnosis
Multiple myeloma is seen named for the "Time" appearance of the cells under a microscope. They infiltrate almost all a patient's bone marrow. These malignant cells from plasma cells are altered. Plasma cells are white blood cells that secrete antibodies as part of the immune response. The altered plasma cells produce abnormal amounts of an antibody protein. No one knows the exact cause or change the location of the cellular.
Multiple myeloma is not limited to a specific site within bone or a bone. It tends to affect the entire skeleton. When only one lesion is found, a multiple myeloma is called. Most physicians believe that multiple myeloma is simply an early, isolated form of multiple myeloma.
Multiple myeloma appears on X-rays as decreased bone density with a lot of "punched out" holes in the bones. These destructive changes are not seen surrounded by the white edge of the bone in other types of destructive lesions. A bone scan can show the bones are involved with multiple myeloma. But, often, the lesions are not seen. If a bone scan is negative, a skeletal survey is carried out in the rule. This consists of X-rays from many different parts of the skeleton.
The diagnosis is made when a large number of abnormal plasma cells in the bone marrow of patients are found. The doctor receives this by a bone marrow biopsy.
A blood test can confirm the diagnosis. The patient's blood is tested for abnormal antibodies produced by myeloma cells.
Some forms of multiple myeloma produce proteins that can be detected with a urine analysis.
Patients may also have:
* Anemia (low red blood cell)
* Leukopenia (low white blood cell)
* Thrombocytopenia (low platelet count)
* Hypercalcemia (high calcium levels in the blood)
Treatment
Multiple myeloma is currently incurable. Chemotherapy may result in an extension of life expectancy and decrease symptoms.
Chemotherapy
The standard treatment drugs are melphalan and prednisone.
The median survival time is three years with this treatment alone. For patients in whom this therapy is ineffective, alternatives are:
* VBMCP (vincristine, carmustine, melphalan, cyclophosphamide and prednisone)
* VAD (vincristine, adriamycin and dexamethasone)
These treatments can cause severe muscular weakness. You can also increase the chance of infection.
Thalidomide and interferon are also sometimes used.
Fortunately, a recent advance in the treatment of multiple myeloma has increased the response rates and survival. This treatment is followed from high-dose chemotherapy followed by autologous stem cell transplantation. In this treatment, the patient, a 20 percent chance to live longer than 10 years. This includes stem cell transplantation:
* Harvest a patient's own blood cells
* Conditioning them with very high doses of melphalan
* Re-infusion, the blood cells back into the patient
Radiotherapy
Radiation therapy is reserved for reducing the size of symptomatic bone lesions.
Supportive Care
Supportive measures is crucial. These include comfort measures, pain and interventions to maintain the function maintained. Supportive care includes the management of bone disease, anemia, infections, kidney failure and pain associated with multiple myeloma.
* Bisphosphonates (drugs) can prevent destructive bone lesions and fractures of the spine.
* manage occasional blood transfusions or erythropoietin anemia can.
* Infusions of antibodies and vaccines can help patients with recurrent infections.
Corticosteroids and fluid intake can cause high blood pressure calcium concentrations (bone loss) and dehydration treatment.
* Narcotics can address the pain associated with bone lesions.
* Surgical procedures are necessary to stabilize and control the pain be associated with bone fractures.
Surgical treatment
Surgery will not cure multiple myeloma. Surgery is used to treat fractures and impending fractures of the spine, pelvis, hip and shoulder. The goal of these operations is to reduce pain and maintain function.
Fixation is reinforced with cement often recommended, as are joint replacement and vertebroplasty (for vertebral fractures). Surgical intervention does not change the survival rate, but it increases the quality of life.
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