Multiple myeloma is treated as part of the Hematologic Malignancies Service at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center. As a major academic medical center, we offer a comprehensive, multidisciplinary approach to treating multiple myeloma and other blood cancers, including a dedicated Blood and Marrow Transplant Service.
UMGCCC takes a team approach to the treatment and care of patients with multiple myeloma. Our treatment team includes physicians with special expertise in medical oncology, hematology, blood and marrow transplantation, orthopedics, diagnostic radiology, and cell component therapy as well as specialized nursing care and support services for nutrition, pharmacy, dental care, social work, psychological counseling, and palliative care.
Dr. Ashraf Badros is a nationally renowned expert in the treatment of multiple myeloma and stem cell transplantation. His research is focused on the development of new targeted drug therapies for multiple myeloma, as well as innovative immunological approaches to treatment of this disease. He was involved in the initial scientific studies of the drug thalidomide and has conducted many clinical trials for the treatment of relapsed and refractory multiple myeloma. Dr. Badros is a frequent speaker at regional and national multiple myeloma conferences and patient education seminars.
Each year, nearly 19,900 people in the United States will learn that they have multiple myeloma, a cancer of the plasma cells. Plasma cells are located in the bone marrow, the tissue in bones that makes blood. Plasma cells are part of the immune system which help protect the body from infections. They do this by producing antibodies -- proteins that fight foreign substances that invade the body.
Usually, bone marrow contains only about two percent plasma cells. But when a person has multiple myeloma, the body keeps making more and more abnormal plasma cells, called myeloma cells, and they make more and more antibodies. These extra cells do not help fight off infection. Instead, they stop the body from making normal infection-fighting antibodies. These extra cells collect in the bone marrow and slowly destroy the bone. Myeloma cells also trigger the release of bone-weakening chemicals that lead to bone destruction and bone pain.
The following are the most common symptoms of multiple myeloma; however, each person may experience symptoms differently:
- Bone pain in the back, ribs or other bones
- Unexplained bone fractures
- Excessive thirst and urination
- Loss of appetite
Multiple myeloma may be found as part of routine blood or urine tests that may show the presence of an abnormal myeloma protein called monoclonal (M) protein. This protein is also sometimes called Bence Jones protein. Bone X-rays may show holes in the bone called lytic lesions. After blood tests and X-rays, the diagnosis is confirmed by testing the bone marrow during a bone marrow aspiration and biopsy, to check on the presence of plasma cells.
After multiple myeloma is diagnosed, the doctor will need to know the extent and characteristics of the myeloma cells to prescribe the best treatment. Chromosome studies should be done on the bone marrow sample taken during the bone marrow aspiration. Other important tests which help to evaluate patients include:
- B2 microglobulin
- C-reactive protein
- Blood count
- Calcium level
- Kidney function
- Type of abnormal myeloma protein
- Comprehensive chemistry panel
- Protein testing
- Imaging studies, including PET/CT scan, MRI and bone marrow biopsy
- Cardiac function tests
- Pulmonary function tests
People with stable or "smoldering" multiple myeloma may not need to be treated at all initially. However, most people with multiple myeloma have symptoms and/or extensive disease and need immediate treatment.
Multiple myeloma is treated in a variety of ways. Stem cell transplant is often combined with chemotherapy. New drugs are continuously being developed and tested. The specialists at UMGCC are involved in many of these clinical trials.
Stem cells are the "mother" cells in bone marrow. Stem cells give rise to the formation of other blood cells, such as platelets (to prevent bleeding), white cells (to fight infection) and red blood cells (to carry oxygen throughout the body). In autologous ("auto" transplants), stem cells are actually only a supportive care adjunct to the high doses of chemotherapy.
Chemotherapy is needed to fight multiple myeloma, but unfortunately chemotherapy also hurts bone marrow function. During stem cell transplantation, stem cells are taken from the patient's body, then frozen and stored. After high doses of chemotherapy are given to kill the cancer cells, the stored stem cells are given back to the patient through an intravenous line. The stem cells then migrate back to the bone marrow where they begin producing healthy new blood cells. In the meantime, higher than usual chemotherapy doses have been used to kill myeloma cells.
Even though high-dose chemotherapy batters bone marrow function. But stem cell transplantation allows patients who have undergone high-dose chemotherapy to recover a normal blood cell count in as little as two weeks.
Stem cell transplantation has become much safer in recent years. The mortality rate has dropped one to two percent, which is no higher than the mortality rate for a six-month course of standard chemotherapy.
Talk about your fears and worries with your doctor, nurse, other health professionals and people with myeloma to help you deal with the stress of living with this disease. UMGCCC offers many supportive services including a monthly support group to help patients cope with their disease. The following suggestions will help you fight multiple myeloma's symptoms:
- Stay active to help your bones be stronger.
- Talk to your doctor about medications and orthopaedic support devices if pain keeps you from being active.
- Drink plenty of fluids to dilute monoclonal protein in your urine and prevent kidney damage.
- Eat a balanced diet to maintain your general health.
- Don't take medication or vitamins without getting approval from your doctor.
- Stool softeners should be used to prevent constipation if narcotic pain medications are utilized.
- Bone strengthening medications are available