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Multiple Myeloma


Disease: Multiple Myeloma Multiple Myeloma
Category: Blood diseases & tumors
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Disease Definition:

The cancer of plasma cells, a type of white blood cell present in the bone marrow, is called multiple myeloma. To help the body fight infections, plasma cells normally make proteins called antibodies.

The number of plasma cells are raised to a higher than normal level in multiple myeloma, which is due to the multiplication of a group of abnormal plasma cells called myeloma cells.
 The level of abnormal proteins in the blood may go up as well, since these cells normally make proteins. The kidneys, immune system, red blood cell count and bones can be affected by health problems caused by multiple myeloma.

The doctor may just monitor the condition of the patient if the patient has multiple myeloma but doesn’t have symptoms. However, there are a number of treatments to help control multiple myeloma in case the patient is experiencing symptoms. 

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


From one person to another, signs and symptoms of multiple myeloma can vary. as the disease progresses, it's likely that the patient will experience one or more of the following, although the condition may not cause symptoms early in the disease:


  • Bone pain in the ribs, skull, back and pelvis in particular.
  • Presence of abnormal proteins that can be produced by myeloma cells in the urine or blood of the patient. Monoclonal or M proteins is the name of these proteins, which are antibodies or parts of antibodies.
  • High level of calcium in the blood. When calcium from affected bones dissolves into the blood, this can occur.

A person may experience the following signs and symptoms when having a high calcium level in the blood:


  • Constipation
  • Mental confusion
  • Nausea
  • Excessive thirst and urination
  • Loss of appetite

The following are some of the other signs and symptoms of multiple myeloma:


  • Weight loss
  • Anemia-related fatigue as myeloma cells replace oxygen-carrying red blood cells in the bone marrow
  • Unexplained bone fractures
  • Weakness or numbness in the legs
  • Repeated infections, such as skin infections, pneumonia, shingles, bladder or kidney infections and sinusitis.

The signs and symptoms may indicate multiple myeloma or some other serious disease if a person:


  • Is persistently more tired than he/she used to be
  • Has lost weight
  • Experiences bone pain
  • Loss of appetite
  • Excessive thirst and urination
  • Increased constipation
  • Weakness or numbness in the legs
  • Repeated infections
  • Persistent nausea
  • Increased constipation

To determine the underlying cause, one should see the doctor.


The bone marrow is the soft blood-producing tissue that fills in the center of most of the bones. It is known that multiple myeloma begins with one abnormal plasma cell in the bone marrow, which then starts to multiply; however, the exact cause of multiple myeloma is still not known.

Eventually overwhelming the production of healthy cells, abnormal cells accumulate because they don’t mature and die as normal cells do. Less than 5% of the cells are plasma cells in healthy bone marrow. However, more than 10% of the cells may be plasma cells in people with multiple myeloma.

The disease is called multiple myeloma because myeloma cells can populate bone marrow in other parts of the body, even far from where they began, and this is because they may circulate in low numbers in the blood. Bones and surrounding tissue can be damaged by uncontrolled plasma cell growth. By inhibiting the body's production of normal antibodies, uncontrolled plasma cell growth can interfere with the immune system's ability to fight infections.

To try to understand what changes occur that cause these cells to become cancer cells, researchers are studying the DNA of plasma cells. Almost all people with multiple myeloma have been found to have genetic abnormalities in their plasma cells that probably contributed to the cancer, though the cause of these changes is not yet discovered. For instance, many myeloma cells are missing all or part of one chromosome — chromosome 13. Cells with a missing or defective chromosome 13 tend to be more aggressive and harder to treat than cells with a normal chromosome 13.

As a relatively benign condition called monoclonal gammopathy of undetermined significance (MGUS) is how multiple myeloma almost always starts out. About 1% of people with MGUS develop multiple myeloma or a related cancer each year. The presence of M proteins, which are produced by abnormal plasma cells, in a person’s blood marks this condition, just like multiple myeloma.
There are no clearly identifiable risk factors for the disease in most people who develop multiple myeloma. This disease isn't contagious.

Someone’s risk of multiple myeloma may increase due to several factors:

When being obese or overweight, the risk of multiple myeloma is increased.

The disease is more likely to develop in men than in women.

Few cases of multiple myeloma occur in people younger than 40. But the majority of people who develop this condition are older than 50, with most diagnosed in their mid-60s.

Blacks are about twice more likely to develop multiple myeloma than whites.

Exposure to radiation and working in petroleum-related industries are other factors that may increase someone’s risk of developing multiple myeloma.



Several complications may be caused by multiple myeloma, such as:

Multiple myeloma can cause anemia and other blood problems when cancerous cells crowd out normal blood cells.

Bone Problems:
Leading to erosion of bone mass and fractures, multiple myeloma can affect the bones as well. Compression of the spinal cord may be caused by this condition. Weakness or even paralysis in the legs is included in the signs of this medical emergency.

Impaired Immunity:
The production of antibodies needed for normal immunity is inhibited by myeloma cells. One is more likely to develop infections such as sinusitis, pneumonia, shingles, skin infections, and bladder or kidney infections when having multiple myeloma.

Impaired Kidney Function:
Including kidney failure, problems with kidney function may be caused by multiple myeloma. Higher calcium levels in the blood related to eroding bones can interfere with the kidney's ability to filter the blood's waste. The proteins produced by the myeloma cells can cause similar problems, especially if one becomes dehydrated.


A person may not need treatment in case his/her multiple myeloma is not causing any symptoms. However, the patient will be regularly monitored for signs that indicate the disease is progressing. The patient may need treatment to help prevent symptoms in case the disease is progressing.

Treatment can slow the progress of the disease, stabilize the condition, relieve pain and control complications of the disease in case the patient is experiencing symptoms.

A person can usually return to near-normal activity with good treatment results, despite the fact that there's no cure for multiple myeloma. Approved clinical trials are another option that can be considered.

The following are the standard treatment options:

The first approved drug in a new class of medications called proteasome inhibitors was Bortezomib. By blocking the action of proteasomes, it causes cancer cells to die. This intravenous medication is approved for previously treated and for newly diagnosed myelomas.

After it was found to cause severe birth defects, thalidomide was removed from the market. This oral drug was originally used as a sedative and to treat morning sickness in the 1950s. However, in 1998 the drug received approval from the Food and Drug Administration (FDA) as treatment for skin lesions caused by leprosy; and nowadays, it is also approved for the treatment of newly diagnosed multiple myeloma.

Lenalidomide is currently used more often than thalidomide because it appears to be more potent and causes fewer side effects, though it is chemically similar to thalidomide. . This oral medication is approved for previously treated and for newly diagnosed myelomas.

To treat multiple myeloma, corticosteroids such as prednisone and dexamethasone have been used for decades. These drugs are typically given as pills.

Stem Cell Transplantation:
To replace diseased or damaged marrow using high-dose chemotherapy — usually high doses of melphalan — along with transfusion of previously collected immature blood cells (stem cells) are involved in stem cell transplantation. The stem cells may be from either blood or bone marrow, and they can come from the patient or from a donor.

To kill myeloma cells, using medicines – taken orally as a pill or given through an intravenous (IV) injection – is involved in chemotherapy. Followed by a rest period, chemotherapy is often given in cycles over a period of months. During what is called a plateau phase or remission, during which time the M protein level remains stable, chemotherapy is often discontinued. If the M protein level begins to rise, the patient may need chemotherapy again. Doxorubicin, melphalan, liposomal doxorubicin, vincristine and cyclophosphamide are common chemotherapy drugs that are used to treat myeloma.

Radiation Therapy:
To damage myeloma cells and stop their growth, high-energy penetrating waves are used in this treatment. To target myeloma cells in a specific area — for instance, to more quickly shrink a tumor that's destroying a bone or causing pain, radiation therapy may be used.

Whether one is considered a candidate for stem cell transplantation is the thing that the initial chemotherapy used to treat multiple myeloma will depend on. To determine whether stem cell transplantation could be right for the patient or not, factors like the general health of this patient, his/her age and the risk of his/her disease progressing play a part.

When a person is considered a candidate for stem cell transplantation:
Because melphalan can have a toxic effect on stem cells making it impossible to collect enough of them, the patient’s initial therapy will likely exclude this drug. Lenalidomide or bortezomib combined with low-dose dexamethasone will typically be the first treatment.

After the patient has undergone 3 to 4 months of treatment with these initial agents, the stem cells will likely be collected. The patient may be recommended undergoing the stem cell transplant soon after the cells are collected or he/she may be recommended delaying the transplant until after a relapse, if it occurs. The important factors that will help the doctor make a recommendation are the personal preferences of the patient and his/her age.

The patient will likely start a new course of treatment with a drug combination that includes melphalan and bortezomib after the stem cell transplantation.

When a person is NOT considered a candidate for stem cell transplantation:
A combination of melphalan, prednisone and thalidomide, often called MPT; or melphalan, prednisone and bortezomib, often called MPV is likely to be the patient’s initial therapy. Melphalan plus prednisone (MP) or lenalidomide plus low-dose dexamethasone are additional options if the side effects are intolerable. This type of therapy is typically given for about one to one and a half year.

A relapse of the disease is eventually experienced by most people who are treated for multiple myeloma. None of the currently available, in some cases, first line therapies can slow the cancer cells from multiplying. Repeating another course of the treatment that initially helped the patient may be recommended if this patient experiences a relapse of multiple myeloma. Trying one or more of the other treatments typically used as first line therapy either alone or in combination is another option.

A number of new treatment options are being studied. For those with multiple myeloma, these drugs offer important options. The patient can talk to the doctor about what clinical trials may be available.

One may need treatment for a number of complications because multiple myeloma can cause those specific conditions. For instance:

To help treat infections or to help reduce their risk, antibiotics may be necessary.

Erythropoietin injections may be prescribed if the patient has persistent anemia. Erythropoietin is a naturally occurring hormone made in the kidneys that stimulates the production of red blood cells. However, in some people with myeloma, the use of erythropoietin may increase the risk of blood clots.  

Back Pain:
The back pain a person may experience with multiple myeloma can be relieved by wearing a back brace or taking pain medications.

Bone Loss:
Medications called bisphosphonates such as zoledronic acid or pamidronate that bind to the surface of the bones and help prevent bone loss can be used. The risk of harm to the jawbone is associated with treatment with these drugs. The patient should avoid dental procedures without consulting the doctor first in case he/she is taking these medications.

Kidney Complications:
Dialysis may be needed for people with severe kidney damage.


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Consultants Corner

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Tahsin Martini

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Dr. Faisal Dibsi

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Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

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