Multiple Myeloma

 

 

OVERVIEW

Multiple myeloma occurs when plasma cells - which produce and release antibodies to attack and help kill germs that cause disease - become malignant, grow out of control, and form tumors in more than one site in the body. In 2007, the American Cancer Society estimates that almost 20,000 new cases of multiple myeloma will be diagnosed in the United States.

Even though multiple myeloma cannot be cured, there are many options for treatment at The Cancer Center at Hackensack University Medical Center. We are one of only about 10 institutions in the nation to have a doctor who solely specializes in the disease. Our chief of the Division of Multiple Myeloma,  David S. Siegel, M.D., Ph.D., is one of the nation's foremost authorities on multiple myeloma and has been treating patients with the disease for more than 25 years . Dr. Siegel is one of 11 investigators who brought the exciting new chemotherapeutic agent Velcade to patients through his clinical trials with the medication. Dr. Siegel's studies have shown that Velcade slows and halts the progression of multiple myeloma. The Cancer Center is one of the largest enrollers of patients in clinical trials for new treatments for multiple myeloma. Dr. Siegel is continuing his studies of Velcade and other chemotherapeutic agents, including Revlimid, and the use of decreased intensity ("mini&quot:) stem cell transplants for elderly or very sick patients who cannot tolerate the rigors of a standard transplant.

Crucial components to a comprehensive approach to diagnosing and treating multiple myeloma at The Cancer Center are the Adult Blood and Marrow Stem Cell Transplantation Program, one of the nation's 10 largest, and the Special Diagnostic Immunology Laboratory. Stem cell transplantation is the most effective treatment for multiple myeloma, and researchers at The Cancer Center are responsible for many of the advances used in stem cell transplants today. The Special Diagnostic Immunology Laboratory is one of only several sites in New Jersey where comprehensive tests are available to detect cancer at the molecular level and to stage and classify it. The laboratory's staff also works closely with the Stem Cell Transplantation Program to evaluate harvested stem cells.

 

RISK FACTORS

Multiple myeloma occurs more frequently in older people (70 is the average age), among African-Americans, in people exposed to radioactivity, in those with a family history, among workers exposed to certain petroleum products, and those with other plasma cell disorders.

 

SYMPTOMS

Although multiple myeloma often produces no symptoms, patients may experience back pain (particularly in the backbone, hips, and skull), blood problems (anemia, a lowered resistance to infections, excessive bleeding during minor injuries), nervous system abnormalities (pain, numbness, weakness of limbs, confusion, dizziness, stroke-like symptoms), kidney problems, and infections, particularly pneumonia.

 

MULTIPLE MYELOMA TREATMENT SERVICES

Although there is currently no cure for multiple myeloma, there are a number of effective treatment options available at The Cancer Center at Hackensack University Medical Center. These include stem cell transplantation, chemotherapy, radiation therapy, immunotherapy, immunosuppressive therapy, and supportive therapy.

Stem Cell Transplantation

The most effective treatment for multiple myeloma is autologous (patient's cells) stem cell transplantation or allogeneic (donated cells) transplantation. Dr. Siegel and his team have pioneered the use of stem cell transplantation combined with high-dose chemotherapy as a primary treatment for the disease. He and his team have also successfully used reduced-intensity ("mini") allogeneic transplants with donated stem cells to treat elderly patients who cannot tolerate a high-dose transplant.

Chemotherapy

Chemotherapy for multiple myeloma treatment usually involves a combination of drugs administered by mouth, vein, or muscle. Dr. Siegel and his team have researched and brought to the treatment forefront the use of new chemotherapeutic agents - such as Velcade and Revlimid - and the T cell stimulator Xcyte, which harnesses the power of a patient's own immune system by accelerating blood cell recovery after stem cell transplantation. Patients may also be given drugs called bisphosphonates to slow down the destruction of bone by the myeloma.

Radiation Therapy

External beam radiation therapy is often used to treat bone that has been damaged by myeloma and has not responded to chemotherapy. Radiation therapy may relieve serious symptoms of numbness, weakness of leg muscles, and trouble with urination or defecation. Radiation therapy is also the most common treatment method for solitary plasmacytomas, in which the abnormal plasma cells only produce one tumor.

Surgery

Surgery is generally not used to treat multiple myeloma, except to remove solitary plasmacytoma or to place metal rods or plates to support the spinal cord if it has been damaged by compression of the multiple myeloma tumors. An orthopedic surgical technique called balloon kyphoplasty is also used to treat spinal compression fractures caused by multiple myeloma.

Immunotherapy

Researchers at The Cancer Center are conducting clinical trials to test new techniques in immunotherapy (also called biologic therapy) to treat multiple myeloma and other types of cancer. Immunotherapy involves using a patient's own cells or live viruses derived from other sources to effect a treatment or to boost the ability of the body's own immune system to attack the cancer. These treatments are given as vaccines or intravenously; they stimulate the body's infection-fighting T cells to recognize and kill cancerous cells.

For patients who have not responded to standard therapy, immunotherapy using the drug thalidomide to block the action of interleukin-6 may be used. The protein interferon may be given to slow the growth of myeloma cells in patients who have completed chemotherapy and are in remission.

Supportive Therapy

Plasmapheresis (removing blood from a vein and then separating blood cells from the plasma) may be used to relieve symptoms of multiple myeloma, but it does not kill myeloma cells.

Immunosuppressive Therapy

Immunosuppressants are medications that are used to prevent the rejection of donor tissue or stem cells after transplantation.