CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0403/04030.txt

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$Unique_ID{BRK04030}
$Pretitle{}
$Title{Myeloma, Multiple}
$Subject{Myeloma, Multiple Plasma Cell Myeloma Myelomatosis Kahler Disease
Smoldering Myeloma Plasma Cell Leukemia Nonsecretory Myeloma Osteosclerotic
Myeloma Solitary Plasmacytoma of Bone Extramedullary Plasmacytoma Waldenstrom
Macroglobulinemia Heavy Chain Disease Primary Amyloidosis Smoldering Myeloma
Plasma Cell Leukemia NonSecretory Myeloma Osteosclerotic Myeloma Solitary
Plasmacytoma of Bone Extramedullary Plasmacytoma }
$Volume{}
$Log{}

Copyright (C) 1988, 1989, 1990, 1992 National Organization for Rare
Disorders, Inc.

566:
Myeloma, Multiple

** IMPORTANT **
It is possible that the main title of the article (Multiple Myeloma) is
not the name you expected.  Please check the SYNONYM listing to find the
alternate names and disorder subdivisions covered by this article.

Synonyms

     Plasma Cell Myeloma
     Myelomatosis
     Kahler Disease

DISORDER SUBDIVISIONS

     Smoldering Myeloma
     Plasma Cell Leukemia
     Nonsecretory Myeloma
     Osteosclerotic Myeloma
     Solitary Plasmacytoma of Bone
     Extramedullary Plasmacytoma

Information on the following diseases can be found in the Related
Disorders section of this report:

     Waldenstrom Macroglobulinemia
     Heavy Chain Disease
     Primary Amyloidosis
     Smoldering Myeloma
     Plasma Cell Leukemia
     NonSecretory Myeloma
     Osteosclerotic Myeloma
     Solitary Plasmacytoma of Bone
     Extramedullary Plasmacytoma

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.


Multiple Myeloma is a rare form of bone marrow cancer.  Major symptoms
may include pain in the bones of the back or chest, weakness, fatigue, anemia
and kidney problems.

Symptoms

Multiple Myeloma starts with pains in the bones of the chest or back which
are triggered by movement of the body.  Weakness, fatigue, anemia, kidney
problems, and/or compressed nerves in the spine may also be present.
Paleness of the skin is a common physical finding and there is increased
susceptibility to bacterial infections, particularly pneumonia.  Sometimes
the liver and spleen become enlarged.

Causes

The exact cause of Multiple Myeloma is not known.  Scientists suspect there
may be a variety of causes such as the effects of radiation, asbestos,
industrial or agricultural toxins, hereditary disposition or viruses. Multiple
Myeloma is characterized by excessive new growth (neoplastic proliferation) of
the plasma cells in bone marrow.  It is initially found in the bones of the
spine, skull, rib cage, pelvis or legs.  The blood shows an increase in levels
of certain immune system cells (suppressor T cells) and abnormally low levels
of helper T cells.

Affected Population

Multiple Myeloma patients account for 1% of all types of cancer and 10% of
all blood malignancies.  It is found in men twice as often as women.  It
usually occurs between the fourth and seventh decades of life.

Related Disorders

Symptoms of the following disorders can be similar to those of Multiple
Myeloma.  Comparisons may be useful for a differential diagnosis:

Amyloidosis refers to a group of diseases characterized by extracellular
depositions of a protein-like material (amyloid), in one or more sites of the
body.  Amyloid deposits, in large amounts, can cause a wide variety of organ
abnormalities.  The organ can take on a firm, rubbery consistency and have a
waxy, pink or gray appearance.  Organ enlargement (especially of the liver,
kidney, spleen, or heart) may be prominent.  (for more information on this
disorder, choose "Amyloidosis" as your search term in the Rare Disease
Database).

Waldenstrom Macroglobulinemia is a lymph and blood cell disorder.
Abnormally large quantities of homogeneous protein molecules are present in
the blood.  The disorder tends to run in families and occurs mainly among
older men.  An enlarged spleen and liver with abnormalities of the lymph
glands are the most frequent symptoms.  Weakness, anemia, fatigue and
excessive bleeding, especially from the nose and mouth, also occur.  (For more
information on this disorder, choose "Waldenstrom " as your search term in
the Rare Disease Database).

Heavy Chain Diseases are characterized by the presence of too many plasma
cells, or lymphocytes that resemble plasma cells, in the bone marrow and
lymph nodes.  This condition includes Gamma, Alpha and Mu Heavy Chain
Disease, which are all disorders of the proliferative type.  Gamma Heavy
Chain Disease is characterized by a deletion of amino acids and anemia.  The
liver, spleen and lymph nodes are enlarged.  Alpha Heavy-Chain Disease occurs
most often in men of Mediterranean ancestry.  It involves the digestive tract
with severe malabsorption of nutrients, loss of weight, diarrhea, and loss of
fat (steatorrhea).  Symptoms are most often progressive.

Mu Heavy-Chain Disease is typified by a form of chronic lymphocytic
leukemia or tumors of the lymph gland.  Analysis of the blood serum usually
reveals excessively low levels of antibodies in the blood
(gammaglobulinemia).

The following disorders may be associated with Multiple Myeloma as
secondary characteristics.  They are not necessary for a differential
diagnosis:

Smoldering Myeloma is characterized by abnormally high levels of atypical
plasma cells in the bone marrow without evidence of symptomatic disease.
Many patients excrete protein in the urine but have no other evidence of
either anemia, bone lesions or kidney failure.

Plasma Cell Leukemia is characterized by the presence of excessive
amounts of plasma cells in the blood.  Most patients initially have leukemia
and approximately thirty percent already have well-documented cases of
Multiple Myeloma.

Non-Secretory Myeloma exists when a patient with Multiple Myeloma does
not produce M protein in either the urine or blood serum.

Osteosclerotic Myeloma patients usually have five percent or less of the
normal amounts of plasma cells in their blood.  One or more osteosclerotic
lesions are present and lytic lesions develop in some cases.  The disease is
chronic and inflammatory, usually causing motor disabilities, high protein
levels in the spinal fluid and/or low motor nerve conduction.  The spleen and
liver are usually enlarged, and discoloration of the skin occurs as well as
fluid retention and clubbing of the fingers.

Solitary Plasmacytoma of Bone is characterized by only one lesion of the
bone.  Diagnosis relies on cell examination, no evidence of Multiple Myeloma
in the bone marrow, and no M protein in the blood serum or urine.

Extramedullary Plasmacytoma occurs when plasma cell tumors arise outside
the bone marrow.  The upper respiratory tract, which includes the nasal
cavity and sinuses, nasopharynx, and larynx, is the most frequent site of
involvement.  However, extramedullary plasmacytomas have been found in
virtually every organ of the body, making a confirmed diagnosis of Multiple
Myeloma necessary.

Therapies:  Standard

Treatment of Multiple Myeloma usually involves chemotherapy and analgesic
drugs for pain.  If kidneys are involved, the administration of fluids may be
necessary to avoid dehydration.  Other treatment may include radiation
therapy to reduce bone masses that may develop.  The use of the biologic
drug, Interferon, combined with chemotherapy drugs may also be recommended.
Plasmapheresis may be of benefit in some cases of Multiple Myeloma.  This
procedure is a method for removing unwanted substances (toxins, metabolic
substances and plasma parts) from the blood.  Blood is removed from the
patient and blood cells are separated from plasma.  The patient's plasma is
then replaced with other human plasma and the blood is retransfused into the
patient.  This therapy is still under investigation to analyze side effects
and effectiveness.  More research is needed before plasmapheresis can be
recommended for use in all but the most severe cases.

Therapies:  Investigational

Studies are being conducted in the use of Sandoglobulin as a treatment
for Multiple Myeloma.  Further investigation is needed to determine it's
safety and effectiveness.

The orphan product Melphalan (Alkeran for injection) is being studied by
the FDA for the treatment of Multiple Myeloma in patients in whom oral
therapy is not correct.  The product is sponsored by Burroughs Wellcome
Company, Research Triangle Park, NC.

This disease entry is based upon medical information available through
March 1992.  Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.

Resources

For more information on Multiple Myeloma, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     National Kidney Foundation
     2 Park Avenue
     New York, NY 10016
     [phone]
     [phone]

     American Kidney Fund
     6110 Executive Blvd., Suite 1010
     Rockville, MD  20852
     [phone]
     [phone]
     [phone] (MD)

     American Cancer Society
     1599 Clifton Rd., NE
     Atlanta, GA  30329
     [phone]

     NIH/National Cancer Institute
     9000 Rockville Pike, Bldg. 31, Rm. 1A2A
     Bethesda, MD 20892
     1-800-4-CANCER

The National Cancer Institute has developed PDQ (Physician Data Query), a
computerized database designed to give doctors quick and easy access to many
types of information vital to treating patients with this and many other
types of cancer.  To gain access to this service, a doctor can contact the
Cancer Information Service offices at 1-800-4-CANCER.  Information
specialists at this toll-free number can answer questions about cancer
prevention, diagnosis, and treatment.

References

INTERNAL MEDICINE, 2nd Ed.:  Jay H. Stein, ed.-in-chief; Little, Brown and
Co., 1987.  Pp. 1104-1106.

EFFECTS OF PLASMAPHERESIS ON THE PLASMA CONCENTRATION OF PROTEINS USED TO
MONITOR THE DISEASE PROCESS IN MULTIPLE MYELOMA.  A. Wahlin, et al.; Acta Med
Scand (1988, issue 223 (3)).  Pp. 263-267.

INTERFERONS IN THE TREATMENT OF MULTIPLE MYELOMA.  M.R. Cooper, et al.;
Cancer (February, 1987, issue 59 (3 Suppl)).  Pp. 594-600.

THE USE OF INTERFERON IN THE TREATMENT OF MULTIPLE MYELOMA.  J.J.
Costanzi, et al.; Semin Oncol (June, 1987, issue 14 (2 Suppl 2)).  Pp. 24-28.