Multiple myeloma

Multiple myeloma (also known simply as myeloma or plasma cell myeloma, or as Kahler's disease after Otto Kahler) is a presently incurable hematological malignancy of plasma cells, the cells of the immune system that produce antibodies. Although it initially develops in the bone marrow, it spreads to the peripheral blood, lymph nodes and other organs. Its prognosis despite therapy is generally poor, and treatment may involve chemotherapy and bone marrow transplant.

Treatment

Treatment for multiple myeloma is focused on disease containment and suppression, as no reliable cure has been found. In addition to direct treatment of the plasma cell proliferation, bisphosphonates (e.g. pamidronate) are routinely administered to prevent fractures, and intravenous immunoglobulins (IVIG) in those patients in whom "normal" antibody levels are low enough to predispose them for severe infections.

Related Topics:
Bisphosphonate - Pamidronate - Intravenous immunoglobulin

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Some of the treatments for myeloma are:

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• thalidomide 200-400 mg with pulsed steroids (usually dexamethasone), occasionally with added oral cyclophosphamide
• chemotherapy regimens (generally only administered to patients who can tolerate these (potentially toxic) treatments):
• vincristine, doxorubicin (adriamycin) and dexamethasone (abbreviated VAD).
• high-dose chemotherapy (melphalan) with autologous stem cell transplant
• nonmyeloablative allogeneic stem cell transplant
• low-dose therapy with melphalan (essentially palliative)
• bortezomib (a proteasome inhibitor) and lenalidomide (a less toxic thalidomide analogue) are recent additions to the therapeutic arsenal.

Frequently, myeloma progresses despite treatment. It has been observed{{mn|Kyle|1}} that "treatment resistance" is a reversible effect, and that some new treatment modalities may re-sensitize the tumor to standard therapy.

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Renal failure in multiple myeloma can be acute (reversible) or chronic (irreversible). Acute renal failure typically resolves when the calcium levels are brought under control. Treatment is dependent on the type of renal failure and may involve dialysis. Which type of renal failure a given patient has is difficult to determine at presentation.

Related Topics:
Acute - Chronic - Dialysis

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