Multiple myeloma

Overview

Multiple myeloma is a blood disorder that starts in a type of white blood cells called plasma cells. It is the most common type of plasma cell cancer. 

Our approach

Northwell Health takes a sophisticated approach to treating multiple myeloma and associated diseases, including monoclonal gammopathy of uncertain significance (MGUS), Amyloidosis and Waldenstrom's macroglobulinemia. All of these diseases are malignancies whose cell of origin is or is closely related to the plasma cell, the cell from which multiple myeloma arises.

The Hematologic Oncology Center, part of Northwell Health Cancer Institute, is home to the program for treating multiple myeloma and associated diseases. The program draws upon established as well as new promising treatments, including chemotherapy, targeted therapies and stem cell transplantation. The Adult Bone Marrow and Stem Cell Transplant Program, one of the largest in the New York metropolitan area and is the only FACT-accredited program in Long Island, Queens and Brooklyn. Regionally and nationally distinguished experts use the latest technology and research-backed therapies to treat all stages of multiple myeloma. 

Highlights of multiple myeloma and associated diseases treatments and services include:

  • Leading-edge therapies that reduce fatigue, alleviate bone pain and help the patient stay strong and independent
  • Access to the  most advanced approaches to chemotherapy
  • FACT-accredited bone marrow / stem cell transplantation program

Multidisciplinary Multiple Myeloma and Associated Diseases Treatment

Within the first several days of a visit, the multidisciplinary team will conduct comprehensive tests and develop a personalized cancer treatment program. 

Specialists review each treatment phase to constantly improve multiple myeloma care and ensure that treatment milestones are reached. From diagnosis through treatment and therapy, patients are the capable hands of experts every step of the way. Patients with amyloidosis and Waldenstrom's can be assured of being cared for by faculty physicians who are expert in the care of these diseases. Patients with MGUS will be guided by clinicians with expertise in providing prognostic information related to the likelihood of needing treatment.

Making a correct diagnosis and treatment plan for amyloidosis can be challenging, but the Hematologic Oncology Center has the staff and resources present to ensure the best possible care. Patients with Waldenstrom's a disease that bears similarities to both myeloma and non-Hodgkin's lymphoma are cared for by experts in both diseases. Expertise in diagnosing and treating myeloma is an essential prerequisite for making crucial distinctions between smoldering multiple myeloma, MGUS and multiple myeloma requiring therapy. 

Symptoms

Symptoms and signs may include:

  • Bone pain, often in the back, hips and ribs
  • Broken bones, often in the spine
  • Feeling weak and very tired, often due to anemia or abnormal kidney function
  • Abnormal kidney function, occasionally kidney failure
  • Feeling very thirsty — often due to high blood calcium levels
  • Frequent infections and fevers
  • Weight loss (a rare symptom)
  • Nausea or constipation
  • Frequent urination

Amyloidosis

Amyloidosis is a rare disease that causes the buildup of protein fibers in tissues and organs. Patients can present with symptoms similar to myeloma, but may also present with:

  • Shortness of breath from cardiac disease
  • Enlarged tongue
  • Gastrointestinal symptoms like abdominal pain and diarrhea
  • Liver enlargement and pain
  • Abnormal liver and/or kidney function tests
  • Easy bruiability

Waldenstrom's macroglobulinemia

Also known as plasmacytoid or lymphoplasmacytoid lymphoma, patients with Waldenstrom's can present with symptoms similar to myeloma except that bone pain and fractures are very rare. Patients may present with:

  • Neurological complaints such as headache
  • Abnormal or blurred vision
  • Fevers or night sweats
  • Anemia
  • Enlarged liver, spleen and less commonly, lymph nodes

Diagnosis

Medical History and Physical Exam

The first step to making a multiple myeloma diagnosis is usually a physical exam, during which a doctor will look for signs of bone pain and tenderness, bruising, and anemia. A doctor will also consider the patient’s personal and family medical history. If multiple myeloma is suspected, the patient will be sent for further tests, usually on an outpatient basis.

Diagnostic Tests

Specialists use a variety of procedures and tests to deliver an accurate multiple myeloma diagnosis as well as to determine how advanced the cancer is:

Imaging Tests

  • X-rays — A skeletal survey X-rays the major bones.
  • PET/CT scan — An imaging technique that can detect areas of growing myeloma cells in the body.
  • MRI (magnetic resonance imaging) — A powerful magnet, radio waves and computer imaging combine to create highly detailed pictures of areas inside the body.

Blood and Urine Tests - After taking a blood and urine sample, the laboratory technician does a series of blood and urine tests. These document and look for: 

  • Excessive proteins called immunoglobulins in the blood
  • Excessive immunoglobulin levels in the urine
  • Anemia, which is identified by low levels of red blood cells
  • Whether kidney function is normal (blood creatinine level)
  • High levels of calcium in the blood
  • A blood marker of myeloma called beta 2 microglobulin
  • Any problems with the health of the liver and the patient’s nutritional status, reflected in a blood test called albumin 

Biopsy – A bone marrow biopsy is necessary to establish a diagnosis of multiple myeloma. To obtain the biopsy, a needle is inserted into the hip bone (the posterior iliac crest) to get a small piece of bone and bone marrow. Special tests including flow cytometry, cytogenetics and FISH (fluorescence in-situ hybridization) are used to help determine how likely the myeloma is to respond to treatment.

Staging

The extent of multiple myeloma is measured in three stages. The most current staging system divides patients into Stages I, II and III depending on the results of two blood tests: albumin and beta 2 microglobulin. The higher the stage, the more likely the need for treatment.

The “CRAB” criteria are used to decide who needs therapy: 

  • High blood-Calcium level
  • Renal (kidney) abnormalities
  • Anemia
  • Bone disease

Patients who have a diagnosis of myeloma but none of the CRAB findings have “smoldering myeloma” — such patients need to be followed closely but may not need immediate therapy. If a patient doesn’t meet all the requirements for a diagnosis of myeloma, then a diagnosis of monoclonal gammopathy of uncertain significance (MGUS) is often made. Depending on the initial findings, such patients have low, intermediate or high chances of going on to develop myeloma.

With the data from these state-of-the-art tests for multiple myeloma diagnosis, a doctor will develop a customized treatment plan aimed at achieving the best possible outcomes.

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