Multiple Myeloma

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Multiple Myeloma
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Overview

Source: In partnership with Genetic and Rare Diseases Information Center, funded by the National Center for Advancing Translational Sciences, and the National Human Genome Research Institute https://rarediseases.info.nih.gov/gard.

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Multiple myeloma

overview Question

What is multiple myeloma?

Multiple myeloma is a form of cancer that occurs due to abnormal and uncontrolled growth of plasma cells in the bone marrow. Some people with multiple myeloma, especially those with early stages of the condition, have no concerning signs or symptoms. When present, the most common symptom is anemia, which can be associated with fatigue and shortness of breath. Other features of the condition may include multiple infections; abnormal bleeding; bone pain; weak and/or easily broken bones; and numbness and/or weakness of the arms and legs. The exact underlying cause of multiple myeloma is currently unknown. Factors that are associated with an increased risk of developing multiple myeloma include increasing age, male sex, African American race, radiation exposure, a family history of the condition, obesity, and/or a personal history of monoclonal gammopathy of undetermined significance (MGUS). Treatment varies based on many factors, but may include one or more of the following interventions: chemotherapy, corticosteroid medications, targeted therapy, stem cell transplant, biological therapy, radiation therapy, surgery and/or watchful waiting.

Date Modified: 2016-03-12T00:00:00

basic Questions

What are the signs and symptoms of multiple myeloma?

In some cases, multiple myeloma is not associated with any signs and symptoms. When present, the most common symptom is anemia (low red blood cell count), which can be associated with fatigue, shortness of breath, and dizziness. Other features of the condition may include:

  • Bone pain
  • Nausea
  • Constipation
  • Loss of appetite
  • Frequent infections
  • Weight loss
  • Excessive thirst
  • Weakness and/or numbness in the arms and legs
  • Confusion
  • Abnormal bleeding
  • Weak bones that may break easily
  • Difficulty breathing

Date Modified: 2016-03-09T00:00:00

What causes multiple myeloma?

Although the exact underlying cause of multiple myeloma is poorly understood, the specific symptoms of the condition result from abnormal and excessive growth of plasma cells in the bone marrow. Plasma cells help the body fight infection by producing proteins called antibodies. In people with multiple myeloma, excess plasma cells form tumors in the bone, causing bones to become weak and easily broken. The abnormal growth of plasma cells also makes it more difficult for the bone marrow to make healthy blood cells and platelets. The plasma cells produced in multiple myeloma produce abnormal antibodies that the immune system is unable to use. These abnormal antibodies build up in the body and cause a variety of problems.

Factors that are associated with an increased risk of developing multiple myeloma include increasing age, male sex, African American race, radiation exposure, a family history of the condition, obesity, and/or a personal history of monoclonal gammopathy of undetermined significance (MGUS).

Date Modified: 2016-03-10T00:00:00

How is multiple myeloma diagnosed?

A diagnosis of multiple myeloma may be suspected based on the presence of characteristic signs and symptoms. Additional testing can then be ordered to confirm the diagnosis. This may include:

The American Cancer Society offers more information regarding the diagnosis of multiple myeloma, including a summary of the many tests that may be recommended. Please click on the link to access this resource.

Some affected people may have no suspicious signs or symptoms of multiple myeloma, especially in the early stages of the condition. In these cases, multiple myeloma is sometimes diagnosed by chance when a blood test or urine test is ordered to investigate another condition.

Date Modified: 2016-03-10T00:00:00

How might multiple myeloma be treated?

The treatment of multiple myeloma varies based on many factors including the age and general health of the affected person; the associated signs and symptoms; and the severity of the condition. In general, one or more of the following interventions may be used to treat multiple myeloma:

The National Cancer Institute offers information regarding the management of multiple myeloma, including more specific information regarding the treatments outlined above. Please click on the link to access this resource.

Date Modified: 2016-03-10T00:00:00

What is the long-term outlook for people with multiple myeloma?

The long-term outlook (prognosis) for people with multiple myeloma can be difficult to predict as some cases progress rapidly despite treatment, while others remain stable without therapy for a number of years. However, some general patterns have been observed. For example, prognosis appears to vary based on the affected person's age and the stage of the condition at the time of diagnosis. In general, survival is higher in younger people and lower in the elderly. Other factors that can be associated with a poor prognosis include a high tumor burden and kidney damage.

Infections are an important cause of early death among people with multiple myeloma. In fact, studies show that the risk of both bacterial infections and viral infections is approximately seven times higher in people affected by the condition.

Date Modified: 2016-03-11T00:00:00

Presentation(s)

Abnormality of metabolism/homeostasis

Autosomal recessive inheritance

Multiple myeloma

Somatic mutation

medical Products

Melphalan

Trade Name: Alkeran® (injection)

Indication: For the palliative treatment of patients with multiple myeloma for whom oral melphalan is not appropriate.

Doxorubicin HCL liposome injection

Trade Name: Doxil® (injection)

Indication: For use in combination with bortezomib for the treatment of patients with multiple myeloma who have not previously received bortezomib and have at least one prior therapy.

Daratumumab

Trade Name: Humax(R)-Cd38

Indication: For the treatment of patients with multiple myeloma who have received at least 3 prior lines of therapy including a proteasome inhibitor and an immunomodulatory agent or are double refractory to a proteasome inhibitor and an immunomodulatory agent

Carfilzomib

Trade Name: Kyprolis

Indication: Treatment of patients with multiple myeloma who have received at least two prior therapies including bortezomib and an immunomodulatory agent and have demonstrated disease progression on or within 60 days of completion of the last therapy.

Ixazomib citrate

Trade Name: Ninlaro

Indication: Use in combination with lenalidomide and dexamethasone for the treatment of patients with multiple myeloma who have received at least one prior therapy.

Pomalidomide

Trade Name: Pomalyst

Indication: Treatment of patients with multiple myeloma who have received at least two prior therapies including lenalidomide and bortezomib and have demonstrated disease progression on or within 60 days of completion of the last therapy.

Lenalidomide

Trade Name: Revlimid®

Indication: For use in combination with dexamethasone for the treatment of multiple myeloma patients who have received at least one prior therapy.

Thalidomide

Trade Name: Thalomid®

Indication: Acute treatment of the cutaneous manifestations of moderate to severe erythema nodosum leprosum (ENL) and as maintenance therapy for prevention and suppression of the cutaneous manifestations of ENL recurrences.

Bortezomib

Trade Name: Velcade®

Indication: Treatment of multiple myeloma patients who have received at least one prior therapy. Treatment of patients with mantle cell lymphoma.

FDA Approved Medicines

  • FDA approved daratumumab, sold as Darzalex, manufactured by Janssen Biotech for the treatment of multiple myeloma ( Multiple Myeloma ) in year 2015.
  • FDA approved pomalidomide, sold as Pomalyst, manufactured by Celgene for the treatment of relapsed and refractory multiple myeloma ( Multiple Myeloma ) in year 2013.
  • FDA approved elotuzumab, sold as Empliciti, manufactured by Bristol-Myers Squibb for the treatment of patients with multiple myeloma who have received prior therapies ( Multiple Myeloma ) in year 2015.
  • FDA approved bortezomib, sold as Velcade, manufactured by Millennium Pharmaceuticals as injectable agent for the treatment of multiple myeloma patients who have received at least two prior therapies. ( Multiple Myeloma ) in year 2003.
  • FDA approved ixazomib, sold as Ninlaro, manufactured by Millennium Pharmaceuticals for the treatment of multiple myeloma ( Multiple Myeloma ) in year 2015.
  • FDA approved carfilzomib, sold as Kyprolis, manufactured by Onyx Pharmaceuticals for the treatment of multiple myeloma ( Multiple Myeloma ) in year 2012.
  • FDA approved panobinostat, sold as Farydak, manufactured by Novartis for the treatment of multiple myeloma ( Multiple Myeloma ) in year 2015.
  • FDA approved plerixafor injection, sold as Mozobil, manufactured by Genzyme for the treatment of non-Hodgkin�s lymphoma and multiple myeloma ( Non Hodgkin Lymphoma | Multiple Myeloma ) in year 2008.