1. Staff Oncologist, Mayo Clinic Arizona
Introduction to Myeloma: Diagnosis, Treatment, Risk Factors and Prevalence
Scottsdale, Arizona
Rochester, Minnesota
Jacksonville, Florida
Alan Bryce, MD
Staff Oncologist, Mayo Clinic Arizona

2. Multiple Myeloma - Background
The Bone Marrow (blood factory) makes 3 kinds of cells:
White Blood Cells …immune system
Red Blood Cells (Hemoglobin) …carry oxygen
Platelets …clotting
There are several kinds of white cells in the marrow
usually 1-3% of them are PLASMA CELLS
plasma cells make good proteins – antibodies or “immunoglobulins” which help fight infection

3. Multiple Myeloma - Introduction
Myeloma is a cancer of the Plasma Cells
They grow out of control in the bone marrow (at least 10% and as high as nearly 100%)
This results in many problems including:
Low hemoglobin (anemia) and platelets
Elevated abnormal immunoglobulins (proteins)
Bone pain and fractures
Infections (partly due to low normal immunoglobulins)
Kidney problems
Other complications…

4. Spectrum of Myeloma Asymp- Normal Active Myeloma Aggressive tomatic
plasma
cell
MGUS
Aggressive
Myeloma
Active Myeloma
Monoclonal
gammopathy
of unknown
significance

5. How do plasma cells become “evil”?

6. Multiple Myeloma – Causes?
The cause of myeloma is still unknown
Some have suggested:
Radiation- Nuclear Bomb Survivors
Chemicals (benzenes), herbicides and insecticides- The “Myeloma Belt”
Genetics or even viruses
Familial Myeloma – still rare
However, nothing is conclusive, and it is likely a combination of many factors…

7. Multiple Myeloma Unfortunately, MM is not a curable disease (yet!!)
Historically most people did not live for much more than 2 years…
However, the average survival is now at least 8 years
This has been a result of three key developments:
1. Early Detection
2. Autologous Stem Cell Transplant
3. Novel Drugs (thalidomide, bortezomib, lenalidomide)

8. Multiple Myeloma - Epidemiology
Incidence
It is a rare condition, occurring in about 4 people per 100,000 (1% of all cancers)
About 2100 new cases this year in Canada
It is more common in men than women
It is more common in the black population
Average age of diagnosis is 65
Less than 10% of cases occur in patients <50
Less than 2% of cases occur in patients <40

9. Myeloma rate in Arizona among race groups, 1995-2009

10. Common Symptoms Not all patients will have all of these symptoms
Fatigue
Mostly due to low hemoglobin (anemia)
Also due to disease itself
Other factors contribute to this (psychological, chemo & other drugs, infections…)
Lack of Appetite
Infections
Due to weakened immune system

11. Common Symptoms contd. Bone Symptoms
The abnormal protein causes an imbalance in bone production leading to bone thinning
This bone loss can lead to osteoporosis, bone pain and bone fractures
Most common location is the spine
High Calcium levels
Often happens when first diagnosed (calcium released by damaged bones)
Can result in thirst, nausea, vomiting, frequent urination, confusion and even coma

12. Common Symptoms contd. Impaired Kidney Function
The abnormal protein and the high calcium can damage the kidneys
About ½ of patients have some degree of kidney damage
Some have severe damage and require dialysis
Neurological symptoms
Bone fractures may compress nerves and cause symptoms
Easy bruising & bleeding occurs in some

13. Diagnosis of Myeloma
The diagnosis of Myeloma is made as a result of several tests:
Blood Counts (CBC – white, red, platelets)
Blood and urine tests for immune proteins
3. Bone Marrow tests (aspirate and biopsy)
4. X-rays
5. Other blood tests

14. Myeloma Treatment Principles of therapy
1. Stop the production of the abnormal plasma cells (chemo)
2. Strengthen the bone and prevent fractures
3. Increase the hemoglobin count and reduce fatigue
4. Reduce risk of infections
5. Promote well being and quality of life

15. Treatment with Chemotherapy
Goal is to reduce the number of plasma cells and the proteins they produce
Timing is important as it may be possible to wait & watch
It is not “curative” but may put the disease into remission
Must be tailored to individual based on disease factors (type, severity, organs involved) and patient factors (age, general health…)
Stem Cell Transplant is a common treatment option

16. Conclusions New Treatments for myeloma have improved survival
Myeloma is usually preceded by many years of MGUS
Screening and early detection can allow therapy to begin before organ damage develops
Bone Marrow transplant and Clinical Trials should be considered when appropriate