Multiple myeloma

Multiple myeloma (also known as plasma cell myeloma, plasmacytoma) is a slow-growing cancer in the bone marrow. The plasma cells become cancerous, i.e., they proliferate unchecked in several (multiple) places in the bone marrow, impact normal blood formation and destroy the bones in this way. Treatment options for multiple myeloma include chemotherapy, radiotherapy, immunotherapy and stem cell transplantation. Additional orthopaedic procedures are often also necessary to treat the bones which have been destroyed.

Multiple myeloma is a rare cancer which occurs predominantly in old age. The disease is characterised by malignant growths in the plasma cells, which are special white blood cells that form in the bone marrow. The causes of multiple myeloma are largely unknown. Men are affected slightly more often than women. When the disease is discovered, half of those affected are over 70 years of age. Multiple myeloma occurs in several places in the bone marrow. If plasma cells multiply unchecked in only one place, this is known as a plasmacytoma.

Multiple myeloma usually develops slowly and frequently causes no symptoms at the beginning. Therefore, it is not uncommon to discover the disease by accident during a blood test, a urine examination or a bone x-ray. The first signs of multiple myeloma can be fatigue, a reduction in performance and weight loss. Those affected also often report severe night sweats. With time, these symptoms can be accompanied by bone pain, spontaneous fractures, anaemia, an increased tendency to bleed and susceptibility to infectious diseases.

Different examinations are carried out to diagnose multiple myeloma. These include a blood test, a urine examination, a bone x-ray or a computed tomography of the bone. If there is suspected multiple myeloma, a bone marrow biopsy will be carried out to detect cancer cells in the bone marrow.

The treatment depends on the symptoms and the severity of the disease. As multiple myeloma usually grows slowly, it is sometimes possible to delay treatment, particularly in the case of early stage multiple myeloma that is discovered by accident. If the disease is at an advanced stage or if it is causing the patient problems, there are different treatment options available. They include chemotherapy, radiation therapy, immunotherapy and stem cell transplantation. Stem cell transplantation involves transfusing the patient’s own healthy hematopoietic stem cells or stems cells from a donor. High-dose chemotherapy is carried out before the transplant to destroy all cancer cells where possible. Stem cell transplantation is physically demanding and presents considerable risk. The decision of whether it is even a viable option depends on the patient’s general state of health. The benefits and risks are carefully weighed up.

If the disease causes fractures, surgery may be necessary.