Kathleen Colson, RN, BSN, BS, from the Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute
Kathleen Colson, RN, BSN, BS, from the Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute, provides a brief overview of multiple myeloma.
Hello. I’m Kathleen Colson and welcome to the Multiple Myeloma Center for Nurses. This video contains a brief overview of Multiple Myeloma.
Multiple myeloma is a malignancy of the plasma cells that are derived from the B-cell lineage.1,2 B-cells are one type of lymphocyte, or immune system cell.1 When B-cells respond to an infection they become plasma cells.1 As you may know, plasma cells produce antigen-specific antibodies that help the body fight infection.1,2
However, in multiple myeloma, the normal process breaks down: normal plasma cells transform into malignant myeloma cells and produce large quantities of an abnormal immunoglobulin called monoclonal, or M-protein.1,3 The malignant cells also crowd out and inhibit the production of normal blood cells and antibodies in the bone marrow.1,3 Multiple myeloma is characterized by destructive bone lesions, hypercalcemia, anemia, and renal failure, the result of accumulation of plasma cells and secretion of monoclonal protein in the serum and/or urine.4
Multiple myeloma is the second most common hematologic malignancy in the United States after non‐Hodgkin lymphoma.2,5 In 2014 alone, approximately 24,000 new cases will be diagnosed with this often fatal disease.5
Multiple myeloma accounts for 1% of all cancers, and nearly 20% of patients who lose their lives to a hematologic malignancy do so to this disease.7-9
Precursors to the malignant form of multiple myeloma are monoclonal gammopathy of undetermined significance, or MGUS, and smoldering myeloma.11
MGUS is characterized by a serum monoclonal protein level of less than 3 grams per deciliter, less than 10% of bone marrow comprises plasma cells, and there is no organ damage nor laboratory abnormalities, such as anemia or hypercalcemia.11-14 Transition from MGUS to multiple myeloma is characterized by a greater than 10% increase in the number of tumor cells in the bone marrow, osteolytic bone lesions, and/or increased tumor mass.8,14 Angiogenesis is also correlated with disease activity.8
Patients with smoldering myeloma have at least 10% plasma cells in the bone marrow and/or a high M-protein level, but have normal blood counts, calcium levels, and kidney function, and no bone or organ damage.14 Smoldering myeloma has higher levels of M-protein than MGUS and a higher risk of progression to symptomatic, or active, multiple myeloma.11,12
Active multiple myeloma is characterized by the presence of urinary or serum monoclonal protein.11 Also, the amount of plasma cells in the bone marrow exceeds 10%, and end-organ damage, or a biopsy-proven plasmacytoma.11,14 The end-organ damage associated with multiple myeloma is calcium elevation, renal insufficiency, anemia, and bone problems. They are often described as the CRAB criteria.15 For detailed information about the CRAB criteria, please view the video “CRAB Criteria” here on the Multiple Myeloma Center for Nurses website.
This concludes the Multiple Myeloma Overview video. To find out more on other topics related to multiple myeloma, please visit MMCenterForNurses.com. There you will also find a number of educational tools to help you discuss these topics with your patients, answers to common questions, and other downloadable materials. Thank you.
1. American Cancer Society. What Is Multiple Myeloma? https://www.cancer.org/cancer/multiple-myeloma/about/what-is-multiple-myeloma.html. Accessed June 3, 2019.
2. Bilotti E, Faiman BM, Richards TA, et al; International Myeloma Foundation Nurse Leadership Board. Survivorship care guidelines for patients living with multiple myeloma: consensus statements of the International Myeloma Foundation Nurse Leadership Board. Clin J Oncol Nurs. 2011;15(4 suppl):5-8.
3. Multiple Myeloma Research Foundation. What is multiple myeloma? https://themmrf.org/multiple-myeloma/what-is-multiple-myeloma/. Accessed June 6, 2019.
4. Bertolotti P, Bilotti E, Colson K, et al. Management of side effects of novel therapies for multiple myeloma: Consensus statements developed by the International Myeloma Foundation’s Nurse Leadership Board. Clin J Oncol Nurs. 2008;12(3 suppl):9-12.
5. American Cancer Society. Cancer facts and figures 2014. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/index. Accessed August 15, 2014.
6. American Cancer Society. What are the key statistics about multiple myeloma? https://www.cancer.org/cancer/multiple-myeloma/about/key-statistics.html. Accessed June 3, 2019.
7. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003;78(1):21‐33.
8. Kuehl WM, Bergsagel PL. Multiple myeloma: evolving genetic events and host interactions [review]. Nat Rev Cancer. 2002;2(3):175‐187.
9. National Cancer Institute. SEER Cancer Statistics Review 1975 – 2016. Table 1.22. https://seer.cancer.gov/csr/1975_2016/results_single/sect_01_table.22_2pgs.pdf#search=us%20complete%20prevalence%20counts. Accessed June 6, 2019.
10. American Cancer Society. Cancer Facts and Figures 2019. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf. Accessed June 5, 2019.
11. Kurtin S, Faiman B. The changing landscape of multiple myeloma: implications for oncology nurses. Clin J Oncol Nurs. 2013;17(6 suppl):7-11.
12. Rajkumar SV. Multiple myeloma: 2011 update on diagnosis, risk-stratification, and management. Am J Hematol. 2011;86(1):57-65.
13. Kurtin S. Laboratory measures for the diagnosis, clinical management, and evaluation of treatment response in multiple myeloma. J Adv Pract Oncol. 2010;1(3):197-206.
14. Rajkumar SV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-e548.
15. Kyle R, Child JA, Anderson K, et al. The International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol. 2003;121(5):749-757.
