At Boston Medical Center (BMC), the care of patients with multiple myeloma is a collaborative, multidisciplinary process. BMC’s Cancer Care Center organizes its services around each patient, bringing together the expertise of diverse specialists to manage care from the first consultation through treatment and follow-up visits. The Cancer Care Center is dedicated to providing treatment that is effective and innovative in curing and controlling cancer, while managing its impact on quality of life.

As the primary teaching affiliate of the Boston University School of Medicine, BMC combines personal, patient-focused care with the state-of-the-art-expertise and technological advances of a major teaching hospital. BMC is at the forefront of clinical practice, surgical expertise, and research in oncology.

To schedule an appointment or refer a patient, call 617.638.6428. Patients with a diagnosis or strong suspicion of cancer are given appointments within 72 hours.

What Is Multiple Myeloma?

Multiple myeloma is a cancer of the bone marrow arising from plasma cells, which are part of the immune system.

There are red blood cells, white blood cells, and platelets. White blood cells help the immune system fight infection. Plasma cells are white blood cells that produce antibodies: proteins that help the immune system protect the body from infection. Plasma cells produce antibodies in response to foreign substances (called antigens) entering the body. Different antibodies bind to different antigens to help destroy them. Some antibodies are able to destroy antigens on their own, whereas others assist other white blood cells in destroying them.

Myeloma begins when a plasma cell becomes abnormal and begins to divide uncontrollably, producing large numbers of these abnormal cells. These abnormal plasma cells are myeloma cells, and they divide out of control and do not die when they should. The cancer cells then accumulate and form a tumor.

A single tumor is called an isolated (or solitary) plasmacytoma. When there are several tumors present, the disease is referred to as multiple myeloma.

A shortage of red blood cells, white blood cells, and/or platelets may result when too many myeloma cells are present in the bone marrow. This can lead to a number of health issues, such as anemia (a shortage of red blood cells, which can cause pallor and fatigue), leukopenia (a shortage of white blood cells, which makes it difficult for the body to fight infection), and bruising or bleeding (caused by a shortage of platelets, which control bleeding).

Myeloma cells also interfere with bone maintenance. Normally, groups of cells work together to maintain proper bone shape and health. Certain groups of cells build bones up, while others break them down. Myeloma cells cause too much bone to break down and not enough replacement bone to be made. Bones then become weak and break easily. Because myeloma causes so much bone to be broken down, it often causes calcium levels in the blood to rise, causing tiredness and weakness.

Symptoms of Multiple Myeloma

The most common symptoms of multiple myeloma include

  • Bone pain, usually in the back or spine
  • Broken bones, usually in the spine
  • Feeling weak and very tired (also called fatigue)
  • Frequent infections and fevers
  • Frequent urination
  • High levels of calcium in the blood
  • Low blood counts
  • Nausea or constipation
  • Weight loss

These symptoms can occur from health issues other than cancer, so it’s important that anyone experiencing these symptoms be seen by a physician.

Causes of Multiple Myeloma

Although the exact causes of multiple myeloma remain unknown, certain risk factors—things that increase an individual's chances of developing cancer—have been identified. While risk factors may be useful in identifying high-risk individuals, they do not determine whether a person develops a disease. Some risk factors, such as diet, are within a person’s control, whereas others, such as age, are not.

Some possible risk factors for multiple myeloma include

  • Age: A person’s chances of developing multiple myeloma increase with age. Few people develop the disease before age 65.
  • Gender: Men have a higher risk of developing multiple myeloma than women. The reason why is unknown.
  • Race: African Americans have the highest risk of developing the disease.
  • Personal history of monoclonal gammopathy of undetermined significance (MGUS): MGUS is a benign (noncancerous) condition. For people who have it, it means abnormal plasma cells are present and producing M proteins. There are generally no symptoms associated with MGUS, and it is usually found with a blood test, the results of which indicate a high level of M protein in the blood. People with MGUS may develop certain cancers, including multiple myeloma. MGUS is not a treatable condition. For those with MGUS, physicians recommend regular lab testing (every 6 to 12 months) to monitor the level of M protein in the blood and regular exams to check for symptom development.
  • Family history: A person’s risk of developing multiple myeloma is higher if that person has a close relative with the disease. Not having a family history of the disease in no way guarantees a person will not get it.
  • Obesity: According to a study by the American Cancer Society, people who are overweight or obese have an increased risk of developing multiple myeloma (American Cancer Society 2015a).
  • Radiation: Exposure to lower levels of radiation can also increase a person’s risk of developing the disease, but very few cases of the disease result from this kind of exposure.

Other possible risk factors currently under study include gene mutations (changes in the DNA sequence of a gene), eating certain foods, and exposure to certain chemicals or germs (viruses in particular).

Staging

Staging is the process of determining how extensive the cancer is. It is an important part of diagnosis because it is used to determine the most appropriate treatment options for patients.

To determine the stage of the disease, physicians may perform a number of tests, including blood tests, CT scans, and MRI scans.

Multiple myeloma ranges from Stage I to Stage III. The stage of the disease takes into account whether it is causing problems in the bones or kidneys or abnormalities in the blood counts or calcium levels.

Some patients have what physicians describe as “smoldering” myeloma. This means the disease is in its early stages, but no symptoms are present.

Contáctenos

Tratamientos y Servicios

Espera vigilante

Los pacientes con mieloma en etapa temprana (ya sea latente o en etapa I) que eligen la espera vigilante serán monitoreados de cerca, pero no recibirán tratamiento hasta que los síntomas de la enfermedad aparezcan o cambien.

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Quimioterapia

La quimioterapia es un medicamento o una combinación de medicamentos que se usan para tratar el cáncer. La quimioterapia puede administrarse por vía oral (en forma de pastilla) o inyectarse por vía intravenosa (IV).

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Bisfosfonatos

Los bisfosfonatos se utilizan para ayudar a que los huesos se mantengan fuertes al reducir la velocidad a la que las células de mieloma los disuelven.

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Radioterapia

La radiación utiliza un equipo especial para liberar partículas de alta energía, como rayos X, rayos gamma, haces de electrones o protones, para matar o dañar las células cancerosas. La radiación (también llamada radioterapia, irradiación o terapia de rayos X) se puede administrar internamente a través de la implantación de semillas o externamente usando aceleradores lineales (llamada radioterapia de haz externo o EBRT).

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Cirugía relacionada con el mieloma múltiple

La cirugía no se usa comúnmente para tratar el mieloma múltiple. Sin embargo, la cirugía puede ser necesaria si se pellizca la médula espinal. También se puede usar para unir varillas o placas de metal para soportar huesos que soportan peso y para tratar fracturas existentes y prevenir futuras.

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Trasplante de células madre

Un trasplante de células madre es un procedimiento que utiliza células madre para reemplazar las células sanguíneas de la médula ósea que han sido dañadas o destruidas por la quimioterapia, la radiación o una enfermedad. Para los pacientes que reciben un trasplante de células madre, el primer paso es reducir la cantidad de cáncer presente en el cuerpo del paciente mediante el tratamiento de inducción. Después del tratamiento de inducción, las células madre se extraen de la sangre o la médula ósea del paciente. Una vez recolectadas, las células se congelan. Una vez que se han extraído las células madre, el paciente recibe quimioterapia de dosis alta para eliminar las células de mieloma sobrantes. El tratamiento también destruye todas las células normales restantes de la médula ósea. Luego, las células madre congeladas se descongelan y se devuelven al paciente a través de una vía intravenosa en un proceso similar a una transfusión de sangre. Las células madre viajan a la médula ósea, donde comienzan a producir nuevas células sanguíneas.

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Diagnósticos y Pruebas

Historial médico personal y familiar

Es probable que su médico le haga una serie de preguntas relacionadas con su historial médico personal y el historial médico de su familia.

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Examen físico

Su médico le hará una serie de preguntas y es probable que le realice un examen físico. El examen físico incluirá el examen de cualquier área específica de preocupación, especialmente en lo que se refiere al motivo de su visita al consultorio.

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Análisis de sangre para mieloma múltiple

Los médicos utilizan varios análisis de sangre para detectar mieloma múltiple, incluidos hemogramas, inmunoglobulinas cuantitativas, SPEP, microglobulina Beta-2 y análisis de química sanguínea.

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Análisis de orina mieloma múltiple

Los médicos analizan la orina en busca de un tipo de proteína M llamada proteína de Bence Jones. La orina recolectada durante un período de 24 horas se envía al laboratorio para ser examinada. Si el laboratorio encuentra un alto nivel de proteína Bence Jones, los médicos controlarán sus riñones, ya que demasiada proteína Bence Jones puede obstruir o dañar los riñones.

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Radiografías de huesos

Las radiografías de huesos se utilizan para ver el daño a los huesos causado por el mieloma. Los médicos suelen tomar una serie de radiografías que incluyen la mayoría de los huesos. Esto se llama examen óseo o examen esquelético.

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Tomografía computarizada (TC)

Las tomografías computarizadas utilizan equipos de rayos X y procesamiento por computadora para producir imágenes bidimensionales del cuerpo. El paciente se acuesta en una mesa y pasa a través de una máquina que parece una rosquilla grande y cuadrada.

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Imágenes por resonancia magnética (IRM)

Esta prueba utiliza un campo magnético, pulsos de radiofrecuencia y una computadora para producir imágenes detalladas de las estructuras corporales en varios lugares. Es posible que le pidan que beba una solución de contraste para obtener mejores imágenes, y lo más probable es que se acueste en una mesa en movimiento mientras se toman las imágenes.

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Tomografía por emisión de positrones (PET)

Una tomografía por emisión de positrones se utiliza para detectar reacciones celulares al azúcar. Las células anormales tienden a reaccionar y "iluminarse" en la exploración, lo que ayuda a los médicos a diagnosticar una variedad de afecciones. Para la tomografía por emisión de positrones, se inyecta en el torrente sanguíneo una sustancia química inofensiva, llamada radiotrazador.

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Aspiración y biopsia de médula ósea

Para una aspiración de médula ósea (también llamada biopsia de médula ósea), el médico usa una aguja gruesa y hueca para extraer una muestra de médula ósea y líquido de la médula ósea.

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Nuestro Equipo

BMC’s comprehensive multiple myeloma team includes physicians who work in hematology and medical oncology, surgical oncology, radiation oncology, and pathology, as well as staff from the Transfusion Medicine Service/Blood Bank. The team’s patient-centered, multidisciplinary approach assures each patient benefits from the collaborative expertise of physicians uniquely focused on their individual needs.

Hematologists

Adam Lerner, MD

Professor of Medicine and Pathology, Boston University School of Medicine

​​​​​​​Radiation Oncologists

Minh T Truong, MD

Chief and Chair, Boston Medical Center Radiation Oncology, Boston Medical Center
Professor, Boston University School of Medicine

standard BMC headshot

Gregory Russo, MD
Attending Physician, Department of Radiation Oncology, Boston Medical Center
Clinical Assistant Professor of Radiation Oncology, Boston University School of Medicine

Transfusion Medicine

Recursos del Paciente

Multiple Myeloma Clinical Trials

BMC offers a number of clinical trials specifically for multiple myeloma patients. Promising new techniques in the diagnosis, treatment, and care of patients with cancer are tested in these studies. The number and types of clinical trials available are constantly changing.

References

American Cancer Society. 2015a. Detailed Guide: Multiple Myeloma. PDF.-----. 2015b.

Overview Guide: Multiple Myeloma Overview. PDF.

Millennium Pharmaceuticals, Inc. 2011.Understanding Multiple Myeloma. Houston: Phyllis Pittman Communications, LTD.

National Cancer Institute. 2008. What You Need To Know About™ Multiple Myeloma. PDF. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services.http://www.cancer.gov/

Afiliaciones

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As the principal teaching affiliate of Boston University School of Medicine (BUSM), Boston Medical Center is devoted to training future generations of healthcare professionals.  Learn more about Boston University School of Medicine.