Current Issues in Cancer: Multiple myeloma

Multiple myeloma occurs in over 2000 new patients in England and Wales each year. It presents most frequently as bone pain and patients tend to become dehydrated and may develop renal failure. No available treatment is curative, but about two thirds of patients achieve a stable response with low dose combination chemotherapy. Combination chemotherapy including doxorubicin and carmustine with the alkylating agents cyclophosphamide and melphalan achieve a higher stable response rate than conventional treatment with melphalan and prednisone without additional haematological toxicity. These responses are associated with loss of bone pain and patients remain symptom free for months without further treatment. Relapse occurs on average in a little under two years and, though second responses are frequently obtained, the disease eventually becomes refractory. This paper looks at who should be treated and the benefits that may be expected from the treatments available.

Multiple myeloma is a diffuse neoplasm of bone marrow plasma cells in which the malignant cells mingle with the haemopoietic cells throughout the red bone marrow. In many patients microplasmacytomas are present within the marrow and occasionally neoplastic cells grow as a tumour from bone. Overt spread of multiple myeloma outside the red bone marrow is seen in only a proportion of patients and then at a late stage of their disease. In most patients the neoplastic clone induces excess osteoclastic activity that results in osteoporosis, osteolytic lesions, and pathological fractures. About a quarter of patients, however, have no clinical or x ray signs of skeletal disease at presentation. Some patients never develop this complication.