eMedicine Specialties > Orthopedic Surgery > Neoplasms

Myeloma: Follow-up

Author: Seema S Rizvi, MD, Associate Medical Director, Lutheran Care Center
Coauthor(s): Howard A Chansky, MD, Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center
Contributor Information and Disclosures

Updated: May 29, 2009

Follow-up

Further Outpatient Care

  • The following laboratory results are helpful in the follow-up care of patients with multiple myeloma:
    • CBC, chemical profile 7 (especially BUN and serum creatinine), serum calcium, and serum uric acid, and SPEP findings.
    • M-component level in the serum and/or urine. (This is an indicator of tumor burden; a reduction with chemotherapy is used as a sign of a treatment response.)
    • Serum beta-2-microglobin (B2M). (An elevated level indicates a large malignant cell mass, renal impairment, or both.)
    • Serum LDH level. (A high level is predictive of an aggressive lymphomalike course.)

Complications

  • Renal failure and insufficiency are seen in 25% of patients with multiple myeloma21 :
    • Myeloma kidney syndrome with multiple etiologies
    • Amyloidosis with light chains
    • Nephrocalcinosis due to hypercalcemia
  • Anemia, neutropenia, or thrombocytopenia is due to bone marrow infiltration of plasma cells.
  • Bacterial infection is the leading cause of death in patients with myeloma. The highest risk is in the first 2-3 months of chemotherapy.
  • Radiculopathy and/or cord compression may occur because of skeletal destruction and nerve compression.
  • Bone disease may result in:
    • Severe bone pain, pathologic fracture due to lytic lesions
    • Increased bone resorption leading to hypercalcemia
    • Spinal cord compression
  • Purpura, retinal hemorrhage, papilledema, coronary ischemia, seizures, and confusion are due to hyperviscosity syndrome.
  • Thrombosis and Raynaud phenomenon due to cryoglobulinemia may be present.
  • Hypercalcemia may cause polyuria and polydipsia, muscle cramps, constipation, and a change in the patient's mental status.

Prognosis

  • Multiple myeloma (MM) is a heterogeneous disease, with survival ranging from 1 year to more than 10 years.
    • The tumor burden and proliferation rate are the 2 key indicators for the prognosis in patients with MM.
    • B2M is an expression of tumor burden and is correlated with the Durie and Salmon staging system for assigning a prognosis.
  • Poor prognostic factors include the following:
    • Tumor mass
    • Hypercalcemia
    • Bence Jones proteinemia
    • Renal failure
  • The prognosis by treatment is as follows:
    • Conventional therapy: Overall survival is approximately 3 years, and event-free survival is less than 2 years.
    • High-dose chemotherapy with stem-cell transplantation: The overall survival rate is greater than 50% at 5 years.
    • Serum amyloid P retention: More than 50% of patients have a median survival of approximately 11 months.
    • Serum amyloid P retention: Median survival is 24 months.

Patient Education

  • What is multiple myeloma (MM), and how does it affect the body? MM is a cancer of bone marrow. People with myeloma have uncontrolled growth of plasma cells and have large numbers of plasma cells in their bone marrow. Plasma cells produce enzymes that stimulate the growth of osteoclasts, which destroy bone (bone resorption). Plasma cells secrete proteins called antibodies, which can potentially be dangerous and cause thickening of the blood (stroke-induced condition).
  • What are the causes of myeloma? The etiology is unknown. Fertilizers and insecticides may cause MM. Myeloma usually occurs in people older than 55 years, it occurs more commonly in African Americans than in whites, and it occurs slightly more frequently in men than in women.
  • What is the treatment for myeloma? Myeloma is life threatening, but treatment helps patients to live better and longer. Remission can last months to decades. The 2 medicines most often used are prednisone (a steroid) and melphalan.
  • What are the adverse effects of medicine? Like most cancer treatments, myeloma treatments generally involved the use of strong drugs to destroy malignant cells; however, these can have adverse effects. Patients undergo blood tests once a month while taking these medicines. Patients will probably lose their hair and have skin rashes, cough, fever, bleeding, and possibly other adverse effects.
  • What are some of the complications of MM? Pain and/or fractures may result when myeloma leads to destruction of bone. Orthopedic surgeons have developed improved techniques to treat these pathologic fractures and also to prevent them from occurring. Radiation therapy and newer medications (bisphosphonates) may also be used to effectively treat bone disease.
  • Where can additional information be found? For information on MM, visit the International Myeloma Foundation (IMF) or call the IMF at 1-800-452-CURE.
  • For excellent patient education resources, visit eMedicine's Blood and Lymphatic System Center. Also, see eMedicine's patient education article Myeloma.
 


More on Myeloma

Overview: Myeloma
Differential Diagnoses & Workup: Myeloma
Treatment & Medication: Myeloma
Follow-up: Myeloma
References
Further Reading
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References

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Keywords

myeloma, multiple myeloma, MM, plasma cell dyscrasia, plasma cell proliferation, hematologic cancer, plasmacytoid lymphocytes, M proteins

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Contributor Information and Disclosures

Author

Seema S Rizvi, MD, Associate Medical Director, Lutheran Care Center
Seema S Rizvi, MD is a member of the following medical societies: American Academy of Family Physicians and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Howard A Chansky, MD, Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center
Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Miguel A Schmitz, MD, Consulting Surgeon, Department of Orthopedics, Klamath Orthopedic and Sports Medicine Clinic
Miguel A Schmitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Sean P Scully, MD, PhD, Professor, Department of Orthopedics, University of Miami
Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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