Myeloma Multiple and Spine Deformities

Dear Ask The Doctor: Hello, My name is Mariam and my dad (who is 66 years old) has Multiple Myeloma. He has been having back problems from the myeloma, so bad that his back is hunched and his rib cage is rubbing against his pelvic bone. I beleive he has mentioned a couple of his vertebrea being damaged, and one may be unrepairable. His cancer doctor isn't helping much with this and we would like to know if this is a specific illness or if his back deformation has a name, so that we can look into this more. I want him to be comfortable and would like to find a way to fix this. Please email me back. I am looking forward to a response from you. Thank you for your time, Mariam

Dear Mariam:

The blood contains several different types of cells, each with an important job in the body. All blood cells develop in the bone marrow which is the spongy substance within our bones. Multiple myeloma (MM) is a disease in which there is a malignant proliferation of plasma cells involving more than 10% of the bone marrow. Most plasma cells reside in the bone marrow, and myeloma, usually occurs within the marrow-containing large bones of the body, such as the skull, spine and hips. Because they are present throughout the bone marrow, plasma cells that have undergone malignant transformation do so in clumps and usually at many sites, which explains the terminology "multiple myeloma”. In myeloma, the abnormal plasma cells eventually invade and destroy the outer, hard layer of bone. The destruction of bones (osteolysis), typically occurring in small areas at different sites, may lead to serious problems as your Dad is experiencing with his spine, even a small osteolytic lesion can cause the bone to fracture and collapse, in the specific case of the spine causing remarkable deformities. The net effect may be problems with mobility, severe pain, and in the presence of spinal involvement: deformities and moderate-to-severe nerve damage. Myeloma is the second most common blood cancer, but it is not a common cancer, is predominantly a cancer of older people. More than 80% of people with myeloma are aged 60 years or older. Standard first-line (primary) therapy for myeloma involves corticoesteroid therapy, with or without chemotherapy. Supportive care is frequently given in conjunction with treatment. Sometimes radiation therapy is added for people with significant bone damage. Stem-cell transplantation is often used as consolidation therapy after a patient has achieved a complete remission (CR), or after a second CR is achieved in recurrent disease. It is also used in patients who are unable to achieve a remission with first line, or so called standard, therapy. Stem-cell transplantation is more effective than conventional chemotherapy in killing myeloma cells. However, it is a physically and emotionally demanding treatment, so not everyone with myeloma is a candidate for such an aggressive approach. Stem cell transplantation is most often used for younger patients or selected older patients with a good performance status. It has been associated with higher remission rates, as well as longer remission and survival than those of standard-dose chemotherapy. Neurosurgeons, orthopedists, or interventional radiologists may offer a procedure called vertebroplasty (injection of bone cement) to stabilize affected bones in the spine.