all about myeloma | Multiple Myeloma

What You Need

To Know About

TM

Multiple

Myeloma

U.S. DEPARTMENT OF

HEALTH AND HUMAN SERVICES

National Institutes of Health

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Contents

About This Booklet 1

What Is Multiple Myeloma? 2

Risk Factors 5

Symptoms 6

Diagnosis 7

Staging 10

Treatment 10

Second Opinion 18

Supportive Care 19

Nutrition and Physical Activity 21

Follow-up Care 22

Sources of Support 23

Taking Part in Cancer Research 24

Dictionary 26

National Cancer Institute Information Resources 35

National Cancer Institute Publications 36

U.S. DEPARTMENT OF

HEALTH AND HUMAN SERVICES

National Institutes of Health

National Cancer Institute

About This Booklet

This National Cancer Institute (NCI) booklet is

about multiple myeloma,* a cancer that starts in

plasma cells, a type of white blood cell. It’s also called

plasma cell myeloma. Each year in the United States,

about 20,000 people learn they have this disease.

This booklet is only about multiple myeloma.

It is not about bone cancer. Although multiple

myeloma affects the bones, it begins in plasma

cells.

Bone cancer begins in bone cells. It’s

diagnosed and treated differently from multiple

myeloma. The NCI’s fact sheet Bone Cancer:

Questions and Answers provides information

about bone cancer.

Also, this booklet is not about plasmacytoma

(a collection of abnormal plasma cells that forms

a single tumor) and other types of plasma cell

tumors. You can find information on our Web site

at http://www.cancer.gov/cancertopics/types/

myeloma. Or, the Cancer Information Service

(1–800–4–CANCER) can send you information

about those diseases.

This booklet tells about diagnosis, treatment options,

and tests the doctor may give you during follow-up

visits. It also tells about supportive care before, during,

or after treatment. Learning about the medical care for

multiple myeloma can help you take an active part in

making choices about your care.

*Words in italics are in the Dictionary on page 26. The Dictionary

explains these terms. It also shows how to pronounce them.

1

a type of white blood cell.
For the latest information about multiple myeloma. We can answer your questions
about cancer.

Normal Blood Cells
Most blood cells develop from cells in the bone
marrow called stem cells. you can take notes or
ask whether you may use a tape recorder. contact our Cancer
Information Service.
please visit our Web site at http://www. Or.

2

.gov/
cancertopics/types/myeloma. or just to listen. You may also
want to have a family member or friend go with you
when you talk with the doctor—to take part in the
discussion. Cancer is a
group of many related diseases. This booklet has lists of questions that you may
want to ask your doctor. To help
remember what your doctor says.

What Is Multiple Myeloma?

Multiple myeloma is a type of cancer. Many people find it helpful to
take a list of questions to a doctor visit.cancer. We can send you NCI booklets and fact
sheets.cancer.gov/help. to take notes.
It’s the most common type of plasma cell cancer. Bone marrow is the soft
material in the center of most bones. Call 1–800–4–CANCER (1–800–422–6237)
or instant message us through the LiveHelp service at
http://www. Myeloma is a cancer
that starts in plasma cells.

Plasma cells are white blood cells that make
antibodies.
• Platelets help form blood clots that control bleeding.

3
.

Plasma cell makes antibodies

Antibodies
bind to germ

Antibodies work with other parts of the
immune system to destroy the germ

Normal plasma cells help protect the body from germs
and other harmful substances. Antibodies are part of the immune system. There are
several types of white blood cells.
Each type has a special job:
• White blood cells help fight infection. Stem cells mature into different types of blood cells. Each type of plasma cell makes a different
antibody.
They work with other parts of the immune system to
help protect the body from germs and other harmful
substances.
• Red blood cells carry oxygen to tissues throughout
the body.

like other cancers.

Myeloma Cells
Myeloma.
In time. begins in cells. These abnormal plasma
cells are myeloma cells. making
more and more abnormal cells. Myeloma cells

M proteins

Myeloma cell (abnormal plasma cell) making M
proteins.
Myeloma begins when a plasma cell becomes
abnormal. and old or damaged cells don’t die when they
should. When
myeloma cells collect in several of your bones. new cells form when the body doesn’t need
them. The new cells divide again and again. The abnormal cell divides to make copies of
itself. These extra cells can form a mass of tissue
called a growth or tumor. myeloma cells collect in the bone marrow. In
cancer.
They may damage the solid part of the bone. the

4

.

200 men and 8.700 women are diagnosed with
multiple myeloma. urine.

Risk Factors

No one knows the exact causes of multiple
myeloma.
You cannot catch it from another person. These proteins can collect in the
blood.” This disease may
also harm other tissues and organs. Sometimes. It is not known why more men
are diagnosed with the disease.disease is called “multiple myeloma.
Studies have found the following risk factors for
multiple myeloma:
• Age over 65: Growing older increases the chance of
developing multiple myeloma.
• Race: The risk of multiple myeloma is highest
among African Americans and lowest among Asian
Americans.
• Being a man: Each year in the United States.
Research has shown that certain risk factors increase
the chance that a person will develop this disease. This disease is
rare in people younger than 35. Usually. Most people with
myeloma are diagnosed after age 65. and organs. about
11. people with MGUS develop

5

.
and the abnormal level of M protein is found with a
blood test. Doctors seldom know why one person
develops this disease and another doesn’t.
• Personal history of monoclonal gammopathy of
undetermined significance (MGUS): MGUS is a
benign condition in which abnormal plasma cells
make M proteins.
Myeloma cells make antibodies called M proteins
and other proteins. However.
we do know that multiple myeloma isn’t contagious. The reason for the difference between
racial groups is not known. there are no symptoms. such as the kidneys.

Many other suspected risk factors are under study. There is
no treatment.
• Family history of multiple myeloma: Studies have
found that a person’s risk of multiple myeloma may
be higher if a close relative had the disease. Researchers continue to study these and
other possible risk factors. certain cancers. having
alterations in certain genes. or
being obese increases the risk of developing multiple
myeloma. such as multiple myeloma. Most people who have
risk factors never develop cancer. usually in the spine
• Feeling weak and very tired
• Feeling very thirsty
• Frequent infections and fevers
• Weight loss
• Nausea or constipation
• Frequent urination

6

. They also get
regular exams to check for the development of
symptoms. usually in the back and ribs
• Broken bones.
Having one or more risk factors does not mean that
a person will develop myeloma.

Symptoms

Common symptoms of multiple myeloma include:
• Bone pain.
Researchers have studied whether being exposed to
certain chemicals or germs (especially viruses). but people with MGUS get regular lab
tests (every 1 or 2 years) to check for a further
increase in the level of M protein. eating certain foods.

Anyone with these
symptoms should tell the doctor so that problems can
be diagnosed and treated as early as possible.
—The lab also checks for high levels of calcium. Your doctor also may
order some of the following tests:
• Blood tests: The lab does several blood tests:
—Multiple myeloma causes high levels of proteins
in the blood. red blood cells.
Only a doctor can tell for sure. your doctor
may ask about your personal and family medical
history and do a physical exam. Usually
though. patients go to the doctor because they are
having other symptoms. doctors suspect multiple
myeloma after an x-ray for a broken bone.
—To see how well the kidneys are working. and beta-
2-microglobulin.

7

. The lab does a
complete blood count to check the number of
white blood cells. The lab checks the levels of many
different proteins. Most often.
Other health problems may also cause these symptoms. these symptoms are not due to cancer. and platelets. albumin. the lab
tests for creatinine.

Diagnosis

Doctors sometimes find multiple myeloma after a
routine blood test.
—Myeloma may also cause anemia and low levels
of white blood cells and platelets. More often.
To find out whether such problems are from
multiple myeloma or some other condition. including M protein and other
immunoglobulins (antibodies).

Bence Jones protein can
clog the kidneys and damage them.• Urine tests: The lab checks for Bence Jones protein. local anesthesia is used
to numb the area.
• X-rays: You may have x-rays to check for broken or
thinning bones. This helps reduce the pain.An x-ray of your whole body can be
done to see how many bones could be damaged by
the myeloma. A biopsy is the only sure way to know
whether myeloma cells are in your bone marrow.
a type of M protein.
Before the sample is taken. If the lab finds a high level of
Bence Jones protein in your urine sample. in urine.
• Biopsy: Your doctor removes tissue to look for
cancer cells. Your
doctor removes some bone marrow from your hip

8
. doctors
will monitor your kidneys. The lab measures the
amount of Bence Jones protein in urine collected
over a 24-hour period.

Some people will have both procedures
during the same visit:
—Bone marrow aspiration: The doctor uses a
thick. A pathologist uses a
microscope to check the tissue for myeloma cells.
—Bone marrow biopsy: The doctor uses a very
thick. who will talk
to me about next steps? When?

9

.

You may want to ask your doctor these
questions before having a bone marrow aspiration
or biopsy:
• Will you remove the sample of bone marrow
from the hip or from another bone?
• Where will I go for this procedure?
• Will I have to do anything to prepare for it?
• How long will it take? Will I be awake?
• Will it hurt? What will you do to prevent or
control the pain?
• Are there any risks? What are the chances of
infection or bleeding after the procedure?
• How long will it take me to recover?
• How soon will I know the results? Who will
explain them to me?
• If I do have multiple myeloma. hollow needle to remove samples of bone
marrow. hollow needle to remove a small piece of
bone and bone marrow.bone or another large bone.
There are two ways your doctor can obtain bone
marrow.

the doctor considers the
results of blood tests.

10

. Sometimes a
combination of methods is used.
Radiation therapy is used sometimes to treat painful
bone disease. Stage II. Stage II or III is more advanced.
• MRI: A powerful magnet linked to a computer is
used to make detailed pictures of your bones.Staging

If the biopsy shows that you have multiple
myeloma.

Treatment

People with multiple myeloma have many treatment
options. there is no bone damage. and more
myeloma cells are found in the body. or Stage III.
Early disease with symptoms (such as bone damage) is
Stage I. including albumin and
beta-2-microglobulin. The stage
takes into account whether the cancer is causing
problems with your bones or kidneys. and stem cell transplant. Staging may
involve having more tests:
• Blood tests: For staging. For example. It may be used alone or along with other
therapies.
Doctors may describe multiple myeloma as
smoldering. Stage I. induction
therapy. The options are watchful waiting. Smoldering
multiple myeloma is early disease without any
symptoms. See the Supportive Care section on page 19
to learn about ways to relieve pain. your doctor needs to learn the extent (stage)
of the disease to plan the best treatment.
• CT scan: An x-ray machine linked to a computer
takes a series of detailed pictures of your bones.

Clinical trials are research studies of new treatment
methods. and they may change from one
treatment session to the next.
but myeloma can seldom be cured.
When treatment for myeloma is needed. People may
receive therapy to help keep the cancer in remission. you may want to
talk to your doctor about taking part in a clinical trial. or you
may ask for a referral. The doctor monitors your
health closely (watchful waiting) so that treatment can
start when you begin to have symptoms. Sometimes a stem cell transplant is part of the
treatment plan.
Your doctor can describe your treatment choices. you may not need
cancer treatment right away. side
effects are common.
Before treatment starts. Your health care team may also include an
oncology nurse and a registered dietitian. The choice of treatment depends mainly on how
advanced the disease is and whether you have
symptoms. Because standard
treatment may not control myeloma. and the possible side effects. If you have multiple myeloma without
symptoms (smoldering myeloma). it can often
control the disease and its symptoms.
Your doctor may refer you to a specialist. Because cancer
treatments often damage healthy cells and tissues. Side effects may not be the same
for each person. the
expected results. you will likely get induction
therapy. Specialists who treat multiple
myeloma include hematologists and medical
oncologists. You and
your doctor can work together to develop a treatment
plan that meets your needs. ask your health care team to
explain possible side effects and how treatment may
change your normal activities.
If you have symptoms. See the Taking Part in Cancer Research
section on page 24.

11

.

for
how long?
• What is the treatment likely to cost? Will my
insurance cover the cost?
• How will treatment affect my normal
activities?
• Would a clinical trial be right for me? Can you
help me find one?
• How often should I have checkups?

12

. You may want to ask your doctor these
questions before you begin treatment:
• What stage of myeloma do I have?
• Is the disease affecting my kidneys?
• How do I get a copy of the report from the
pathologist?
• What are my treatment choices? Which do you
recommend for me? Why?
• Will I have more than one kind of treatment?
How will my treatment change over time?
• What are the expected benefits of each kind of
treatment?
• What are the risks and possible side effects of
each treatment? What can we do to control the
side effects?
• What can I do to prepare for treatment?
• Will I need to stay in the hospital? If so.

this choice has risks. you can avoid the
side effects of treatment until you have symptoms. you
should discuss your feelings with your doctor. Another
approach is an option in most cases. You will receive treatment if
symptoms occur. what problems should
I tell you about?

13

. you will have regular checkups (such as
every 3 months). it may reduce the chance to control
myeloma before it gets worse. By delaying treatment. can I change my
mind later on?
• Will the cancer be harder to treat later?
• How often will I have checkups?
• Between checkups. In
some cases. If you
choose watchful waiting but grow concerned later.
You may decide against watchful waiting if you
don’t want to live with untreated myeloma.
Although watchful waiting avoids or delays the side
effects of cancer treatment.
If you and your doctor agree that watchful waiting is
a good idea.Watchful Waiting
People with smoldering myeloma or Stage I
myeloma may be able to put off having cancer
treatment.

You may want to ask your doctor these
questions before choosing watchful waiting:
• If I choose watchful waiting.

The targeted
therapy blocks the action of an abnormal protein
that stimulates the growth of myeloma cells.Induction Therapy
Many different types of drugs are used to treat
myeloma.
or at home.

14

.
• Targeted therapy: Targeted therapies use drugs that
block the growth of myeloma cells. The treatment usually takes place in an
outpatient part of the hospital. bruise or bleed
easily.
The side effects depend mainly on which drugs are
given and how much:
• Blood cells: When a drug used for myeloma
treatment lowers the levels of healthy blood cells. but the drug can also harm normal
cells that divide rapidly. If
your levels are low.
You may receive the drugs by mouth or through a
vein (IV). Some people may need to stay in the
hospital for treatment. and feel very weak and tired. Your health
care team will check for low levels of blood cells.
There are also medicines that can help your body
make new blood cells. A steroid may be used alone or with
other drugs to treat myeloma. your health care team may stop
therapy for a while or reduce the dose of drug. at your doctor’s office.
• Steroids: Some steroids have antitumor effects. It is
thought that steroids can trigger the death of
myeloma cells.
Each type of drug kills cancer cells in a different
way:
• Chemotherapy: Chemotherapy kills fast-growing
myeloma cells.
and many different combinations are used to treat
myeloma. People often receive a combination of drugs.
you’re more likely to get infections.

Ask your health care team about medicines
and other ways to help you cope with these
problems.
The drugs used for myeloma may also cause
dizziness.
You may find it helpful to read the NCI booklet
Chemotherapy and You.

You may want to ask your doctor these
questions before having induction therapy:
• Which drugs will I get? What will the
treatment do?
• When will treatment start? When will it end?
How often will I have treatments?
• Where will I go for treatment? Will I have to
stay in the hospital?
• Will I have side effects during treatment? What
side effects should I tell you about? Can I
prevent or treat any of these side effects?
• Will there be lasting side effects? How long
will they last? What can I do about them?
• How often will I need checkups?

15

. diarrhea. drowsiness. constipation.
• Cells that line the digestive tract: Chemotherapy
and targeted therapy can cause poor appetite. it will grow back. and low blood pressure. numbness or tingling in hands or
feet.• Cells in hair roots: Chemotherapy may cause hair
loss. but it
may be somewhat different in color and texture. If you lose your hair. You may also want to read the
NCI fact sheet Targeted Cancer Therapies: Questions
and Answers. Most of these problems
go away when treatment ends. nausea
and vomiting. or mouth and
lip sores.

Doctors use blood
tests to be sure the donor’s cells match your cells.
• From a family member or other donor: An
allogeneic stem cell transplant uses healthy stem
cells from a donor.) New blood
cells develop from the transplanted stem cells.

16

.
• From your identical twin: If you have an identical
twin. you receive healthy stem cells through a
vein. The
cells may be treated to kill any myeloma cells
present. Before you get the high-dose
chemotherapy. The high doses
destroy both myeloma cells and normal blood cells
in the bone marrow. (It’s like getting a blood transfusion. Your stem cells are frozen and stored. The new
blood cells replace the ones that were destroyed by
treatment.
Stem cell transplants take place in the hospital. A stem cell transplant allows you
to be treated with high doses of drugs.
Some people with myeloma have two or more
transplants. After
you receive high-dose chemotherapy. the stored
stem cells are thawed and returned to you.
Allogeneic stem cell transplants are under study for
the treatment of multiple myeloma. sister. or parent
may be the donor. a syngeneic stem cell transplant uses stem
cells from your healthy twin. your stem cells are removed. After you receive high-dose
treatment. Your brother. Sometimes the stem cells come
from a donor who isn’t related.
Stem cells may come from you or from someone
who donates their stem cells to you:
• From you: An autologous stem cell transplant uses
your own stem cells.Stem Cell Transplant
Many people with multiple myeloma may get a
stem cell transplant.

how will we find one?
• How long will I be in the hospital? Will I need
special care? How will I be protected from
germs? Will my visitors have to wear a mask?
Will I?
• What care will I need when I leave the
hospital?
• How will we know if the treatment is working?
• What are the risks and the side effects? What
can we do about them?
• What changes in normal activities will be
necessary?
• What is my chance of a full recovery? How
long will that take?
• How often will I need checkups?

17

. There are two ways to get stem cells for people with
myeloma. You’ll be at risk
for infections because of the large doses of
chemotherapy you received. the transplanted
stem cells will begin to produce healthy blood cells. Or they can
come from the bone marrow (bone marrow
transplant). you may stay in the
hospital for several weeks or months.
After a stem cell transplant. In time.

You may want to ask your doctor these
questions before having a stem cell transplant:
• What kind of stem cell transplant will I have?
If I need a donor. They usually come from the blood
(peripheral blood stem cell transplant).
You may find it helpful to read the NCI fact sheet
Bone Marrow Transplantation and Peripheral Blood
Stem Cell Transplantation: Questions and Answers.

you have more information and perhaps a
greater sense of control. Some
people worry that the doctor will be offended if they
ask for a second opinion. The delay in starting treatment usually won’t
make treatment less effective.Second Opinion

Before starting treatment. a local or state
medical society. In most cases. Some
people with multiple myeloma need treatment right
away.
Either way. Such groups are listed in the
NCI fact sheet National Organizations That Offer
Services to People With Cancer and Their Families. knowing that you’ve
looked at your options.
Nonprofit groups with an interest in multiple
myeloma may be of help. a nearby hospital.
There are many ways to find a doctor for a second
opinion. Usually the opposite is true. You can ask your doctor. the doctor may agree
with your first doctor’s diagnosis and treatment plan.
Most doctors welcome a second opinion. or a medical school
for names of specialists.
It may take some time and effort to gather your
medical records and see another doctor. And many
health insurance companies will pay for a second
opinion if you or your doctor requests it. You can feel more confident
about the decisions you make. NCI’s Cancer Information
Service at 1–800–4–CANCER can tell you about
nearby treatment centers. To make sure. Other sources can be found
in the NCI fact sheet How To Find a Doctor or
Treatment Facility If You Have Cancer.
it’s not a problem to take several weeks to get a second
opinion. you
should discuss this delay with your doctor.
Or the second doctor may suggest another approach. you might want a second
opinion about your diagnosis and treatment plan.

18

.
If you get a second opinion.

and to help you cope
with the feelings that a diagnosis of cancer can bring.

Infections
Because people with multiple myeloma get
infections very easily.
You may receive supportive care to prevent or control
these problems and to improve your comfort and
quality of life during treatment.gov/help).gov/
cancerinfo/coping and from NCI’s Cancer Information
Service at 1–800–4–CANCER or LiveHelp
(http://www.
Some people receive vaccines against the flu and
pneumonia.
Supportive care is treatment to prevent or fight
infections.Supportive Care

Multiple myeloma and its treatment can lead to
other health problems.cancer. to control pain and other symptoms.
The health care team may advise you to stay away
from crowds and from people with colds and other
contagious diseases. At any stage of the disease.

Anemia
Myeloma and its treatment can lead to anemia. You may want to talk with your health care
team about when to get certain vaccines. Drugs or a blood
transfusion can help with this problem. you
can have supportive care.

19

. If an infection develops.
which may make you feel very tired. You may need
to stay in the hospital for treatment. to
relieve the side effects of therapy. it can be
serious and should be treated promptly.cancer. you may receive antibiotics and
other drugs.
You can get information about supportive care
on NCI’s Web site at http://www.

Your
health care provider can suggest ways to relieve or
reduce pain:
• A brace that relieves pain in the neck or back
• Drugs that fight pain anywhere in the body
• Radiation therapy from a large machine aimed at
the bone
• Surgery to fix a compressed (squeezed) spinal cord
Some people get pain relief from massage or
acupuncture when used along with other approaches.

20

. If you have a very
high level of calcium in your blood. You also may feel nauseated. A high calcium level can also make you very
tired.
and bones become thin wherever there are myeloma
cells. restless. such as walking. also helps keep bones strong. dehydrated.
You may find it helpful to read the NCI booklet
Pain Control.

Thinning Bones
Myeloma cells keep new bone cells from forming. Drinking a lot of
fluids and taking drugs that lower the calcium in the
blood can be helpful. Physical
activity. weak. you may lose your
appetite. and thirsty. you may learn relaxation techniques such as
listening to slow music or breathing slowly and
comfortably.Pain
Multiple myeloma often causes bone pain.
Also.

Too Much Calcium in the Blood
Multiple myeloma may cause calcium to leave the
bones and enter the bloodstream. Your doctor may give you drugs to prevent bone
thinning and help reduce the risk of fractures. or
confused.

or mouth
sores) can make it hard to eat well. Also. the
NCI booklet Eating Hints for Cancer Patients has
many useful ideas and recipes.
However.

21

. and staying as
active as you can.
A person with serious kidney problems may need a
kidney transplant. you may not feel like eating during
treatment or soon after.

Nutrition and Physical Activity

It’s important for you to take care of yourself by
eating well. proteins can build up in the heart. There are drugs to treat
amyloidosis. You may be uncomfortable or
tired. In addition. Dialysis removes wastes from the blood. drinking plenty of fluids. The buildup of proteins can
cause many problems.
This problem is caused by abnormal proteins collecting
in tissues of the body.

Amyloidosis
Some people with myeloma develop amyloidosis. causing
chest pain and swollen feet. the side effects of treatment
(such as poor appetite.
You need the right amount of calories to maintain a
good weight. Your doctor. If the problems are severe. a
registered dietitian. some of them severe. For
example. Eating well may help you feel better and
have more energy.Kidney Problems
Some people with multiple myeloma have kidney
problems. vomiting. nausea. or another health care provider can
suggest ways to deal with these problems. You may find that foods do not taste as good as
they used to. You also need enough protein to keep up
your strength. a person may
need dialysis.

the disease sometimes returns because
undetected myeloma cells remained somewhere in the
body after treatment.
you should contact your doctor. or bone marrow biopsy. Also. Walking. Research shows that people with cancer feel better
when they are active. swimming. Even
when the cancer seems to have been completely
destroyed. It also can help relieve
stress.

22

. be sure to
let your doctor or nurse know about it. Checkups help ensure that any
changes in your health are noted and treated if needed.
Your doctor will check for return of cancer. checkups help detect health
problems that can result from cancer treatment.
blood tests. yoga.

Follow-up Care

You’ll need regular checkups after treatment for
multiple myeloma. You may also want to
read the NCI fact sheet Follow-up Care After Cancer
Treatment: Questions and Answers.
If you have any health problems between checkups. if your
activity causes you pain or other problems.
The NCI has publications to help answer questions
about follow-up care and other concerns. You may find
it helpful to read the NCI booklet Facing Forward:
Life After Cancer Treatment. be sure
to talk to your doctor before you start. and
other activities can keep you strong and increase your
energy. x-rays. Also.
Checkups may include a careful physical exam. Whatever physical activity you choose. Exercise may reduce nausea and pain and make
treatment easier to handle.

• Social workers. working.
Here’s where you can go for support:
• Doctors.
You may also worry about caring for your family. your family. what health problems or
symptoms should I tell you about?

Sources of Support

Learning you have myeloma can change your life
and the lives of those close to you.

23

. hospital stays. nurses. social workers can
suggest resources for financial aid. These changes can
be hard to handle. and medical bills are common.
keeping your job. or continuing daily activities. and other members of your health
care team can answer many of your questions about
treatment. It’s normal for you. Often. counselors. transportation. or other activities. You may want to ask your doctor these
questions after you have finished treatment:
• How often will I need checkups?
• Which follow-up tests do you suggest for me?
• Between checkups.
Concerns about treatments and managing side
effects. or emotional support.
home care. or members of the
clergy can be helpful if you want to talk about your
feelings or concerns. and
your friends to have new and confusing feelings to
work through.

In these groups.
Researchers are testing new drugs and drug
combinations.
such as stem cell transplants. You may want
to talk with a member of your health care team
about finding a support group.
Although clinical trials may pose some risks.gov/help) can help
you locate programs.cancer.
Research already has led to advances in treatment. or on the Internet.

24

.
Even if people in a trial do not benefit directly.
For tips on coping. they
still make an important contribution by helping doctors
learn more about myeloma and how to control it. And doctors continue to
look for better ways to treat myeloma. They are also testing ways to improve
stem cell transplants for people with multiple
myeloma.
patients or their family members meet with other
patients or their families to share what they have
learned about coping with the disease and the effects
of treatment. you may want to read the NCI
booklet Taking Time: Support for People With Cancer. doctors
do all they can to protect their patients.• Support groups can also help. services.
over the telephone.

Taking Part in Cancer Research

Doctors all over the country are conducting many
types of clinical trials (research studies in which people
volunteer to take part). and publications.
They can give you names of national organizations
that offer services to people with cancer and their
families. Clinical trials are designed to
answer important questions and to find out whether
new approaches are safe and effective.
• Information specialists at 1–800–4–CANCER and
at LiveHelp (http://www. Groups may offer support in person.

gov/help can answer questions and
provide information about clinical trials. This booklet describes how treatment studies
are carried out and explains their possible benefits and
risks.
talk with your doctor. You may want to read the NCI
booklet Taking Part in Cancer Treatment Research
Studies.gov/clinicaltrials.
NCI’s Web site includes a section on clinical trials
at http://www.cancer.

25

. If you are interested in being part of a clinical trial. Information specialists at
1–800–4–CANCER or at LiveHelp at
http://www. It has
general information about clinical trials as well as
detailed information about specific ongoing studies
of myeloma.cancer.

Albumin (al-BYOO-mun): A protein found in blood.

Generally. The purpose of this

26

. heart.

Amyloidosis (am-a-loy-DOE-sis): A group of diseases

in which protein is deposited in specific organs

(localized amyloidosis) or throughout the body

(systemic amyloidosis). and adrenal

glands. Each antibody can

bind to only one specific antigen. milk.gov/dictionary.

egg white. liver. including some types of cancer).

Antibiotic (an-tih-by-AH-tik): A drug used to treat

infections caused by bacteria and other

microorganisms. You
can access it at http://www.

Anemia (a-NEE-mee-a): A condition in which the

number of red blood cells is below normal. and other substances. and liver. donor.
Acupuncture (AK-yoo-PUNK-cher): The technique of

inserting thin needles through the skin at specific

points on the body to control pain and other symptoms.

Antibody (AN-tee-BAH-dee): A type of protein made

by plasma cells (a type of white blood cell) in response

to an antigen (foreign substance). secondary amyloidosis

often affects the spleen.Dictionary

Definitions of thousands of terms are on the NCI
Web site in the NCI Dictionary of Cancer Terms. skin. kidneys. but could be an

unrelated donor. but not identical.

This is often a sister or brother. joints. Amyloidosis may be either

primary (with no known cause) or secondary (caused

by another disease.cancer.

tongue. primary amyloidosis affects the nerves.

Allogeneic stem cell transplant (A-loh-jeh-NAY-ik):

A procedure in which a person receives blood-forming

stem cells (cells from which all blood cells develop)

from a genetically similar.

binding is to help destroy the antigen. sponge-like
tissue in the center of most bones.
Beta-2-microglobulin (MY-kroh-GLOB-yoo-lin): A
small protein normally found on the surface of many
cells. Some antibodies destroy antigens directly. red blood cells. including
some types of cancer.
Others make it easier for white blood cells to destroy
the antigen. depending on the nature of the
antigen. Benign tumors
may grow larger but do not spread to other parts of the
body.
Benign (beh-NINE): Not cancerous. and in small amounts in
the blood and urine. and later given back to the same person. It produces white
blood cells. An increased amount in the blood
or urine may be a sign of certain diseases. such as multiple myeloma or
lymphoma. It is
found in the urine of most people with multiple
myeloma (cancer that begins in plasma cells). and platelets.
stored.
Autologous stem cell transplant (aw-TAH-luh-gus):
A procedure in which blood-forming stem cells (cells
from which all blood cells develop) are removed. The pathologist may
study the tissue under a microscope or perform other
tests on the cells or tissue.
Bence Jones protein: A small protein made by plasma
cells (white blood cells that produce antibodies).

27

.
Biopsy (BY-op-see): The removal of cells or tissues for
examination by a pathologist.
Bone marrow aspiration (MAYR-oh as-pih-RAY-
shun): The removal of a small sample of bone marrow
(usually from the hip) through a needle for
examination under a microscope.
Bone marrow (MAYR-oh): The soft. Antibodies can
work in several ways. including lymphocytes.

A test to check the

number of red blood cells. and other body tissues.

28

. prevention. Creatinine levels are

measured to monitor kidney function.

Cancer (KAN-ser): A term for diseases in which

abnormal cells divide without control. the pictures are created by a computer

linked to an x-ray machine.

Clinical trial: A type of research study that tests how

well new medical approaches work in people.

Bone marrow transplant (MAYR-oh): A procedure

to replace bone marrow that has been destroyed by

treatment with high doses of anticancer drugs or

radiation.

Chemotherapy (KEE-moh-THAYR-uh-pee):

Treatment with drugs that kill cancer cells. or

syngeneic (marrow donated by an identical twin).

allogeneic (marrow donated by someone else). or treatment of a disease.

CT scan: Computed tomography scan. and

platelets in a sample of blood.

diagnosis. white blood cells. These

studies test new methods of screening.

Calcium (KAL-see-um): A mineral found in teeth.

bones.

Creatinine (cree-AT-ih-nin): A compound that is

excreted from the body in urine.

Complete blood count: CBC.Bone marrow biopsy (MAYR-oh BY-op-see): The

removal of a sample of tissue from the bone marrow

with a needle for examination under a microscope. Transplantation may be autologous (an

individual’s own marrow saved before treatment). Cancer cells can

invade nearby tissues and can spread to other parts of

the body through the blood and lymph systems. A series of

detailed pictures of areas inside the body taken from

different angles. Also called computerized

tomography and computerized axial tomography

(CAT) scan.

Infection: Invasion and multiplication of germs in the
body. small and large intestines. Genes are pieces of
DNA. They can cause a
fever and other problems.
Immune system (ih-MYOON SIS-tem): The complex
group of organs and cells that defends the body against
infections and other diseases. Severe diarrhea or
vomiting can cause dehydration. Infections can occur in any part of the body and
can spread throughout the body. or fungi.
Digestive tract (dy-JES-tiv): The organs through which
food and liquids pass when they are swallowed.

29

.
Hematologist (HEE-muh-TAH-loh-jist): A doctor who
specializes in treating blood disorders.
Induction therapy (in-DUK-shun THAYR-uh-pee):
Treatment designed to be used as a first step toward
shrinking the cancer and in evaluating response to
drugs and other agents. and
rectum and anus. and eliminated. and most genes contain the information for
making a specific protein.Dehydration: A condition caused by the loss of too
much water from the body.
Dialysis (dye-AL-ih-sis): The process of filtering the
blood when the kidneys are not able to cleanse it. yeast.
Immunoglobulin (IH-myoo-noh-GLOB-yoo-lin): A
protein that acts as an antibody. Induction therapy is followed
by additional therapy to eliminate whatever cancer
remains. These organs are the mouth.
digested.
esophagus. stomach.
Gene: The functional and physical unit of heredity
passed from parent to offspring. The germs may be
bacteria. depending on where the
infection occurs. viruses.

30

.
M protein (PROH-teen): An antibody found in
unusually large amounts in the blood or urine of people
with multiple myeloma and other types of plasma cell
tumors.IV: Into or within a vein.
MRI: Magnetic resonance imaging (mag-NEH-tik
REH-zuh-nunts IH-muh-jing).
A medical oncologist also gives supportive care and
may coordinate treatment given by other specialists. A medical oncologist often is the
main health care provider for someone who has cancer. A procedure in which
radio waves and a powerful magnet linked to a
computer are used to create detailed pictures of areas
inside the body. Also called monoclonal protein. Also called intravenous.
Medical oncologist (MEH-dih-kul on-KAH-loh-jist):
A doctor who specializes in diagnosing and treating
cancer using chemotherapy. myelomatosis. or plasma cell myeloma. and
biological therapy. hormonal therapy. Also called Kahler
disease. Patients with monoclonal
gammopathy of undetermined significance are at an
increased risk of developing cancer.
Monoclonal gammopathy of undetermined
significance: MGUS. IV usually refers to a way of
giving a drug or other substance through a needle or
tube inserted into a vein.
Multiple myeloma (MUL-tih-pul MY-eh-LOH-muh):
A type of cancer that begins in plasma cells (white
blood cells that produce antibodies). The patient remains awake but has no feeling in
the part of the body treated with the anesthetic.
Local anesthesia (A-nes-THEE-zhuh): Drugs that
cause a temporary loss of feeling in one part of the
body. A benign condition in which
there is a higher-than-normal level of a protein called
M protein in the blood.
Oncology nurse (on-KAH-loh-jee): A nurse who
specializes in caring for people who have cancer.

31

.

Plasma cell (PLAZ-muh): A type of white blood cell

that produces antibodies. Also called radiotherapy and

irradiation. neutrons.

gamma rays. or syngeneic (blood cells donated by an

identical twin).

Plasmacytoma (PLAZ-muh-sy-TOH-muh): A type of

cancer that begins in plasma cells (white blood cells

that produce antibodies). Also called

multiple myeloma.

Peripheral blood stem cell transplant (puh-RIH-fuh-
rul): A method of replacing blood-forming cells

destroyed by cancer treatment.

Plasma cell myeloma (PLAZ-muh MY-eh-LOH-muh):

A type of cancer that begins in plasma cells (white

blood cells that produce antibodies).

Radiation therapy (RAY-dee-AY-shun THAYR-uh-
pee): The use of high-energy radiation from x-rays. allogeneic (blood cells donated by

someone else).

and plasmacytoma are types of plasma cell tumors. monoclonal

gammopathy of undetermined significance (MGUS). Kahler disease. A plasmacytoma may turn

into multiple myeloma.Pathologist (puh-THAH-loh-jist): A doctor who

identifies diseases by studying cells and tissues under

a microscope.

Platelet (PLATE-let): A type of blood cell that helps

prevent bleeding by causing blood clots to form. or myelomatosis. Multiple myeloma. Transplantation

may be autologous (an individual’s own blood cells

saved earlier). and other sources to kill cancer

cells and shrink tumors.

Plasma cell tumor (PLAZ-muh TOO-mer): A tumor

that begins in plasma cells (white blood cells that

produce antibodies). Immature blood cells

(stem cells) in the circulating blood that are similar to

those in the bone marrow are given to the patient after

treatment. This helps the bone marrow recover and

continue producing healthy blood cells.

Red blood cell: RBC. blood cells develop from blood-
forming stem cells. A cell that carries oxygen to all
parts of the body. For example.
Stem cell: A cell from which other types of cells
develop. but need to be checked
often for signs of progression to fully developed
multiple myeloma.
vomiting. Patients with smoldering myeloma
usually have no symptoms. Some common side
effects of cancer treatment are fatigue.
Side effect: A problem that occurs when treatment
affects healthy tissues or organs.
Smoldering myeloma (MY-eh-LOH-muh): A very
slow-growing type of myeloma in which abnormal
plasma cells (a type of white blood cell) make too
much of a single type of monoclonal antibody (a
protein). and
mouth sores.

32

.
Risk factor: Something that may increase the chance of
developing a disease. This protein builds up in the blood or is
passed in the urine. exposure to radiation or other
cancer-causing agents. pain.
obesity. nausea. Some examples of risk factors
for cancer include age.
Registered dietitian (dy-eh-TIH-shun): A health
professional with special training in the use of diet and
nutrition to keep the body healthy. use of tobacco products. certain eating habits.
Stem cell transplant: A method of replacing immature
blood-forming cells that were destroyed by cancer
treatment. Also called erythrocyte. lack of exercise. The stem cells are given to the person after
treatment to help the bone marrow recover and
continue producing healthy blood cells. a family history of certain
cancers. decreased blood cell counts. and certain genetic changes. A registered
dietitian may help the medical team improve the
nutritional health of a patient. hair loss.

such as bacteria or viruses. Also called palliative care.

Syngeneic stem cell transplant (SIN-juh-NAY-ik):

A procedure in which a patient receives blood-forming

stem cells (cells from which all blood cells develop)

donated by his or her healthy identical twin. social. and spiritual problems related to

a disease or its treatment. Also called

neoplasm.Steroid (STAYR-oyd): A type of drug used to relieve

swelling and inflammation.

Tissue (TISH-oo): A group or layer of cells that work

together to perform a specific function. The goal of supportive care is to prevent and

treat as early as possible the symptoms of a disease. such as

monoclonal antibodies.

Supportive care: Care given to improve the quality of

life of patients who have a serious or life-threatening

disease.

Transfusion (trans-FYOO-zhun): The infusion of

components of blood or whole blood into the

bloodstream. A vaccine

can help the body recognize and destroy cancer cells or

microorganisms. and symptom management.

33

.

comfort care. and

psychological. Some steroid drugs may

also have antitumor effects. or it may have been taken from the person

earlier and stored until needed. to find and attack specific

cancer cells.

Tumor (TOO-mer): An abnormal mass of tissue that

results when cells divide excessively or do not die

when they should.

Vaccine: A substance or group of substances meant to

cause the immune system to respond to a tumor or to

microorganisms. The blood may be donated from another

person.

side effects caused by treatment of a disease. Tumors may be benign (not

cancerous) or malignant (cancerous).

Targeted therapy (THAYR-uh-pee): A type of

treatment that uses drugs or other substances.

These cells are made by

bone marrow and help the body fight infections and

other diseases. White blood cells

include lymphocytes.

Watchful waiting: Closely monitoring a patient’s

condition but withholding treatment until symptoms

appear or change.

macrophages. x-rays

are used to treat cancer. In low doses. eosinophils. In high doses.Virus (VY-rus): A microorganism that can infect cells

and may cause disease.

White blood cell: WBC.

x-rays are used to diagnose diseases by making

pictures of the inside of the body. Also called observation. neutrophils.

34

.

X-ray: A type of high-energy radiation. and mast cells. Refers to a blood cell that

does not contain hemoglobin.

35

.gov/contact or send an email to
cancergovstaff@mail.National Cancer Institute Information
Resources

You may want more information for yourself. and
they will respond in English or Spanish.
supportive care. Use the online contact form at
http://www. It has
information about NCI’s research programs. contact NCI staff. Calls to the CIS are confidential and free. and ongoing clinical trials. The following NCI services
are available to help you. screening. funding
opportunities. Information specialists translate the
latest scientific information into plain language.
online assistance through LiveHelp at
http://www. treatment.nih. genetics.
Telephone: 1–800–4–CANCER (1–800–422–6237)

Internet
NCI’s Web site provides information from numerous
NCI sources.cancer. and your doctor.gov/espanol
If you’re unable to find what you need on the Web
site.cancer.
Also.

Telephone
NCI’s Cancer Information Service (CIS) provides
accurate. and the
general public. diagnosis.
Web site: http://www. It offers current information about cancer
prevention. up-to-date information about cancer to
patients and their families.gov
Spanish Web site: http://www. as well as
through TRS providers for the hearing or speech
impaired.gov.cancer. health professionals.gov/help.cancer. your
family. information specialists provide live. and cancer statistics.

gov/publications on the
Internet. on
the Internet.O.
Many are available in both English and Spanish. People in the United States and its
territories may use this Web site to order printed
copies. downloaded. MD 21227

Clinical Trials
• Taking Part in Cancer Treatment Research Studies

36

. This Web site also explains how people
outside the United States can mail or fax their
requests for NCI booklets.National Cancer Institute Publications

NCI provides publications about cancer.
• On the Internet: Many NCI publications may be
viewed.
You may order these publications by telephone. and ordered from
http://www. Box 24128

Baltimore. or by mail. including
the booklets and fact sheets mentioned in this booklet.
• By mail: NCI publications may be ordered by
writing to the address below:

Publications Ordering Service

National Cancer Institute

P.cancer.
• By telephone: People in the United States and its
territories may order these and other NCI
publications by calling the NCI’s Cancer
Information Service at 1–800–4–CANCER. You may also read them online
and print your own copy.

or Other
Organizations
• How To Find a Doctor or Treatment Facility If You
Have Cancer (also in Spanish)
• Cancer Support Groups: Questions and Answers
• National Organizations That Offer Services to
People With Cancer and Their Families (also in
Spanish)

Cancer Treatment and Supportive Care
• Chemotherapy and You (also in Spanish)
• Targeted Cancer Therapies: Questions and Answers
• Radiation Therapy and You (also in Spanish)
• Bone Marrow Transplantation and Peripheral Blood
Stem Cell Transplantation: Questions and Answers
(also in Spanish)
• Eating Hints for Cancer Patients (also in Spanish)
• Pain Control (also in Spanish)

Coping With Cancer
• Taking Time: Support for People with Cancer

Life After Cancer Treatment
• Follow-up Care After Cancer Treatment: Questions
and Answers
• Facing Forward: Life After Cancer Treatment (also
in Spanish)
• Facing Forward: Ways You Can Make a Difference
in Cancer

37

.Finding a Doctor. Support Groups.

Advanced or Recurrent Cancer
• Coping With Advanced Cancer
• When Cancer Returns

Complementary Medicine
• Thinking about Complementary & Alternative
Medicine: A guide for people with cancer
• Complementary and Alternative Medicine in Cancer
Treatment: Questions and Answers (also in Spanish)

Caregivers
• When Someone You Love Is Being Treated for
Cancer: Support for Caregivers
• When Someone You Love Has Advanced Cancer:
Support for Caregivers
• Facing Forward: When Someone You Love Has
Completed Cancer Treatment
• Caring for the Caregiver: Support for Cancer
Caregivers

38

.

please write to:
Office of Communications and Education
National Cancer Institute
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You must have permission to use or reproduce the
artwork in this booklet for other purposes. MD 20892–8323
You do not need our permission to reproduce or
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To inquire about permission to reproduce NCI
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diagnose.
designers. In addition. The written text of this
NCI booklet is in the public domain.The National Cancer Institute
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08-1575

Revised August 2008

Printed September 2008

.NIH Publication No.

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