Last Modified : 2006-06-07
Plasma cells develop from B lymphocytes (B cells), a type of white blood cell that is made in the bone marrow. Normally, when bacteria or viruses enter the body, some of the B cells will change into plasma cells. The plasma cells make a different antibody to fight each type of bacteria or virus that enters the body, to stop infection and disease.
Plasma cell neoplasms are diseases in which there are too many plasma cells, or myeloma cells, that are unable to do their usual work in the bone marrow. When this happens there is less room for healthy red blood cells, white blood cells, and platelets. This condition may cause anemia or easy bleeding, or make it easier to get an infection. The abnormal plasma cells often form tumors in bones or soft tissues of the body. The plasma cells also make an antibody protein, called M protein, that is not needed by the body and does not help fight infection. These antibody proteins build up in the bone marrow and can cause the blood to thicken or can damage the kidneys.
There are several types of plasma cell neoplasms.Plasma cell neoplasms include the following:
Multiple myelomaIn multiple myeloma, abnormal plasma cells (myeloma cells) build up in the bone marrow, forming tumors in many bones of the body. These tumors may prevent the bone marrow from making enough healthy blood cells. Normally, the bone marrow produces stem cells (immature cells) that develop into three types of mature blood cells:
As the number of myeloma cells increases, fewer red blood cells, white blood cells, and platelets are made. The myeloma cells also damage and weaken the hard parts of the bones. Sometimes multiple myeloma does not cause any symptoms. The following symptoms may be caused by multiple myeloma or other conditions. A doctor should be consulted if any of the following problems occur:
A tumor can damage the bone and cause hypercalcemia (a condition in which there is too much calcium in the blood). This can affect many organs in the body, including the kidneys, nerves, heart, muscles, and digestive tract, and cause serious health problems.
Hypercalcemia may cause the following symptoms:
In rare cases, multiple myeloma can cause organs to fail. This may be caused by a condition called amyloidosis. Antibody proteins build up and may bind together and collect in organs, such as the kidney and heart. This can cause the organs to become stiff and unable to function.
PlasmacytomaIn this type of plasma cell neoplasm, the abnormal plasma cells (myeloma cells) collect in one location and form a single tumor, called a plasmacytoma. A plasmacytoma may form in bone marrow or may be extramedullary (in soft tissues outside of the bone marrow). Plasmacytoma of the bone often becomes multiple myeloma. Extramedullary plasmacytomas commonly form in tissues of the throat and sinuses; these usually can be cured.
Symptoms depend on where the tumor is.
In macroglobulinemia, abnormal plasma cells build up in the bone marrow, lymph nodes, and spleen. They make too much M protein, which causes the blood to become thick. The lymph nodes, liver, and spleen may become swollen. The thickened blood may cause problems with blood flow in small blood vessels.
Symptoms of macroglobulinemia depend on the part of the body affected. Most patients with macroglobulinemia have no symptoms. A doctor should be consulted if any of the following problems occur:
In this type of plasma cell neoplasm, there are abnormal plasma cells in the bone marrow but there is no cancer. The abnormal plasma cells produce M protein that may be found during a routine blood or urine test. In most patients, the amount of M protein stays the same and there are no symptoms or problems. In some patients, MGUS may later become a more serious condition, such as multiple myeloma or lymphoma.
Age can affect the risk of developing plasma cell neoplasms.Plasma cell neoplasms are found most often in people who are middle aged or older.
Anything that increases your risk of getting a disease is called a risk factor. For multiple myeloma and plasmacytoma, other risk factors include the following:
The following tests and procedures may be used:
The prognosis (chance of recovery) depends on the following:
Treatment options depend on the following:
The process used to find out the amount of cancer in the body is called staging. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
Certain tests may be repeated to see how well the treatment is working.
The stage of multiple myeloma is based on the number of myeloma cells in the body.There are three stages for multiple myeloma. The number of myeloma cells in the body is determined by the following:
It is also important to know how well the kidneys are working.
The following stages are used for multiple myeloma:In stage I multiple myeloma, there is a low number of myeloma cells in the body.
Stage II multiple myelomaIn stage II multiple myeloma, there is a moderate number of myeloma cells in the body.
Stage III multiple myelomaIn stage III multiple myeloma, there is a large number of myeloma cells in the body.
Other plasma cell neoplasms are staged differently than multiple myeloma.In isolated plasmacytoma of bone, one plasma cell tumor is found in the bone, less than 5% of the bone marrow is made up of plasma cells, and there are no other signs of cancer.
Extramedullary plasmacytomaOne plasma cell tumor is found in the soft tissue but not in the bone or the bone marrow.
MacroglobulinemiaThere is no standard staging system for macroglobulinemia.
Monoclonal Gammopathy of Undetermined SignificanceIn monoclonal gammopathy of undetermined significance (MGUS), the amount of M protein in the blood stays the same, less than 10% of the bone marrow is made up of plasma cells, and the patient has no signs of cancer.
Multiple myeloma and other plasma cell neoplasms are refractory when the number of plasma cells continues to increase even though treatment is given.
Different types of treatments are available for patients with multiple myeloma and other plasma cell neoplasms. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Eight types of standard treatment are used:Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Other drug therapyCorticosteroid therapy
Corticosteroids are steroids that have antitumor effects in lymphomas and lymphoid leukemias.
Thalidomide
Thalidomide is a drug that prevents the growth of new blood vessels into a solid tumor.
Bisphosphonate therapy
Bisphosphonates are substances that bind to the surface of damaged bones and reduce new bone damage, allowing the bone to rebuild. This will also reduce the amount of calcium released into the blood from bone damage.
High-dose chemotherapy and radiation therapy with stem cell transplantThis treatment is a way of giving high doses of chemotherapy and radiation therapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy and radiation therapy are completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
Biologic therapyBiologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
Monoclonal antibody therapy is one type of biologic therapy. It is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
Radiation therapyRadiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
SurgerySurgery to remove the tumor may be done, usually followed by radiation therapy. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
Watchful waitingWatchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.
PlasmapheresisPlasmapheresis is a procedure in which blood is removed from the patient and sent through a machine that separates the plasma (the liquid part of the blood) from the blood cells. The patient's plasma contains the unneeded antibodies and is not returned to the patient. The normal blood cells are returned to the bloodstream along with donated plasma or a plasma replacement. Plasmapheresis does not prevent new antibodies from forming.
Other types of treatment are being tested in clinical trials. These include the following:Clinical trials are studying different combinations of biologic therapy, chemotherapy, steroid therapy, and drugs such as thalidomide or lenalidomide.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Patients without symptoms may not need treatment. When symptoms appear, treatment for any stage of multiple myeloma may include the following:
Treatment with bisphosphonate drug therapy may be given to slow bone loss and reduce bone pain. Treatment of amyloidosis is usually chemotherapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Standard treatment of isolated plasmacytoma of bone is usually radiation therapy.
Standard treatment of extramedullary plasmacytoma may include the following:
Treatment of Waldenström's macroglobulinemia may include the following:
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Treatment of monoclonal gammopathy of undetermined significance (MGUS) is usually watchful waiting, which will include regular blood tests to check the level of M protein in the blood.
Treatment of refractory plasma cell neoplasms may include the following: