The most common plasma cell neoplasm is called multiple myeloma. Plasma cell neoplasms are abnormal growths in the white blood cells that produce antibodies. Antibodies are proteins in the immune system that help our bodies fight disease and infection. Some of these abnormal growths are benign, and some are cancerous. Multiple myelomas account for 1 percent (22,000 annually) of all cancers diagnosed in America.

In multiple myeloma, abnormal plasma cells build up in the bone marrow and form many bone tumors. Bone tumors can prevent our bone marrow from creating healthy blood cells. These include red cells to carry oxygen, white cells to fight infection, and platelets, which help prevent bleeding. It can damage bone strength and lead to breaks. Myeloma is not cancer of the bone but affects bones.

Other plasma cell neoplasms and related conditions:

• Monoclonal gammopathy of undetermined significance (MGUS): This condition is usually not cancerous, but can progress to multiple myeloma.
• Smoldering myeloma: Patients with smoldering myeloma have more plasma cells in the bone marrow, but no organ damage. It carries the increased risk of turning into multiple myeloma. Patients with smoldering myeloma get observed without any therapy, except in clinical trials.
• Plasmacytoma: Plasmacytoma is cancerous. It differs from multiple myeloma in that the abnormal plasma cells (myeloma cells) are in one place and form one tumor. The tumor can sometimes be removed for a cure. Plasmacytomas can be inside a bone (which can become multiple myeloma) or can occur outside the bone. When outside the bone, they typically grow in tissues of the throat, tonsil or paranasal sinuses.
• Amyloidosis: Amyloidosis occurs when too much amyloid (protein) accumulates in tissues or organs. When the amyloid protein deposits increase, it interferes with function and may cause organ failure. Systemic amyloidosis is the most common. Although amyloidosis is not cancer, it may be related to blood cancers like multiple myeloma.

Tests

Our goal at Sylvester is to get a correct diagnosis of your cancer, often down to the genetic level. This allows us to determine the best treatment options for you. After a complete medical history and physical, testing for myeloma includes:

Laboratory Tests (blood and urine analysis by our pathologists — experts in microscopic cellular changes):

• Complete blood count (CBC): A blood sample is studied to review the number and percentage of red and white blood cells. Platelet count is also measured, as is hemoglobin, the protein that carries oxygen in the blood.
• Blood chemistry studies: These studies test blood samples to measure the amounts of substances released into the blood by organs and tissues.
• 24-Hour Urine Collection: This collects body proteins in urine, which can be studied.
• Quantitative Immunoglobulins: Immunoglobulins are antibodies in the blood — proteins made by the immune system. Antibodies fight bacteria, viruses, and toxins. This blood test helps evaluate the health of your immune system. It measures an excess or deficiency in one or more of the immunoglobulin classes.
• Serum Protein Electrophoresis (SPEP): This test measures the presence of proteins called albumins and globulins in the blood to help us identify any disease.
• Serum Free Light Chain Testing: Light chains are proteins made by our bodies' plasma cells. Serum free light chain testing can help detect, diagnose, and monitor plasma cell disorders like multiple myeloma and primary amyloidosis. This test also is used to check the effectiveness of treatment.

Skeletal Bone Survey
X-rays taken of all bones to look for damage.

Magnetic Resonance Imaging (MRI)
Magnets, radio waves, and a computer help produce detailed images of organs and structures within the body.

Computed Tomography (CT or CAT) Scan
This diagnostic imaging procedure uses X-rays and computer technology to produce horizontal images of the body. The scans show detailed pictures of any part of the body, including the bones, muscles, fat, and organs.

Positron Emission Tomography (PET) Scan
Radioactive-tagged glucose (sugar) is injected into the blood. Cancerous cells use glucose for energy more than normal cells, so the cancer cells appear highlighted on a scan. Many small tumors can be found using this machine.

Bone Marrow Biopsy
Bone marrow aspiration (biopsy) involves taking a small amount of bone marrow fluid (aspiration) or solid bone marrow tissue (called a core biopsy), usually from the hip bones. It is examined for the number, size, and maturity of blood cells. The tissue sample obtained can be viewed under a microscope to look for certain changes in the chromosomes in a test called a cytogenetic/FISH analysis.

• OnControl^®  Bone Marrow Sampling Device: Developed by one of our oncologists, the powered hand-held device provides for consistent bone marrow samples for diagnosis and treatment monitoring. Our team can obtain representative bone marrow samples in less than five minutes with less pain for an accurate diagnosis the first time.

Genomic Tumor Profiling, Also Called Somatic DNA Testing
This test is the driver for precision medicine. It looks at your tumor’s molecular signature to identify characteristics indicating how aggressive it is and what types of treatment will work best. Through this genomic profiling, your pathologist can identify groups of mutations in your tumor tissue sample and create a tumor profile for your specific cancer. Genomic profiling also helps your team of experts predict the aggressiveness of your cancer is and how likely it is to spread.

Treatments

Treatments for multiple myeloma and plasma cell neoplasms include chemotherapy, corticosteroids, targeted therapy (proteasome inhibitors), high-dose chemotherapy (with stem cell transplant), biologic therapy, radiation therapy, surgery to remove the tumor (followed by radiation therapy), and active surveillance. Clinical trials are exploring new drug and treatment combinations.

The main treatments and their goals for myeloma are listed below in the order from the most to the least common. You may have more than one therapy in your treatment plan.

Chemotherapy
Chemotherapy is the main way to treat multiple myeloma. The treatment uses drugs to kill cancer cells. Chemotherapy medicines may be injected into your cerebrospinal fluid (CSF). This procedure is called intrathecal chemotherapy. It helps to prevent cancer growth and can reach cancer cells around the brain and nervous system.

We offer intravenous (infusion) chemotherapy at the Comprehensive Treatment Unit (CTU) at Sylvester's main location in Miami. This 12,000-square-foot unit includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, Coral Gables, and Deerfield Beach locations.

Immunotherapy
This treatment stimulates the body's natural immune system to fight diseases. There are currently two main immunotherapy drugs that help keep multiple myeloma cells from reproducing within the bone marrow. The drugs help stop tumors from forming new blood vessels.

• Revlimid® (lenalidomide) is an oral medication (pill) that is effective across the spectrum of myeloma diseases.
• Pomalyst® (pomalidomide) is a newer immunomodulator drug that is similar to Revlimid, but more potent. It is FDA approved for use in patients with relapsed/refractory myeloma.

Interferon
Interferons are hormone-like substances normally produced by the body, but that get produced in the laboratory. Alpha interferon can be given as a drug to slow the growth of myeloma cells and prolong remission after chemotherapy treatment.

Targeted Agents
These drugs are sometimes called biologics and are made from living cells. Biologics target certain parts of the cell and the signals cells need for cancer to develop and grow. In general, they inhibit the growth and spread of tumors by targeting specific parts of malignant cells, killing them.

Corticosteroids
These steroid hormones, such as dexamethasone and prednisone, can be an important part of the treatment of multiple myeloma. They may be used alone or combined with other drugs. Corticosteroids have an anti-tumor effect and can help decrease nausea and vomiting that chemo may cause.

Radiation Therapy
The goal of radiation therapy in multiple myeloma treatment programs is to ease symptoms. It can help with bone pain and help prevent or treat a fracture in the area of the bone weakened by cancer. It may also be used to cure a single collection of myeloma cells called a plasmacytoma.

Stem Cell Transplants
Stem cells get removed from your bone marrow or blood before a transplant (autologous). They may also be from a sibling or unrelated donor (allogeneic). High dose chemotherapy and radiation therapy before the transplant kill as many of the cancer cells as possible. The healthy, new stem cells are put back in your body. The new stem cells allow your healthy blood cells to grow again in your body.

Active Surveillance
If you have cancer that is growing very slowly (unlikely do any harm for a long time), we may recommend holding off on treatment. Instead, we will monitor your cancer through regular appointments and testing. If we see any changes that might require treatment, we will recommend a preferred treatment plan.

Surgery
Surgery can remove plasmacytomas and other tumors. Radiation therapy often follows surgery.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has recognized Sylvester for its outstanding work conducting research in its laboratories, treating patients in its clinics and hospitals, and reaching out to medically underserved communities with innovative prevention strategies.

Advanced radiation oncology tools. Our RapidArc® radiotherapy system delivers intensity modulated external radiation therapy (IMRT). These tools lead to more efficient and effective treatments, shorter treatment times, pinpoint accuracy in tumor targeting, and less damage to surrounding healthy tissue.

More cancer clinical trials than any other South Florida hospital. If appropriate for your cancer and stage, our clinical trials provide you with easy access to the very newest ways to treat and potentially cure your cancer.

OnControl^® bone marrow sampling device. Developed by one of our oncologists, this powered hand-held device provides for consistent bone marrow samples for diagnosis and treatment monitoring. This device obtains bone marrow samples in less than five minutes with less pain for an accurate diagnosis the first time.

All your care in one place. Many patients in our Adult Stem Cell Transplant Program come from other area hospitals. By having your blood disorder treated at Sylvester, stem cell transplant is available here, fully integrated with your cancer treatment if needed.