In 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:

1. Red blood cells that carry oxygen and other materials to all tissues of the body.
2. White blood cells that fight infection and disease.
3. Platelets that help prevent bleeding by causing blood clots to form.

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:

1. Bone pain, often in the back or ribs.
2. Bones that break easily.
3. Fever for no known reason or frequent infections.
4. Easy bruising or bleeding.
5. Trouble breathing.
6. Weakness of the arms or legs.
7. Feeling very tired.

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.

Other factors affecting prognosis

There are other factors that can affect your prognosis, apart from the stage of your cancer. One consideration is how well you are overall. Doctors call this your ‘performance status'. You may see this written PS. A score of 0 means you are completely able to look after yourself. A score of 1 means you can do most things for yourself, but need some help. The scores continue to go up, depending on how much help you need. This is relevant to survival because overall, the fitter people are, the better able they are to withstand their cancer and treatment. This is particularly important in myeloma because fitter patients can withstand more intensive treatment.

What is chemotherapy?

Chemotherapy uses anti cancer or ‘cytotoxic' drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. As they circulate in the blood they can reach cancer cells wherever they are in your body.

Chemotherapy by mouth

Your doctor is more likely to suggest treatment with tablets if you are aged over 70 or are not fit enough to have a stem cell transplant. You will usually have the chemotherapy drugs melphalan or cyclophosphamide. Doctors often give a steroid drug called prednisolone with this chemotherapy. So you may see or hear it called MP or CP.

Occasionally doctors use chemotherapy tablets as initial treatment for people going on to have a stem cell transplant. They might use the chemotherapy drug idarubicin (Zavedos) with steroids. This combination is called Z-Dex.