The Myeloma Alphabet Soup Handbook
Glossary of Myeloma Terms

Absolute lymphocytosis: The presence of more than 15,000 lymphocytes in a cubic millimeter of blood.

Active Immiunity: Immunity produced by the body in response to stimulation by a desease-causing organism or a vaccine.

Agammaglobulinamia: An almost total lack of immunoglobins, or antibodies.

Albumin: A protein found in nearly every animal. A constisuent of the blood serum which in cancer patients is reduced in amount but which gathers abundantly in cancers cells.

Alkylating agents: The genetic material, or DNA, of a cell is made up of molecules, called bases, that must be duplicated and precisely paired when the cell divides. Alkylating agents interfere with the orderly pairing process and prevent successful division. Some of the prominent drugs in this family: Cytoxan and Melphalan.

Allogeneic bone marrow transplantation: A procedure in which a patient receives bone marrow from a compatible, though not genetically identical, donor.

Alopecia: Partial or complete loss of hair. This may result from radiotherapy to the head (hair may not completely return after therapy) or from certain chemotherapeutic agents (hair always returns).

Ambulatory infusion: The administration of chemotherapy by a small pump device usually worn under the clothes. The pump delivers anticancer drugs slowly and gradually, with minimal or no side effects. Since there is no need to remain in the hospital or even at home, this method allows patients to work and carry on with their normal activities.

Amino acids: The building blocks of proteins, analogous to the freight cars making up a train.

Amyloidosis: A condition in which myeloma light chains (Bence Jones proteins) are deposited in tissues and organs thoughtout the body. This occurs more commonly with lambda versus kappa Bence Joses proteins. In patients with amyloidosis, the light chain proteins bind to certain tissues such as heart, nerves and kidney rather than being excreted out of the body through the kidney.

Anemia: A below-normal number of red blood cells.

Anergy: A state of unresponsiveness, induced when the T cell's antigen receptor is stimulated, that effectively freezes T cell responses pending a "second signal" from the antigen-presenting cell.

Angiogenesis: The growth of new blood vessels. This may be stimulated by certain chemicals produced by cancers, and may be a requirement for cancers to spread. New treatments are being investigated to prevent this new blood vessel formation.

Antimetabolites: These compounds chemically resemble vitamins or other nutrients and are therefore absorbed by the cell. But once inside, they disrupt the cell's metabolic machinery. Such agents include methotrexate, 5-FU and 6-mercaptopurine (6-MP). 5-FU, for example, resembles uracil, a substance the cell needs to make DNA. It is not, however, a proper substitute and effectively blocks DNA synthesis.

Antibiotics: Some of these were discovered in research for new drugs to fight infections. They disrupt the synthesis of RNA, a substance the cell needs to make essential proteins. Two leading antibiotics in cancer therapy: Bleomycin and Adriamycin.

Antibodies: Proteins produced by certain white blood cells in response to the presence of foreign substances (antigens). Each antibody can bind to only one specific antigen. The purpose of this binding is to help destroy that antigen.

Antibody: A protein (gamma globulin) made by the body in response to a specific foreign protein, or antigen. The antigen may result from an infection, a cancer or some other source. If the same alien substance attacks again, the white blood cells are able to recognize it and reproduce the specific antibody to fight it.

Antibody-dependent cell-mediated cytotoxicity: An immune response in which antibody, by coating target target cells, makes them vulnerable to attack by immune cells.

Antiemetics: Drugs given to prevent or minimize nausea and vomiting.

Antigen: Any substance that the body regards as foreign. When introduced into the body, an antigen causes the immune system to produce a corresponding antibody to fight it.

Antigen-presenting cells: B cells, cells of the monocyte lineage (including marcophages as well as dendritic cells), and various other body cells that "present" antigen in a form that T cells can recognize.

Antimetabolites: A family of antitumor drugs that resemble normal vitamins or building blocks of metabolism. They bind to the tumor's enzymes and chemical pathways. The tumor cells "think" they are getting the real vitamin or building block and starve to the point where they can't grow or multiply.

Antimicrobial therapy: Treatment to kill microorganisms (such as bacteria or fungi) or to suppress their growth.

Antinuclear antibody: An autoantibody directed against a substance in the cell's nucleus.

Antiserum: Serum that contains antibodies.

Antitoxins: Antibodies that interlock with and inactivate toxins produced by certain bacteria.

Aplastic anemia: A form of anemia that occurs when the bone marrow fails to produce adequate numbers of blood cells.

Apoptosis: The programming of cells in the body to become old and die at the correct time. This vital feature of healthy human cells allows for replacement of tissues as needed. Cancer cells may persist because they may escape apoptosis. Some new methods of therapy are being studied to reprogram cancer cells to learn to die again.

Appendiclar skeleton: The long bones, such as the arms and legs, which are attached to spine, chest and pelvis.

Aspirate: To remove material from a body cavity by suction through a needle. Also refers to the material that is removed in this way.

Asymptomatic: Without symptoms.

Autoantibody: An antibody that reacts against a person's own tissue.

Autoimmunity: A condition in which the body's immune system fights and rejects its own tissues.

Autologous bone marrow transplantation: A procedure in which bone marrow that had been removed from a patient is given back to that patient.

Avascular Necrosis:

Axial skeleton: The skill, spine and pelvis regions of the skeleton.

Bacterium: A microscopic organism composed of a single cell. Many but not all bacteric cause disease.

Basophil: A white blood cell that contributes to inflammatory reactions. Along with mast cells, basophils are responsible for the symptoms of allergy.

B cells: White blood cells, also known as B lymphocytes, that develop in the bone marrow and are capable of producing antibodies.

Bence Jones: The name used to identify myeloma protein present in the urine. The myeloma or M-protein consists of kappa or lambda light chains. The amount of Bence Jones protein is expressed in terms of G per 24 hours. Normally a very small amount of protein (less than 0.1 G per 24 hrs.) can be present in the urine but this is albumin rather than Bence Jones protein. The presence of any Bence Jones protein is abnormal. Named after British physician Henry Bence Jones (1813-1873), who first discovered the protein.

Benign (be-NINE): Not cancerous; does not invade nearby tissue or spread to other parts of the body.

Beta-2-Microglobulin: B2M, the light chain of the HLA antigen, is an important independent predictor of survival in myeloma. High serum levels predict early death; however, among patients who survive 2 years, their initial B2M is no longer predictive of subsequent survival. In contrast to PCPI, which is an expression of the proliferative rate of the myeloma, serum levels of B2M reflect the tumor burden. Since B2M is a low molecular-weight protein that can pass the glomerulus, serum levels are also a reflection of renal function. Thus, measurement of serum B2M provides, in effect, a one-test index which reflects the combined effect of 2 adverse factors, high tumor burden and impaired renal fuction. When B2M and PCLI are combined, it is possible to assign half the patients either to a very favorable prognostic group in which both values are low and the prognosis approaches 6 years or to a very poor prognosis group in which both values are high and the prognosis is well under 2 years. The remaining 50% of patients have an intermediate, less well defined prognosis by this system.

Beta-2-microglobulin (B2M) forms the small invariable light chain subunit of class I HLA antigens on the cell membrane of all nucleated cells. During the continuous turnover of the HLA molecules, B2M is shed from the cell membrane into blood. Lymphocytes are the main source of serum free B2M. Serum B2M concentration is increased in renal diseases, various malignant diseases and some inflammatory and autoimmune disorders. In lymphatic malignancies serum B2M has significant prognostic value. Interferons (IFNs) have the ability to enhance the expression of class I and II histocompatibility antigens. Accordingly, IFNs cause a rise in formation and release of B2M. Currently, treatment with IFN alpha is used in diseases, like multiple myeloma, where serum B2M measurements are used to assess tumor burden. We have measured serum B2M levels during IFN alpha treatment in patients with both multiple myeloma and chronic myeloproliferative diseases, and IFN alpha caused a significant increase in serum B2M. It can be concluded that use of IFN alpha abolishes the value of serum B2M as an indicator of disease activity.

Prognostic value of pretreatment serum beta-2 microglobulin in myeloma.

Biological response modifier (BRM): A substance that boosts, directs, or restores the body's normal immune (defense) system. Examples include interferon, IL-2 and LAK cells. BRMs are produced naturally in the body and can also be manufactured in the laboratory.

Biological therapy (by-o-LOJ-i-kul): Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also called immunotherapy.

Biopsy (BY-op-see): The removal of a sample of tissue, which is then examined under a microscope to check for cancer cells. When only a sample of tissue is removed, the procedure is called incisional biopsy; when the whole tumor is removed, it is excisional biopsy. Removing tissue or fluid with a needle is called needle biopsy or needle aspiration.

Bisphosphonate: A type of drug which binds to the surface of bone where it is being resorbed (eaten into) and protects against osteoclast activity.

Blood-brain barrier: A network of blood vessels located around the central nervous system with very closely spaced cells that make it difficult for otentially toxic substances-including anticancer drugs-to penetrate the blood vessel walls and enter the brain and spinal cord.

Bolus (or "Push"): chemotherapy Administration of intravenous chemotherapy over a short time, usually five minutes or less. The other method is called infusion chemotherapy, which may last from 15 minutes to several hours or days.

Bone marrow: The soft, spongy tissue in the center of many bones; it produces white blood cells, red blood cells, and platelets.

Bone marrow aspiration: The removal of a sample of fluid and cells from the bone marrow for examination under a microscope. Aspiration is done with a needle. The results of the examination tell the doctor whether cancer cells are present. MM is probable if more than 10% of the cells seen in the sample are plasma cells.

Bone marrow biopsy (BMB): The removal of a sample of solid tissue from the bone marrow for examination under a microscope. The results of the examination tell the doctor whether cancer cells are present.

Bone marrow examination: The process of removing bone marrow by withdrawing it through a needle for pathological examination. It is usually withdrawn from the breast bone (sternum) or the hip bone. Both these bones are just under the skin, making the removal of marrow easy, safe and only momentarily uncomfortable with a local anesthetic. The procedure takes about 10 minutes-nine and a half minutes for the anesthetic to take effect and 30 seconds for the actual procedure.

Bone marrow suppression: A decrease in one or more of the blood counts. This condition can be caused by chemotherapy, radiation, disease or various medications.

Bone marrow transplantation (BMT): A procedure in which doctors replace marrow destroyed by treatment with high doses of anticancer drugs or radiation. The replacement marrow may be taken from the patient before treatment or may be donated by another person. When the patient's own marrow is used, the procedure is called autologous (aw-TOL-o-gus) bone marrow transplantation.

Bone remodeling: The coordinated, or coupled activity of osteoclasts (which resorb or destory bone) and osteoblasts (which create new bone matrix) to form new bone while destroying old bone in a balanced way such that the total amount of bone remains the same.

C-reactive progein: Is an acute-phase reactant that may correlate with interleukin-6 levels.

Calcitonin: A hormone secreted by the thyroid gland which blocks bone resorption temporarily.

Calcitrol: An activated form of Vitamin D useful for persons who require extraVitamin D.

Calcium: An important body mineral that is a vital component of bone. The calcium level may be elevated if tumors involve bone.

Cancer: A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissue and can spread through the bloodstream and lymphatic system to other parts of the body.

Carcinogen (kar-SIN-o-jin): A substance or agent that is known to cause cancer.

Catheter (KATH-e-ter): A thin plastic tube. When a catheter is place in a vein, it provides a pathway for drugs, nutrients, or blood products. Blood samples also can be removed through the catheter.

Cellular immunity: Immune protection provided by the direct action of immune cells (as distinct from soluble molecules such as antibodies).

Cell surface marker: An identifying substance on the surface of cells.

Chemotherapy (kee-mo-THER-a-pee): Treatment with anticancer drugs.

Chromosome: A structure in the nucleus of a cell containing DNA, which transmits genetic information. Normally, 46 chromosomes appear as a long thread inside each human cell.

Clinical: Refers to the treatment of humans, as opposed to animals or laboratory studies. Also refers to the general use of a treatment by a practicing physician, as opposed to research done in cancer research centers ("preclinical").

Clinical trials: The procedure in which new cancer treatments are tested in humans. Clinical trials are conducted after experiments in animals and preliminary studies in humans have shown that a new treatment method might be effective.

Clotting episodes: The inappropriate development of blood clots due to disease.

Colony-stimulating factors: Substances that stimulate the production of blood cells. Treatment with colony-stimulating factors (CSF) can help the blood- forming tissue recover from the effects of chemotherapy and radiation therapy. These include granulocyte colony-stimulating factors (G-CSF) and granulocyte-macrophage colony-stimulating factors (GM-CSF).

Combination chemotherapy: The use of several anticancer drugs at the same time. Most chemotherapy is now given this way, since it is a much more effective method.

Committed cells: Cells that have matured sufficiently that microscopic examination can reveal what type of cell they will be when fully matured.

Complement: A complex series of blood proteins whose action "complement" the work of antibodies. Complement destroys bacteria, produces inflammation, and regulates immune reactions.

Complete Remission/Complete Response (CR): "Remission" and "response" are used interchangeably. CR is the common abbreviation for both. For many years, particularly in U.S. studies CR has meant > 75% reduction in serum myeloma protein level along with improvement in symptoms and signs of myeloma. With the introduction of high dose therapy plus transplantation, the definition of CR has become more stringent; absence of myeloma protein from serum and/or urine by standard testing; absence of myeloma cells from the bone marrow and /or other areas of myeloma involvement; clinical remission and improvement of other laboratory parameters to normal. The absence of myeloma cells and myeloma protein does not mean that the myeloma is completely gone. More sensitive testing methods can usually detect the minute levels of myeloma that are indeed present. CR does not mean cure: relapse is influenced by the type of initial treatment as well as the maintenance used (e.g. alpha interferon).

Cooperative groups: Clinical trials of new cancer treatments require many patients, generally more than any single physician or hospital can see. A number of physicians and/or hospitals form a cooperative group to treat a large number of patients in the same way so that the effectiveness of a new treatment can be evaluated quickly.

Corticosteroids: Complex chemical compounds produced in the outer layer of the adrenal gland, which is located near the kidney. They are important in regulating body chemistry. Corticosteroids can be manufactured in the laboratory and used as drugs.

Coupling: The normal coordination between osteoblasts and osteoclasts to maintain a balance state of new bone production and destruction.

Creatinine: A small chemical compound normally excreted by the kidney. If the kidney are damaged the serum level of creatinin builds up resulting in an elevated serum creatinine. The serum creatinine test is the one most commonly used to measure kidney function.

Creatinine clearance: A sensitive test of kidney function that requires a 24-hour urine sample and a blood sample. The test is often required to make sure it is safe to give anticancer drugs that may be toxic to the kidneys.

Here is a website that discusses creatinine and creatinine clearance:

CT or CAT scan: Detailed pictures of areas of the body created by a computer linked to an x-ray machine. Also called computed tomography scan or computed axial tomography scan. Diagnostic Tests and Procedures:

Cytokines: Hormones or growth factors produced by cells that help regulate cell processes.

Cytoplasm: The fluid, liquid, or "watery" part of a cell; the cytoplasm surrounds the nucleus of the cell.

Cytotoxic T cells: A subset of T lymphocytes that can kill body cells infected by viruses or transformed by cancer.

Differentiation: The process in which cells mature and become specialized.

DNA: (Deoxyribonucleic acid) nucleic acid present in all living cells. DNA contains the genetic information of the cell.

DEXA: (Dual Photon X-ray Absorptionmetry) An X-ray study which can measure the amount of bone loss: the best measure of bone density.

Dendritic cells: White blood cells found in the spleen and other lymphoid organs. Dendritic cells typically use threadlike tentacles to enmesh antigen, which they present to T cells.

Dose limiting: A side effect, complication or risk that makes it impossible or unwise to exceed a specific dose of a chemotherapeutic agent. A total dosage of bleomycin of more than 400 units, for example, may produce severe lung scarring. Lung toxicity is, therefore, dose limiting.

Drug resistance: The development of resistance in cancer cells to a specific drug or drugs. If resistance develops, a patient in remission from chemotherapy may relapse despite continued administration of anticancer drugs

Dysphagia: Difficulty in swallowing; a sensation of food sticking in the throat.

Electrophoresis: A laboratory test in which a patient's serum is subjected to a separation technique involving movement in an electric field. The amount of movement is determined by the size and the electric charge of the protein involved. The technique allows both the calculation of the amount of myeloma protein as well as the identification of the specific M spike characteristic for each patient. Used as a tool for both diagnosis and monitoring.

Emesis: A fancy word for vomiting.

Enzyme: A protein, produced by living cells, that promotes the chemical processes of life without itself being altered.

Eosinophil: A white blood cell that contains granules filled with chemicals damaging to parasites, and enzymes that damp down inflammatory reactions.

Epitope: A unique shape or marker carried on an antigen's surface, which triggers a corresponding antibody response.

Erythrocytes: Give the blood it's red color. They carry an iron-rich protein known as hemoglobin, which picks up oxygen from the lungs, transports it and releases it to the organs and tissue. When people are short of red blood cells, they are anemic. Anemia can cause weakness and lack of energy, dizziness, shortness of breath, headaches, and irritability.

Erythropoietin: Erythropoietin is a hormone produced by the kidneys. Red cell production is stimulated by erythropoietin. Myeloma patients with damaged kidneys don't produce enough erythropoietin and can become anemic. Injections with synthetic erythropoietin (e.g. procrit) can be helpful.

Extramedullary plasmacytoma: Patients with isolated plasma cell tumors of soft tissues, most commonly occurring in the tonsils, nasopharynx, or paranasal sinuses.

Fibrous: Containing fibers (threadlike noncellular structures). When bone marrow becomes fibrotic, it can be difficult to obtain a bone marrow sample.

Gamma globulin: Proteins in the blood that contain antibodies, part of the body's defense against infection.

Gene: A unit of genetic material (DNA) that carries the directions a cell uses to preform a specific function, such as making a given protein.

Gene therapy: Treatment that alters genes (the basic units of heredity found in all cells in the body). In early studies of gene therapy for cancer, researchers are trying to improve the body's natural ability to fight the disease or to make the tumor more sensitive to other kinds of therapy.

Genetic: Inherited; having to do with information that is passed from parents to their children through DNA.

Glucocorticosteroid: Anther name for steroid, a type of drug that helps control multiple myeloma cells.

Graft: Tissue taken from one person (donor) and transferred to another person (recipient) or taken from one part of a person's body and transferred to another part of that same person's body.

Graft-versus-host disease: A condition that may develop after allogeneic bone marrow transplantation; the transplanted marrow (graft) attacks the patient's (host's) organs.

Granulocyte: White blood cells filled with granules containing potent chemicals that allow the cells to digest microorganisms, or to produce inflammatory reactions. Neutrophils, eosinophils, and basophils are examples of granulocytes.

Granulocyte colony-stimulating factor (G-CSF): A growth factor that promotes the production and development of granulocytes.

Group C status: A designation for investigational anticancer drugs that are effective against one or more forms of cancer but have not been approved for general marketing by the U.S. Food and Drug Administration. Doctors may obtain Group C drugs from the National Cancer Institute to treat patients who would benefit from their use.

Helper T cells: A subset of T cells that typically carry the T4 marker and are essential for turning on antibody production, activating cytotoxic T cells, and initating many other immune reponses.

Hematocrit: The percentage of blood that consists of red blood cells. Sometimes expressed as packed cell volume (PCV).

Hematologist: A doctor who specializes in studying and treating diseases of the blood.

Hematopoiesis: The formation and development of blood cells, usually taking place in the bone marrow.

Hemoglobin: The protein found in red blood cells that carries oxygen. Hemoglobin gives blood its red color.

Hemolytic anemia: Anemia resulting from the breakdown of red blood cells in the bloodstream before the end of their usual life span of 120 days.

Histocompatibility testing: A method of matching the self antigens (HLA) on the tissues of a transplant donor with those of the recipient. The closer the match, the better the chance that the transplant will take.

Hormone therapy: Treatment that prevents certain cancer cells from getting the hormones they need to grow.

Hormones: Chemicals produced by glands in the body. Hormones control the actions of certain cells or organs.

Host: In the case of organ or bone marrow transplantation, the recipient of the organ or marrow.

Hybridoma: A hybrid cell created by fusing a B lymphocyte with a long-lived neoplastic plasma cell, or a T lymphocyte with a lymphoma cell. A B-cell hybridoma secretes a single specific antibody.

Hypercalcemia: Elevation in the blood calcium level. This is common in myeloma patients and usually results from bone destruction with release of calcium into the blood stream. It is often associated with reduced kidney function since calcium can be toxic to the kidneys. For this reason hypercalcemia is usually treated on an emergency basis using IV fluids combined with drugs to reduce bone destruction (Pamidronate[Aredia]) along with direct treatment for the myeloma.

Hypogammaglobulinemia: Abnormally low levels of immunoglobulins.

Human leukocyte antigens (HLAs): A series of proteins on the surface of cells that are important in transplantation and transfusion. When bone marrow transplantation is being considered, the HLAs on white blood cells (leukocytes) of the patient and the potential donor are compared. HLAs on platelets are matched when platelets are being transfused. A perfect HLA match occurs only between identical twins.

Idiotypes: The unique and characteristic parts of an antibody's variable region, which can themselves serve as antigens.

IgA, IgG: The two most common types of multiple myeloma. The A and the G refer to the type of protein produced by the myeloma cells. The myeloma protein, which is an immunoglobulin, consists of two heavy chains, (e.g. G type) combined with two light chains, which are either kappa or lambda. The kappa and lambda light chains can be produced alone, resulting in either kappa or lambda light chain (Bence Jones) myeloma. The terms heavy and light refer to the size or molecular weight of the protein with the heavy chains being larger than the light chains. Since the light chains are smaller, they are more likely to leak out into the urine resulting in urine Bence Jones protein. Note: Myeloma proteins are very different from food protein which are necessary as part of the diet to build normal body tissue such as muscle, skin and other body organs. Therefore, an abundance of myeloma protein does not mean one should adopt a low protein diet.

IgD, IgE: Two types of myeloma similar to IgA and IgG but which occur much less frequently.

Immune complex: A cluster of interlocking antigens and antibodies.

Immune response: The reactions of the immune system to foreign substances.

Immune system: The complex group of cells and organs that defends the body against infection and disease.

Immunocompetent: Capable of developing an immune response.

Immunoelectrophoresis: A way to separate serum gamma globulins-called IgA, IgG and IgM-into groups according to their immunologic qualities.

Immunofixation: Immunologic method used to identify M-protein type (IgG, IgA, kappa or lamdba). Very sensitive inmmunnnostaining technique which identifies the exact heavy and light chain type of the M-protein.

Immunoglobulins: A family of large protein molecules, also known as antibodies.

Immunosuppression: Reduction of the immune responses, for instance by giving drugs to prevent transplant rejection.

Immunotherapy (IM-yoo-no-THER-a-pee): See Biological therapy.

Immunotoxin: A Monoclonal antibody linked to a natural toxin, a toxic drug, or a radioactive substance.

Incidence: The number of new cases of a specific disease occurring during a given period.

Infusion pumps: Small, preloaded mechanical devices used to continuously administer intravenous chemotherapy over a designated time.

Interferons: Natural substances produced in response to infections. They have been created artificially by recombinant DNA technology in an attempt to control cancer.

Interleukins: Proteins that carry regulatory signals between blood-forming cells. Large quantities of interleukins can be produced in the laboratory and used to treat some forms of cancer. Interleukins are biological response modifiers.

Interleukin-2 (in-ter-LOO-kin): A type of biological response modifier (a substance that can improve the body's natural response to disease). It stimulates the growth of certain disease-fighting blood cells in the immune system.

Interleukin-6: A growth factor essential to myeloma cells.

Intramuscular (IM): The injection of a drug into a muscle; from there it is absorbed into the circulation.

Intrathecal: Into the fluid around the brain and spinal cord--a way of injecting drugs.

Intravenous: Into a vein, a way of injecting drugs.

Impaired renal function: As measured by creatinine in serum, worsens the prognosis whatever the stage of the disease. If the patient has a serum creatinine level of more the 2.0 mg/100 ml serum, renal function is considered impaired.

Kidney failure: Renal failure Malfunction of the kidneys due to disease or the toxic effects of drugs or chemicals. Urine volume may or may not be diminished.

Kupffer cells: Specialized macrophages in the liver.

LAK cells: Lymphocytes transformed in the laboratory into lymphokine-activated killer cells, which attack tumor cells.

Langerhans cells: Dendritic cells in the skin that pick up antigen and transport it to lymph cells.

Leukocytes: All white blood cells.

Leukocytosis: An increase in the number of leukocytes in the blood.

Leukopenia: A below-normal number of white blood cells.

Leukoplakia: White plaque on the mucous membranes of the mouth and gums. This may be precancerous.

Light chain: In 75% of patients, the plasma cells also produce monoclonal incomplete immunoglobulins, called light chains. These are exereted in the urine and are the so-called Bence Jones proteins.

Local treatment: Treatment that affects the tumor and the area close to it.

Lymph (limf): An almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease.

Lymphatic system (lim-FAT-ik): The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. This system also has channels that carry lymph.

Lymphatic vessels: A bodywide network of channels, similar to the blood vessels, which transport lymph to the immune organs and into the bloodstream.

Lymph nodes: Small bean-shaped organs of the immune system, distributed widely throughout the body and linked by lymphatic vessels. Lymph nodes are garrison of B, T, and other immune cells.

Lymphocytes: Small white blood cells produced in the lymphoid organs and paramount in the immune defenses.

Lymphoid organs: The organs of the immune system, where lymphocytes develop and congregate. They include the bone marrow, thymus, lymph nodes, spleen, and various other clusters of lymphoid tissue. The blood vessels and lymphatic vessels can also be considered lymphoid organs.

Lymphokines: Powerful chemical substances secreted by lymphocytes. These soluble molecules help direct and regulate the immune responses.

Lytic lesion: A hole in the bone caused by replacement of bone with something soft; shows up on X-ray as a dark shadow in the gray-white area of bone.

Macrophage: A large and versatile immune cell that acts as a microbe-devouring phagocyte, an antigen-presenting cell, and an important source of immune secretions.

Major Histocompatibility complex (MHC): A group of genes that controls several aspects of the immune response. MHC genes code for self markers on all body cells.

Macroglobulinemia: Describes an increase in the serum concentration of a monoclonal IgM.

Malignant (ma-LIG-nant): Cancerous.

Mast cell: A granule-containing cell found in tissue. The contents of mast cells, along with those of basophils, are responsible for the symptoms of allergy.

Median age: In a list of ages arranged from youngest to oldest, the median age is in the center; half of the ages in the list are below the median and half are above it.

Medullary: In the central or inner portion; the medullary portion of bone is the bone marrow.

Megakaryocyte: A large cell that has a lobulated nucleus, is found esp; in the bone marrow, and is considered to be the source of blood platelets.

MGUS: MGUS is characterized by a monoclonal protein (M protein) in the serum or urine without other clinical features of MM. MGUS patients are asymptomatic and have stable serum M-protein measurements. MGUS is more common than myeloma occurring in 1% of the population over age 50 and 3% over age 70. It is of great clinical importance to distinguish between patients with MM from individuals with MGUS because MGUS patients may be safely observed off chemotherapy. Unnecessary treatment can lead to acute leukemia or morbidity/mortality from chemotherapy.
Biology of the Transition of Monoclonal Gammopathy of Undetermined Significance (MGUS) to Multiple Myeloma.

Metabolism: A general term for the physical and chemical processes and reactions to them taking place in the body. These processes are primarily concerned with the way nutrients are used in the body.

Metastasis (meh-TAS-ta-sis): The spread of cancer from one part of the body to another. Cells in the metastatic (secondary) tumor are like those in the original (primary) tumor.

MIBI (2-methoxy-isobutyl-isonitrile): Belongs to a class of Tc-99m based lipophilic cationic agents. Tc-MIBI with its favorable gamma emission characteristics has been proposed as an alternative to TI- 201 for myocardial perfusion imaging. Recently, there have been a number of reports of extracardiac clinical applications of Tc-MIBI including positive uptake in a variety of malignant tumors in different body sites including lymph nodes, bone and lung. We report on the findings in the first cohort of patients with MM and related plasma cell disorders evaluated with Tc-MIBI scanning. A variety of other radiologic (skeletal survey, CT) and scanning (MRI, gallium) techniques were carried out to delineate the nature of the positive uptake and clinical utility of MIBI scanning in patients with MM. Initial data indicate that MIBI allows detection of active bone disease, and early detection of reduced metabolic activity (eg, steroid effect). In patients with multiple skeletal lytic lesions, sites of active disease are dramatically positive with MIBI. In contrast to gallium, MIBI is negative with bone healing. MIBI shows promise as a new technique available for assessing active MM bone disease.

Microbes: Minute living organisms, including bacteria, viruses, fungi, and protozoa.

Mitosis: Is a process whereby a cell replicates its DNA (genes) and then divides into two identical cells.

Monoclonal: A term used to describe the characteristic feature of a myeloma protein. Since myeloma develops from a single malignant plasma cell (monoclone), the type of myeloma protein produced is also monoclonal; that is of a single type rather that many (polyclonal). The important practical aspect of a monoclonal protein is that it shows up as a sharp spike (M spike) in the serum electophoresis test which is commonly used to diagnose or monitor myeloma.

Monoclonal antibodies: Antibodies specific for a single target antigen. They can be produced in large quantities in the laboratory. Monoclonal antibodies are being studied in clinical trials to determine their effectiveness in cancer detection, diagnosis, and treatment.

Monocytes: A large phagocytic white cell which, when it enter tissue, develops into a macrophage.

Monokines: Powerful chemical substances secreted by monocytes and macrophages. These soluble molecules help direct and regulate the immune responses.

Mononuclear cells: Monocytes and lymphocytes; white blood cells other than granulocytes.

M-Protein: A term synonymous with monoclonal protein, myeloma protein and M spike, all of which refer to the protein produced by the myeloma cell. "It should not be confused with IgM (the typical immunoglobulin of the Waldenstrum's macroglobulinemia)".

MRI: A procedure using a magnet linked to a computer to create pictures of areas inside the body. Also called magnetic resonance imaging. Diagnostic Tests and Procedures:

M-Spike: Another name for M-protein. The term "spike" refers to the sharp or spiked pattern which occurs on the protein elecrophoresis when a monoclonal or M-protein is present.

Multi Drug Resistance (MDR): A term used to describe resistance to standard treatment used in multiple myeloma. It is typically associated with resistance to adriamycin and vincristine (both chemotherapy drugs). The resistance is caused by a build up of a protein called p-glyco protein in the outer cell membrane of the myeloma cell. This results in drugs such as adriamycin being kicked back out of the myeloma cell instead of building up in the myeloma cell and eventually killing the myeloma cell. New drugs which block this p-glyco protein pump are now in clinical trials (e.g. PSC833 a new cyclosporin analogue).

Mutagenic: Causing a permanent change in genetic material (DNA).

Myelodysplastic syndromes: Conditions that result when blood cells fail to form or reproduce normally.

Myeloproliferative disorders: A group of diseases characterized by the abnormal excess growth of cells in the bone marrow.

Myeloma: A malignancy of plasma cells, specialized lymphocytes that normally produce antibodies. Multiple bone lesions are common.

Nadir: The lowest point to which white blood cell or platelet counts fall after chemotherapy.

National Cancer Institute: A highly regarded research center in Bethesda, Maryland, that conducts basic and clinical research on new cancer treatments and supervises clinical trials of new treatments throughout the United States.

Natural Killer (NK) cells: Large granule-filled lymphocytes that take on tumor cells and infected body cells. They are known as "natural" killers because they attack without first having to recognize specific antigens.

Neoplasm: A new abnormal growth. Neoplasms may be benign or malignant.

Nephelometry: The most commonly used laboratory method to determine the amount of myeloma protein in the blood. (see: immunofixation which identifies the type of myeloma protein). Rather than electrophoresis it uses a light scattering technique. Nephelometry is popular because once the monoclonal spike has been identified it represents an efficient automated method to measure myeloma protein levels. However it has to be double checked against electrophoresis to ensure accuracy.

Neutropenia: A below-normal number of neutrophils.

Neutrophil: A type of white blood cell (also known as a polymorphonuclear neutrophil). Neutrophils are a type of granulocyte.

Nonsecretory: No monoclonal protein is secreted by the plasma cells, therefore no protein appears in either the blood or the urine.

Nuclear: Having to do with the nucleus of a cell. The nucleus is considered the control center of a cell.

Nucleic acids: Large naturally occurring molecules composed of chemical building blocks known as nucleotides. There are two kinds of nucleic acids, DNA and RNA.

Nucleus: The part of a cell that contains genetic information. The nucleus is considered the control center of the cell.

OKT3: A monoclonal antibody that targets mature T cells.

Oncogenic: Capable of causing cancer.

Oncologist: A doctor who specializes in studying and treating cancer.

Opsonize: To coat an organism with antibodies or a complement protein so as to make it palatable to phagocytes.

Osteoblast: The cells which produce osteoid become mineralized with calcium to become new hard bone.

Osteoclast: A type of cell found in the bone marrow at the junction between the bone marrow and the bone. Active myeloma growth stimulates the osteoclast to destroy bone: this process is call bone resorption. Normally bone resorption is counter-balance by the activity of osteoblasts, which create new bone. In myeloma, osteoblast activity is blocked. The combination of accelerated bone resorption and blocked new bone formation is what results in lytic bone lessions in myeloma.

Osteoid: The protein product elaborated by osteoblasts which is a scaffold that becomes mineralized with calcium to form hard bone.

Paraprotein: Abnormal protein, does not form competent antibodies to combat antigens.

Partial Remission or Response (PR): Partial remission or response means a level of response less than CR. In Southwest Oncology Group (SWOG)studies, it has meant >50% <75% response. In most other studies it has meant just >50% Response (BUT NOT CR).

Pathologic Bone Fracture: A fracture which occurs when myeloma weakens the bone to the point where the bone can no longer bear normal weight or stress.

Pathologist (path-OL-o-jist): A doctor who identifies diseases by studying cells and tissues under a microscope.

PDQ (Physician Data Query): A comprehensive, up-to-date information service on state-of-the-art cancer treatment provided by the National Cancer Institute via computer and fax.

Pelvic: Having to do with the pelvis, the lower part of the abdomen, located between the hip bones.

Peripheral stem cell support (per-IF-er-ul): A method of replacing blood-forming cells destroyed by cancer treatment. Certain cells (stem cells) in the blood that are similar to those in bone marrow are removed from the patient's blood before treatment. The cells are given back to the patient after treatment.

PET (positron emission tomography): A new type of scan that detects areas of cells that are living and growing more rapidly than others. It may thus find areas of cancer by detecting their growth, rather than the space they occupy, as in CT and MRI scans.

Peyer's patches: A collection of lymphoid tissues in the intestinal tract.

Phagocytes: Large white blood cells that contribute to the immune defenses by ingesting microbes or other cells and foreign particles.

Phagocytosis: The process by which phagocytes (literally, cell eaters) surround and destroy microorganisms or any foreign matter.

Plasma: The yellowish fluid in which all blood cells circulate, contains many other substances like salts, various proteins, antibodies, and blood-clotting factors.

Plasma cells: Large antibody-producing cells that develop from B cells.

Plasma Cell Labeling Index: This is a measure of the rate at which the malignant cells are multiplying; the higher the rate of multiplication, the poorer the prognosis.

Plasmacytoma: A term used to describe a collection of plasma cells found in a single location rather than diffusely thoughtout multiple areas of the bone marrow, soft tissue or bone.

Plamapheresis: Is used when blood protein levels are dangerously high and need to be lowered quickly. It involves connecting the patient to a machine that filters protein out of the blood and replaces it with fluid.

Platelets: Platelets, circulate in the blood, are not true cells but are fragments of cells called megakaryocytes, which are found only in the bone marrow. Together with the blood vessel walls and substances in the plasma called coagulation factors, platelets clot the blood, forming a major protection against continued bleeding when a blood vessel is damaged or severed. Platelets disintegrate as they function in the clotting process; otherwise, they survive an average of 10 days. An abnormally low number of platelets (a condition known as thrombocytopenia) may result in easy bruising and excessive bleeding from wounds or in mucous membranes (such as those of the gums and nose) and other tissues. Platelet transfusions are used in cancer patients to prevent or control bleeding when the number of platelets has decreased.

Polyclonal: Derived from different cells; of or pertaining toseveral clones.

Potassium: An important mineral in the body that is often lost during illness, especially with diarrhea. Low potassium levels can cause weakness.

Prognosis (prog-NOS-sis): The probable outcome or course of a disease; the chance of recovery.

Progression-Free survival: A popular term used to describe improved survival of a patient which can be directy attributed to the treatment given for the myeloma. This term identifies myeloma patients in complete remission versus those who have had an episode of relapes.

Prophylaxis: An attempt to prevent disease.

Proteins: Organic compounds made up of amino acids. Proteins are one of the major constituents of plant and animal cells.

Protocol: A carefully designed and written description of a cancer treatment program. It includes dosages and formulas for any drugs to be administered.

Purging: Removal of tumor cells from bone marrow before autologous transplantation.

Radiation therapy (ray-dee-AY-shun): Treatment with high-energy rays to kill or damage cancer cells. External radiation therapy is the use of a machine to aim high- energy rays at the cancer. Internal radiation is the placement of radioactive material inside the body as close as possible to the cancer.

Radioactive (RAY-dee-o-AK-tiv): Giving off radiation.

Radionuclide scanning: An exam that produces pictures (scans) of internal parts of the body. The patient is given an injection or swallows a small amount of radioactive material. A machine called a scanner then measures the radioactivity in certain organs.

Radiologist: A doctor who specializes in using radiation to diagnose or treat disease.

Red blood cells: (also called erythrocytes) serve two important functions. With the help of an iron-containing protein called hemoglobin, they carry oxygen from the lungs to cells in all parts of the body. Oxygen helps cells obtain energy from the nutrients we eat. RBC's also take carbon dioxide back to the lungs from the cells; carbon dioxide is released as a waste product of cell processes. Too few RBC's or too little hemoglobin is a condition known as anemia. It can cause weakness, lack of energy, dizziness, shortness of breath, headache, and irritability.

Refractory: Not responding favorably to treatment. There are two main types of refractory myeloma patients, primary refractory patients who never achieve a response and progress while still on induction chemotherapy; and secondary refractory patients who do respond to induction chemotherapy, but fail to respond to treatment after relapse. The primary group has a poorer prognosis than the secondary group.

Relapse: The reappearance of signs and symptoms of disease after treatment.

Relative survival rate: A survival rate that takes normal life expectancy into account; the likelihood that a patient will not die of his or her disease by some specified time after diagnosis.

Remission: Disappearance of the signs and symptoms of cancer. When this happens, the disease is said to be "in remission". Remission can be temporary or permanent.

Resistance: Failure of a tumor to respond to radiotherapy or chemotherapy. The resistance may be evident during the first treatment (primary) or, after an initial response, during the subsequent treatments

Retrovirus: One of a large group of RNA viruses that are capable of copying and transferring genetic material.

Ribonucleic acid: (RNC) nucleic acid is present in all living cells. RNA controls protein synthesis by translating the genetic information within the cell. Some viruses contain DNA, others contain RNA. If you block DNA or RNA replication, you cause cell death.

Scavenger cells: Any of a diverse group of cells that have the capacity to engulf and destroy foreign material, dead tissues, or other cells.

Screening: Checking for disease when there are no symptoms.

Secondary leukemia: Leukemia (most often AML) that arises when bone marrow is damaged by chemotherapy given to treat certain types of cancer or other diseases.

Serum: The clear liquid that separates from the blood when it is allowed to clot. This fluid retains any antibodies that were present in the whole blood.

Serum osteocalcin: A protein produced and secreted by osteoblasts when they are making osteoid. Some believe that a low level reflects active myeloma whereas a higher than normal level reflects stable myeloma.

Serum protein electrophoresis (SPEP): A laboratory testing method that separates serum proteins into different groups-albumin, alpha globulin, beta globulin and gamma globulin. The different patterns produced are characteristic of various diseases.

Shingles: An acute viral infammation of the sensory ganglia of spinal and cranial nerves associated with a vesicular eruption and neuralgic pain and caused by reactivation of the herpesvirus causing chicken pox ... also called herpes zoster.

For more information on Shingles:
What is shingles?
Shingles and the General Practitioner.
Herpes Zoster

Side effects: Problems that occur when treatment affects healthy cells. Common side effects of cancer treatment are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

Smoldering Myeloma: A term used to describe patients who have a momoclonal protein in the serum and /or urine, increased plasma cells in the bone marrow, but no evidence of active bone destruction or any other features of active myeloma. It is a condition very similar to MGUS but with higher levels of monoclonal protein and/ or plasma cells, plus trends which may raise concerns about transition to active myeloma.

Spleen: An organ in the abdomen that plays an important role in immune system activities; it is part of the lymphatic system.

Stage: The extent of a cancer, especially whether the disease has spread from the original site to other parts of the body.

Stem cells: The cells from which all blood cells develop. These cells may divide to form more stem cells or mature into a variety of blood cell types. The bone marrow is rich in stem cells.

Steroids: A class of fat-soluble chemicalsincluding cortisone and male and female sex hormones-that are vital to many functions within the body. Some steroid derivatives are used in cancer treatment.

Stomatitis: Inflammation and soreness of the mouth. This is sometimes a side effect of chemotherapy or radiotherapy.

Superantigens: A class of antigens, including certain bacterial toxins, that unleash a massive and damaging immune response.

Syngeneic bone marrow transplantation: Grafting between two genetically identical individuals (identical twins).

Systemic treatment (sis-TEM-ik): Treatment that reaches cells all over the body by traveling through the bloodstream.

T cells: White blood cells that are important in the body's immune system. Also known as T lymphocytes, they mature in the thymus.

Tissue (TISH-oo): A group or layer of cells that together perform a specific function.

Thrombocytes: See Platelets.

Thrombocytopenia: A below-normal number of platelets in the blood. The normal level is 150,000 - 250,000. It is unusual to have any bleeding problems unless the level is less than 50,000. Major bleeding is usually associated with a reduction to less than 10,000.

Thrombocytosis: A condition in which too many platelets (thrombocytes) are found in the blood.

Thymus: A small gland located in the top of the chest, behind the breastbone and between the lungs. The thymus is where T lymphocytes proliferate and mature.

Toxins: Poisons produced by certain animals, plants, or bacteria.

Tumor: A mass of excess cells.

Tumor burden: The tumor burden is the quantity of myeloma cells in the body. Typically, this is measured in terms of the percentage of bone marrow cells that are plasma cells, the pervasiveness and severity of bone lessions and amount of protein in the blood/urine. Myeloma tumor burden is an indicator of how far the disease has progressed. Generally, the higher the tumor burden, the more severe the disruption of normal body chemistry and immune system function. The higher the tumor burden, the higher the risk of harmful symptoms the higher the need to treat the patient and to reduce to tumor burden.

Tumor markers: Substances found in abnormal amounts in the blood, in other body fluids, or in tumor tissue of some patients with certain types of cancer.

Tumor Necrosis Factor: Induces both myeloma cell proliferation and bone resorption. TNF has effects that are similar to these of IL-1 in stimulating formation of mature osteoclasts, and this cytokine also induces hypercalemia in vivo.

Uric acid: A waste product created when the body digests and uses food and liquids.

Vesicant drugs: Chemotherapeutic agents that can cause significant tissue irritation and soreness if they leak outside the vein after injection.

Vincristine: (Chemo) Derived from the periwinkle plant, prevents cells from doubling.

Virus: A tiny infectious agent that is smaller than bacteria. Many common infections such as colds and hepatitis are caused by viruses. Viruses invade cells, alter the cells chemistry and cause them to produce more virus. Several viruses produce cancers in animals. Their role in the development of human cancers is now being studied.

Vitro: In the lab.

Vivo: In the body.

White blood cells: Cells that help the body fight infection and disease.

X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. When more than 30% of a bone has been eaten away, the damage will appear as a lytic lesion (dark spot) on an X-ray, giving the appearance of "holes" in the bone. These holes can weaken the bone and cause pathological (disease-related) fractures. As a result, bone pain and / or pathological are offer the first noticeable symptom of myeloma.

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Last Updated: 06/12/01