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GLOSSARY OF TERMS & DEFINITIONS
09.20.07

Accrual: The process of enrolling patients in a clinical research study (trial), or the number of patients already enrolled in a trial or anticipated to enroll in a trial.

Acute: A sudden onset of symptoms or disease.

Albumin: Simple water-soluble proteins that are found in blood serum and many other animal and plant tissues.

Alkylating Agent: A chemotherapeutic agent such as melphalan or cyclophosphamide. Alkylating refers to the way in which these agents cross-link the DNA of myeloma cells and block cell division.

Allogeneic: See "Transplantation."

Amyloidosis: A condition in which myeloma light chains (Bence Jones proteins) are deposited in tissues and organs throughout the body. This occurs more commonly with lambda versus kappa Bence Jones 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 kidneys.

Analgesic: Any drug that relieves pain. Aspirin and acetaminophen are mild analgesics.

Analog: A chemical compound that is structurally similar to another but differs slightly in composition.

Anemia: A decrease in the normal number of red blood cells, usually below 10g/dL with over 13-14g/dL being normal. Myeloma in the bone marrow blocks red blood cell production causing shortness of breath, weakness and tiredness.

Anesthesia: Loss of feeling or awareness. Local anesthesia causes loss of feeling in a part of the body. General anesthesia puts the person to sleep.

Angiogenesis: Blood vessel formation, which usually accompanies the growth of malignant tissue, including myeloma.

Angiogenesis inhibitors: Compounds that attempt to cut off the blood supply to tumors.

Antibiotics: Drugs used to treat infection.

Antibody: A protein produced by certain white blood cells (plasma cells) to fight infection and disease in the form of antigens such as bacteria, viruses, toxins, or tumors. Each antibody can bind only to a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies disable antigens directly. Others make the antigen more vulnerable to destruction by other white blood cells.

Antiemetic agent: A drug that prevents or controls nausea and vomiting.

Antifungal agent: A drug used to treat fungal infections.

Antigen: Any foreign substance (such as a bacteria, virus, toxin or tumor) that, when introduced into or arising in the body, causes the immune system to produce natural antibodies.

Antineoplastic agent: A drug that prevents, kills, or blocks the growth and spread of cancer cells.

Appendicular skeleton: The long bones (i.e. arms and legs) which are attached to spine, chest and pelvis.

Apoptosis: A normal cellular process involving a genetically programmed series of events leading to the death of a cell.

Aspiration: The process of removing fluid or tissue, or both, from a specific area.

Asymptomatic myeloma: Myeloma that presents no signs or symptoms of disease. Also called indolent, smoldering, or early myeloma.

Axial Skeleton: The skull, spine, and pelvis region of the skeleton.

B cells: White blood cells that develop into plasma cells in the bone marrow and are the source of antibodies. Also known as B lymphocytes.

Basophil: A type of white blood cell. Basophils are granulocytes.

Bence Jones: A myeloma protein present in urine. The amount of Bence Jones protein is expressed in terms of grams per 24 hours. Normally a very small amount of protein ( <0.1g/24h) can be present in the urine, but this is albumin rather than Bence Jones protein. The presence of any Bence Jones protein is abnormal.

Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. MGUS is a benign condition.

Beta 2 Microglobulin (ß2M): A small protein found in the blood. High levels occur in patients with active myeloma. Low or normal levels occur in patients with early myeloma and/or inactive disease. Approximately 10% of patients have myeloma that does not produce ß2M. For these patients, ß2M testing cannot be used to monitor the disease. At the time of relapse, ß2M can increase before there is any change in the myeloma protein level. Therefore, 90% of the time, ß2M is very useful for determining disease activity.

Biological response modifiers (BRMs): Substances that stimulate the body's response to infection and disease. The body naturally produces small amounts of these substances. Scientists can produce some of them in the laboratory in large amounts and use them in cancer treatment.

Biopsy: The removal of a sample of tissue for microscopic examination to aid in diagnosis.

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

Blood cells: Minute structures produced in the bone marrow; they include red blood cells, white blood cells, and platelets.

Blood count: The number of red blood cells, white blood cells, and platelets in a sample of blood.

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

Bone marrow aspiration: The removal, by a needle, of a sample of fluid and cells from the bone marrow for examination under a microscope.

Bone marrow biopsy: The removal, by a needle, of a sample of tissue from the bone. The cells are checked to see whether they are cancerous. If cancerous plasma cells are found, the pathologist estimates how much of the bone marrow is affected. Bone marrow biopsy is usually done at the same time as bone marrow aspiration.

Bone remodeling: The normal coordination (coupling) between osteoclast cells (which resorb or destroy bone) and osteoblast cells (which create new bone matrix) to maintain a balanced state of bone production and destruction.

Bone scan: A technique to create images of bones on a computer screen to indicate areas of injury, disease, or healing. A small amount of radio-active material is injected into a vein and travels through the bloodstream. It collects in the bones, especially in abnormal areas of the bones, and is detected by a scanner. This is a valuable test to determine if cancer has spread to the bone, if anticancer therapy has been successful, and if affected bony areas are healing. Also known as "bone scintigraphy."

BUN (Blood Urea Nitrogen): A measure of the urea level in the blood. Urea is cleared by the kidney. BUN is a laboratory blood test to assess how well the kidney is functioning. Diseases, such as myeloma, which compromise kidney function, frequently lead to increased levels of BUN.

Calcium: A mineral found mainly in the hard part of bone matrix or hydroxyapatite.

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

Carcinogen: Any substance or agent that produces or stimulates cancer growth.

CAT or CT [Computerized (Axial) Tomography scan]: A test using computerized X-rays to create three-dimensional images of organs and structures inside the body, used to detect small areas of bone damage or soft tissue involvement.

Catheter: A tube that is placed in a blood vessel to provide a pathway for drugs or nutrients. A Central Venous Catheter is a special tubing that is surgically inserted into a large vein near the heart and exits from the chest or abdomen. The catheter allows medications, fluids, or blood products to be given and blood samples to be taken.

Cell: The basic unit of any living organism.

Cell differentiation: The process during which young, immature (unspecialized) cells take on individual characteristics and reach their mature (specialized) form and function.

Cell proliferation: An increase in the number of cells as a result of cell growth and cell division.

Chemotherapy: The treatment of cancer with drugs that kill all rapidly-dividing cells..

  • Combination chemotherapy–The use of more than one drug given in a chemotherapy regimen during cancer treatment.

Chromosome: A strand of DNA and proteins in the nucleus of a cell. Chromosomes carry genes and function in the transmission of genetic information. Normally, human cells contain 46 chromosomes.

Chronic: Persisting over a long period of time.

Clinical: Involving direct observation of a patient.

Clinical trial: A research study of new treatment that involves patients. Each study is designed to find better ways to prevent, detect, diagnose, or treat cancer and to answer scientific questions.

  • Control group – The arm of a randomized clinical trial which gets the standard treatment.
  • End Point – What a clinical trial is trying to measure or find out; the goal of the trial. Typical end points include measurements of toxicity, response rate, and survival.
  • Experimental group – The arm of a randomized trial which gets the new treatment.
  • Randomized clinical trial – A research study in which subjects are randomly assigned to receive a particular treatment.
  • Phase I trial – A trial designed to determine the MTD (maximum tolerated dose) of a new drug or a new combination of drugs that has never been tried in humans. It is usually the first human testing of a new treatment, although in Phase I trials of combination therapies, the individual elements may already have been well tested. Patients in Phase I trials must have advanced cancer that is refractory to any standard treatment. In a typical Phase I trial, successive groups ("cohorts") of 3 to 6 patients are given the treatment. All patients in a cohort get the same dose. The first cohort typically gets a very low dose, and the dose is raised in each subsequent cohort until a set number of patients experience DLT (dose limiting toxicity). The dose level used for the previous cohort is then taken to be the Maximum Tolerated Dose. This dose is then used in a Phase II trial.
  • Phase II trial – A trial designed to determine the response rate of a new therapy that has already been tested in Phase I trials. Typically, 14 to 50 patients with one type of cancer are treated to see how many have a response. Patients are usually required to have advanced cancer that is refractory to any standard treatment, and in addition, they must have measurable disease. If results from a Phase II trial are promising enough, the treatment may then be tested in a Phase III trial. If the results are obviously much better than the standard treatment, then it may not be necessary to do a Phase III trial, and the treatment may become standard based on Phase II trial results.
  • Phase III trial – A trial designed to compare two or more treatments for a given type and stage of cancer. The end point of a Phase III trial is usually survival or disease-free survival. Phase III trials are usually randomized, so patients don't choose which treatment they receive. A typical Phase III trial has 50 to thousands of patients. Some Phase III trials compare a new treatment that has had good results in Phase II trials with an older, well known, standard treatment. Other Phase III trials compare treatments that are already in common use. Some treatments in Phase III trials may be available outside the clinical trial setting.

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

Cyst: An accumulation of fluid or semisolid material within a sac.

Cytokine: A substance secreted by cells of the immune system that stimulates growth/activity in a particular type of cell. Cytokines are produced locally (i.e. in the bone marrow) and circulate in the bloodstream.

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

Dexamethasone: A powerful corticosteroid given alone or with other chemotherapy drugs.

Diagnosis: The process of identifying a disease by its signs and symptoms.

Dialysis: When a patient's kidneys are unable to filter blood, the blood is cleaned by passing it through a dialysis machine.

Disease-free survival: The length of time the patient survives without any detectable cancer.

DLT (Dose Limiting Toxicity): Side-effects that are severe enough to prevent giving more of the treatment.

DNA: The substance of heredity; a large molecule that carries the genetic information that cells need to replicate and to produce proteins.

Drug resistance: The result of cells' ability to resist the effects of a specific drug.

Edema: Swelling; an abnormal accumulation of fluid in part of the body.

Efficacy: The power to produce an effect; in cancer research "efficacy" refers to whether the treatment is effective.

Electrophoresis: A laboratory test in which a patient's serum (blood) or urine molecules are subjected to separation according to their size and electrical charge. For myeloma patients, electrophoresis of the blood or urine allows both the calculation of the amount of myeloma protein (M-protein) as well as the identification of the specific M-spike characteristic for each patient. Electrophoresis is used as a tool both for diagnosis and for monitoring.

Enzyme: A substance that affects the rate at which chemical changes take place in the body.

Erythrocytes: Red blood cells (RBCs). RBCs carry oxygen to body cells and carbon dioxide away from body cells.

Erythropoietin: A hormone produced by the kidneys. Myeloma patients with damaged kidneys don't produce enough erythropoietin and can become anemic. Injections with synthetic erythropoietin can be helpful. Blood transfusion is another alternative, especially in an emergency. Synthetic erythropoietin is being used prophylactically before chemotherapy and as a supportive therapy after chemotherapy to avoid anemia.

Free light chains: A portion of the monoclonal protein of light molecular weight that can be measured in a sensitive assay, the Freelite® test.

Gene: A specific sequence of DNA or RNA; the biological unit of heredity located in a specific place on a chromosome and found in all cells in the body. When genes are missing or damaged, cancer may occur.

Gene therapy: Treatment that alters genes. Using genes to stimulate the immune system. In studies of gene therapy for cancer, researchers are trying to improve the body's natural ability to fight the disease and to make the tumor more sensitive to other kinds of therapy. Treatment focuses on replacing damaged or missing genes with healthy copies.

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

Graft-versus-host disease (GVHD): A reaction of donated bone marrow against a recipient's own tissue.

Granulocyte: A type of white blood cell that kills bacteria. Neutrophils, eosinophils, and basophils are granulocytes.

Hematocrit (Hct): The percentage of red blood cells in the blood. A low hematocrit measurement indicates anemia.

Hematologic: Orginating in the blood, or disseminated by the circulation or through the bloodstream.

Hematologist: A doctor who specializes in the problems of blood and bone marrow.

Herpes simplex: The most common virus; it causes sores often seen around the mouth, commonly called cold sores.

Herpes zoster: A virus that settles around certain nerves in patients who have previously had a chicken pox (varicella) infection, causing blisters, swelling, and pain. This condition is also called shingles.

Hormones: Chemicals produced by various glands of the body that regulate the actions of certain cells or organs.

Human leukocyte antigen (HLA) test: A blood test used to match a blood or bone marrow donor to a recipient for transfusion or transplant.

Hypercalcemia: A higher-than-normal level of calcium in the blood. This condition can cause a number of symptoms, including loss of appetite, nausea, thirst, fatigue, muscle weakness, restlessness, and confusion. Common in myeloma patients and usually resulting from bone destruction with release of calcium into the blood stream. 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 along with direct treatment for the myeloma.

IgG, IgA: The two most common types of myeloma. The G and the A refer to the type of protein produced by the myeloma cells. The myeloma protein, which is an immunoglobulin, consists of two heavy chains, (for example of a G type) combined with two light chains, which are either kappa or lambda. Therefore, the two most common subtypes of myeloma have identical heavy chains (i.e., IgG kappa and IgG lambda). 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.

IgD, IgE: Two types of myeloma which occur less frequently.

IgM: Usually associated with Waldenstrom's macroglobulemia. In rare cases can be a type of myeloma.

Immune system: The complex group of organs and cells that produces antibodies to defend the body against foreign substances such as bacteria, viruses, toxins, and cancers.

Immunodeficiency: A lowering of the body's ability to fight off infection and disease.

Immunofixation: An immunologic test of the serum or urine used to identify proteins in the blood. For myeloma patients, it enables the doctor to identify the M-protein type (IgG, IgA, kappa, or lambda). The most sensitive routine immunostaining technique, it identifies the exact heavy and light chain type of M-protein.

Immunoglobulin (Ig): A protein produced by plasma cells; an essential part of the body's immune system. Immunoglobulins attach to foreign substances (antigens) and assist in destroying them. The classes of immunoglobulins are IgA, IgG, IgM, IgD, and IgE.

Immunosuppression: Weakening of the immune system that causes a lowered ability to fight infection and disease. Immunosuppression may be deliberate, such as in preparation for bone marrow transplantation to prevent rejection by the host of the donor tissue, or incidental, such as often results from chemotherapy for the treatment of cancer.

Immunotherapy: Treatment that stimulates the body's natural defenses to fight cancer. Also called biological therapy.

Incidence: The number of new cases of a disease diagnosed each year.

Induction Therapy: The initial treatment used in an effort to achieve remission in a newly diagnosed myeloma patient.

Informed Consent: The process requiring a doctor to give a patient enough information about a proposed procedure for the patient to make an informed decision about whether or not to undergo it. The doctor must, in addition to explaining all procedures, address the issues of risks, benefits, alternatives, and potential costs.

Infusion: Delivering fluids or medications into the bloodstream over a period of time.

Infusion pump: A device that delivers measured amounts of fluids or medications into the bloodstream over a period of time.

Inhibit: To stop something, to hold in check.

Injection: Pushing a medication into the body with the use of a syringe and needle.

Interferon: A naturally produced hormone (cytokine) released by the body in response to infection or disease which stimulates the growth of certain disease-fighting blood cells in the immune system. Interferon can be artificially produced by genetic engineering techniques and used as a form of immunotherapy, primarily in the maintenance (plateau) phase to block any regrowth of myeloma and thus delay or prevent relapse.

Interleukin: A naturally produced chemical released by the body or a substance used in biological therapy. Interleukins stimulate the growth and activities of certain kinds of white blood cells. Interleukin-2 (IL-2) is a type of biological response modifier that stimulates the growth of certain blood cells in the immune system which can fight some types of cancer. Interleukin-6 (IL-6) is a cytokine which is a potent stimulus to osteoclast and plasma cell activities.

LDH: Lactate dehydrogenase, an enzyme that may be used to monitor myeloma activity.

Lesion: An area of abnormal tissue change. A lump or abscess that may be caused by injury or disease, such as cancer. In myeloma, "lesion" can refer to a plasmacytoma or a hole in the bone.

Leukocytes: Cells that help the body fight infections and other diseases. Also called white blood cells (WBCs).

Leukopenia: A low number of white blood cells.

Lymphocytes: White blood cells that fight infection and disease.

Lytic lesions: The damaged area of a bone that shows up as a dark spot on an X-ray when enough of the healthy bone in any one area is eaten away. Lytic lesions look like holes in the bone and are evidence that the bone is being weakened.

M proteins (M spike): Antibodies or parts of antibodies found in unusually large amounts in the blood or urine of multiple myeloma patients. M spike refers to the sharp pattern that occurs on protein electrophoresis when an M protein is present. Synonymous with monoclonal protein and myeloma protein. (see "monoclonal" below)

Maintenance therapy: Chemotherapy that is given to patients in remission to delay or prevent a relapse.

Malignant: Cancerous; capable of invading nearby tissue and spreading to other parts of the body.

MDR (Multi Drug Resistance): A resistance to standard treatment, typically associated with resistance to Adriamycin and vincristine, both chemotherapy drugs. The resistance is caused by a buildup of the p-glycoprotein in the outer cell membrane of the myeloma cells. This results in drugs being kicked back out of the myeloma cell instead of building up and eventually killing that cell.

Melanoma: A cancer of the pigment-forming cells of the skin or the retina of the eye. Not associated with myeloma despite the similar-sounding name.

Metastasize: To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor. This term is commonly used to describe a disease process in solid tumors (e.g., breast, prostate) and not in myeloma, which is a blood-related cancer.

MGUS (Monoclonal Gammopathy of Undetermined Significance): A benign condition in which the M protein is present but there is no underlying disease.

Molecule: The smallest particle of a substance that retains all the properties of the substance and is composed of one or more atoms.

Monoclonal: A clone or duplicate of a single cell. Myeloma develops from a single malignant plasma cell (monoclone). The type of myeloma protein produced is also monoclonal; a single form rather than many forms (polyclonal). The important practical aspect of a monoclonal protein is that it shows up as a sharp spike (M spike) in the serum electrophoresis test.

Monoclonal antibodies: Artificially manufactured antibodies specifically designed to find and bind to cancer cells for diagnostic or treatment purposes. They can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to tumor cells.

Monocyte: A type of white blood cell.

MRI (Magnetic Resonance Imaging): A diagnostic test that uses magnetic energy, rather than X-ray energy, to produce detailed two- or three-dimensional images of organs and structures inside the body. Gives very fine resolution of soft tissues, especially encroachments on the spinal cord, but is less accurate for bone lesions.

MTD (Maximum Tolerated Dose): The highest dose of a treatment that most people can safely withstand.

Myelodysplastic syndrome: A condition in which the bone marrow does not function normally and does not produce enough blood cells. This condition may progress and become acute leukemia.

Myeloid: Referring to myelocytes, a type of white blood cell. Also called myelogenous. Multiple myeloma is a non-myeloid cancer.

Myelosuppression: A decrease in the production of red blood cells, platelets, and some white blood cells by the bone marrow.

Neoplasia: Abnormal new growth of cells.

Neoplasm: A new growth of tissue or cells; a tumor that can be referred to as benign or malignant.

Neutropenia: A reduced level of neutrophils. Cytotoxic chemotherapy has a tendency to induce neutropenia. In contrast, lymphocytes which are more important in viral infections, tend not to be affected by cytotoxic treatment. Neutropenia can be prevented or reduced using a synthetic hormone called G-CSF (e.g., Neupogen).

Neutrophil: A type of white blood cell necessary to combat bacterial infection.

Oncogene: A gene or DNA sequence that normally directs cell growth, but which can also promote or allow the uncontrolled growth of cancer if damaged (mutated) by an environmental exposure to carcinogens, or if damaged or missing because of an inherited defect. A gene that has the potential to cause a normal cell to become cancerous.

Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment.

Osteoblast: The cell which produces osteoid, which becomes mineralized with calcium to form new hard bone.

Osteoclast: A cell found in the bone marrow at the junction between the bone marrow and the bone that resorbs or breaks down old bone. In myeloma, the osteoclasts are over-stimulated while osteoblast activity is blocked. The combination of accelerated bone resorption and blocked new bone formation results in lytic lesions.

Osteoid: The protein product which becomes mineralized with calcium to form hard bones.

Osteonecrosis of the jaws: A previously rare jaw problem now being observed in a small percentage of patients taking bisphosphonates. The condition produces pain, swelling, and bone damage around the tooth sockets in the jaws. There is bone necrosis or loss of bone which can lead to loose teeth, sharp edges of exposed bone, bone spurs, and the breaking loose of small bone spicules or dead bone. A case definition is >3 months with non-healing exposed bone. Symptoms may not be obvious at first, or may include pain, swelling, numbness or a "heavy jaw" feeling, or loosening of a tooth.

Osteoporosis: Reduction in bone density typically associated with old age. Diffuse involvement of bones with myeloma produces what looks like osteoporosis on X-ray and bone density measurement.

Palliative treatment: Aimed to improve the quality of life by relieving pain and symptoms of disease but not intended to alter its course.

Pathological fracture: A break in a bone usually caused by cancer or some disease condition. Occurs in myeloma-weakened bones, which can't bear normal weight or stress.

Pathology: The study of disease by the examination of tissues and body fluids under the microscope. A doctor who specializes in pathology is called a pathologist.

PET (positron emission tomography) scan: A diagnostic test that uses a sophisticated camera and computer to produce images of the body. PET scans show the difference between healthy and abnormally functioning tissues.

Placebo: An inert (inactive) substance often used in clinical trials for comparison with an experimental drug.

Plasma: The liquid part of the blood in which red blood cells, white blood cells, and platelets are suspended.

Plasma cells: Special white blood cells that produce antibodies. The malignant cell in myeloma. Normal plasma cells produce antibodies to fight infection. In myeloma, malignant plasma cells produce large amounts of abnormal antibodies that lack the capability to fight infection. The abnormal antibodies are the monoclonal protein, or M protein. Plasma cells also produce other chemicals that can cause organ and tissue damage (i.e. anemia, kidney damage and nerve damage).

Plasmacytoma: A collection of plasma cells found in a single location rather than diffusely throughout the bone marrow, soft tissue, or bone.

Plasmapheresis: The process of removing certain proteins from the blood. Plasmapheresis can be used to remove excess antibodies from the blood of multiple myeloma patients.

Platelet: One of the three major blood elements, others being the red blood cells and white blood cells. Platelets plug up breaks in the blood vessel walls and stimulate blood clot formation. Platelets are the major defense against bleeding. Also called thrombocytes.

Port - Implanted: A catheter connected to a quarter-sized disc that is surgically placed just below the skin in the chest or abdomen. The catheter is inserted into a large vein or artery directly into the bloodstream. Fluids, drugs, or blood products can be infused, and blood can be drawn through a needle that is stuck into the disc.

Prognosis: The projected outcome or course of a disease; the chance of recovery; the life expectancy.

Progression-free survival: The time period during which the patient survives and the cancer does not become worse. The improved survival of a patient that can be directly attributed to the treatment given for the myeloma. This term identifies myeloma patients who are in complete remission versus those who have had an episode of relapse or progression.

Progressive disease: Disease that is becoming worse, as documented by tests.

Protocol: A detailed plan of treatment including the dose and schedule of any drugs used.

Precancerous: A term used to describe a condition that may, or is likely to become, cancer.

Radiation therapy: Treatment with x-rays, gamma rays, or electrons to damage or kill malignant cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (implant radiation).

Radiologist: A doctor who specializes in creating and interpreting images of areas inside the body. The images are produced with x-rays, sound waves, magnetic fields, or other types of energy.

Recurrence: The reappearance of a disease after a period of remission.

Red blood cells (erythrocytes): Cells in the blood that contain hemoglobin and deliver oxygen to and take carbon dioxide from all parts of the body . Red cell production is stimulated by a hormone (erythropoietin) produced by the kidneys. Myeloma patients with damaged kidneys don't produce enough erythropoietin and can become anemic. Injections with synthetic erythropoietin can be helpful. Blood transfusion is another alternative, especially in an emergency. Synthetic erythropoietin is being used prophylactically before chemotherapy and as supportive therapy after chemotherapy to avoid anemia.

Refractory: Disease that is unresponsive to standard treatments.

Regression: The shrinkage of cancer growth.

Relapse: The reappearance of signs and symptoms of a disease after a period of improvement.

Remission or Response: Complete or partial disappearance of the signs and symptoms of cancer. Remission and response are used interchangeably.

  • Complete Remission (CR) - CR is the absence of myeloma protein from the 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. CR is not the same thing as a cure.
  • Partial Remission (PR) - PR is a level of response less than CR. In SWOG studies, it has meant >50% <75% response. In other studies it has meant > 50% response.

RNA (ribonucleic acid): Any of various nucleic acids that are associated with the control of cellular chemical activities. RNA is one of the two nucleic acids found in all cells – the other is DNA (deoxyribonucleic acid). RNA transfers genetic information from DNA to proteins produced by the cell.

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

Shingles: See "Herpes zoster."

Side effects: Problems that occur due to drugs used for disease treatment. Common side effects of cancer treatment are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

Skeletal survey (Metastatic survey): A series of plain X-rays of the skull, spine, ribs, pelvis, and long bones to look for lytic lesions and/or osteoporosis.

Stable Disease: This describes patients who have some response to treatment but <50% reduction in myeloma protein levels. Stable disease is not necessarily bad or sub-optimal (as compared to CR or PR) provided the myeloma has stabilized and is not progressing. With slow moving myeloma, stabilization can last for many years.

Stage: The extent of a cancer in the body.

Staging: Doing exams and tests to learn the extent of the cancer in the body.

Stem cells: The immature cells from which all blood cells develop. Normal stem cells give rise to normal blood components, including red cells, white cells and platelets. Stem cells are normally located in the bone marrow and can be harvested for transplant.

Steroid: A type of hormone. Steroids are often given to patients along with one or more anticancer drugs and appear to help to control the effects of the disease on the body.

Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the patient's comfort and quality of life.

Systemic therapy: Treatment using substances that travel through the bloodstream, reaching and affecting cancer cells all over the body.

Thrombocytes: See "Platelets."

Thrombocytopenia: A low number of platelets in the blood. The normal level is 150,000-250,000. If the platelet count is less than 50,000, bleeding problems could occur. Major bleeding is usually associated with a reduction to less than 10,000.

TNF (Tumor necrosis factor): A type of biological response modifier that can improve the body's natural response to disease.

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

Transfusion: The transfer of blood or blood products.

Transplantation: Stem cells are used to rescue to patient' s blood-forming potential following high dose chemotherapy and/or radiation treatment. Transplant is not a treatment, but a method of support to make high dose treatment possible.

  • Bone marrow transplantation – This term refers to the process of collecting stem cells from the bone marrow and infusing them into a patient. This term is used less freuently today in myeloma as stem cells are now collected from the peripheral or circulating blood.
  • Peripheral blood stem cell transplantation – Doctors remove healthy stem cells from a patient's circulating blood system (not from the bone marrow) and store them before the patient receives high-dose chemotherapy and possibly radiation therapy to destroy the cancer cells. The stem cells are then returned to the patient, where they can produce new blood cells to replace cells destroyed by the treatment.
  • Allogeneic – The infusion of bone marrow or stem cells from one individual (donor) to another (recipient). A patient receives bone marrow or stem cells from a compatible, though not genetically identical, donor.
  • Autologous – A procedure in which stem cells are removed from a patient's blood and then are given back to the patient following intensive treatment.
  • Matched unrelated donor transplants (MUDs) – Refers to stem cell transplantation procedures in which the patient and the stem cells are genetically matched but are not from family members. This procedure is not recommended for myeloma patients because it carries an unacceptably high mortality rate.
  • Syngeneic – The infusion of bone marrow or stem cells from one identical twin into another.

Tumor: An abnormal mass of tissue that results from excessive cell division. Tumors perform no useful body function. They may either be benign or malignant.

Tumor marker: A substance in blood or other body fluids that may suggest that a person has cancer.

Vaccine: A preparation of killed microorganisms, living attenuated organisms, or living fully virulent organisms that is administered to produce or artificially increase immunity to a particular disease.

Virus: A small living particle that can infect cells and change how the cells function. Infection with a virus can cause a person to develop symptoms. The disease and symptoms that are caused depend on the type of virus and the type of cells that are infected.

Waldenstrom's macroglobulemia: A rare type of indolent lymphoma that affects plasma cells. Excessive amounts of IgM protein are produced. Not a type of myeloma.

White blood cells (WBC): General term for a variety of cells responsible for fighting invading germs, infection, and allergy-causing agents. These cells begin their development in the bone marrow and then travel to other parts of the body. Specific white blood cells include neutrophils, granulocytes, lymphocytes, and monocytes.

X-ray: High-energy electromagnetic radiation used in low doses to diagnose diseases and in high doses to treat cancer.

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