Understanding
Anemia and
Fatigue
International Myeloma Foundation
12650 Riverside Drive, Suite 206
North Hol ywood, CA 91607 USA
Telephone:
800-452-CURE
(USA & Canada)
818-487-7455
Fax: 818-487-7454
TheIMF@myeloma.org
myeloma.org
Table of Contents
Introduction
5
WhatIsMultipleMyeloma?
6
TheStagesofMultipleMyeloma
8
WhatIsFatigue?
10
WhatIsAnemia?
11
WhatCausesFatigueandAnemia
inPatientswithMultipleMyeloma?
11
HowAreFatigueandAnemiaDiagnosed? 13
WhenShouldAnemiaandFatigue
BeTreated?
16
WhatTreatmentsAreAvailableforFatigue
andAnemia?
17
HowAreTheseTreatmentsAdministered? 20
WhatAreSomeofthePossibleSideEffects
ofTreatment?
21
WillTreatmentforFatigueandAnemia
InterferewithTreatmentforMyeloma?
22
WhatElseCanBeDonetoHelpPatients
withAnemiaandFatigueFeelBetter?
23
AbouttheIMF
24
Glossary
27
©2011, International Myeloma Foundation, North Hol ywood, California (v11)
Introduction
You may be wondering why you feel so
tired and cannot do many of the things you
want to do, or used to do. You may also be
wondering if there is anything you can do to
feel bet er, be more productive, and regain
your energy. Your healthcare team may have
told you that you have anemia, which may
explain, in part, why you feel so tired and
lack the energy necessary to perform your
daily activities. Anemia and fatigue can be
caused by multiple myeloma itself or by the
treatment for the disease. You have been
given this booklet to learn more about fatigue
and anemia and how they relate to multiple
myeloma and its treatment. In this booklet,
you wil also learn about what you can do
and which medications are available to help
you bet er manage your fatigue and anemia
and enable you to feel bet er and participate
in more activities. After reading this booklet,
you should know the fol owing:
n What fatigue and anemia are and how
they relate to multiple myeloma;
n When anemia and fatigue should be
treated;
n How anemia and fatigue are treated;
n The possible side ef ects of treatment of
anemia and fatigue;
n If treatment for anemia interferes with
your treatment for multiple myeloma;
n What else you can do to feel less tired.
4
5
A short overview of multiple myeloma wil
n Release of an abnormal protein, mono-
be presented first, so that you can see how
clonal protein (M-protein), into the blood-
fatigue and anemia are related to the dis-
stream;
ease and its treatment, and bet er understand
n Suppression of normal immune function;
why it is so important that they be managed
observed as reduced levels of normal
properly.
immunoglobulins and increased suscepti-
This booklet is meant to provide you with
bility to infection.
general information only. It is not meant to
Myeloma cel s can also grow in the form
replace the advice of your doctor, nurse, or
of localized tumors or plasmacytomas.
other healthcare practitioner. Your health-
Plasmacytomas may be single or multiple,
care team can answer questions related to
and either medul ary (confined within bone
your specific treatment plan. Al words that
marrow and bone) or extramedul ary (out-
appear in bold type are defined in a glos-
side of the bone). When there are multiple
sary at the end of this booklet.
plasmacytomas inside or outside bone, this
condition is also cal ed multiple myeloma.
What Is Multiple Myeloma?
When confronted with a diagnosis of multiple
Multiple myeloma (also known as "myelo-
myeloma, your doctor must determine the
ma" and "plasma cel neoplasm") is a
stage of the disease. Disease staging wil
malignancy of the immunoglobulin-produc-
help determine what parts of the body
ing plasma cel s found in the bone marrow. It
have been af ected and to what extent. This
is a hematologic malignancy that resembles
wil al ow the doctor to determine the best
leukemia. However, the malignant plasma
treatment option.
cel s, or myeloma cel s, rarely enter the blood
stream as they do in a true leukemia. Instead,
the myeloma cel s accumulate in the bone
marrow, causing the fol owing:
n Disruption of normal bone marrow func-
tion, most commonly causing anemia (a
low level of red blood cel s in the blood-
stream), although reduction in white blood
cel and platelet counts can also occur;
n Damage to bone surrounding accumulated
myeloma cel s;
6
7
The Stages of Multiple Myeloma
A prognostic factor system cal ed the
International Staging System (ISS) was
Stage I (low cel mass)
600 bil ion
introduced in 2005. It is based upon
Al of the fol owing:
myeloma cel s*
the levels of two blood proteins: beta-2
· Hemoglobin value >10 g/dL
microglobulin (2M) and albumin; the levels
· Serum calcium value normal or <10.5 mg/dL
of these proteins predict overal outcome with
· Bone X-ray, normal bone structure (scale 0)
myeloma treatment.
or solitary bone plasmacytoma only
· Low M-component production rates
STAGE
CRITERIA
IgG value <5.0 g/dL
Stage 1
Serum 2 microglobulin <3.5 mg/L
IgA value <3.0 g/dL
Serum albumin 3.5 g/dL
· Urine light chain M-component
Stage 2
Serum 2 microglobulin < 3.5 mg/L
on electrophoresis <4 g/24h
and serum albumin < 3.5 g/dL
Stage I (intermediate cel mass)
600 to 1,200
or
Fit ing neither stage I nor stage I I
bil ion
Serum 2 microglobulin 3.5 - 5.5 mg/L
myeloma cel s*
Stage 3
Serum 2 microglobulin >5.5 mg/L
Stage I I (high cel mass)
>1,200 bil ion
One or more of the fol owing:
myeloma cel s*
Multiple myeloma is a serious malignancy,
· Hemoglobin value <8.5 g/dL
but it is treatable. Many patients experi-
· Serum calcium value >12 mg/dL
ence a series of responses, relapses, and
· Advanced lytic bone lesions (scale 3)
remissions. New treatments can extend the
· High M-component production rates
survival of many patients diagnosed with
IgG value >7.0 g/dL
multiple myeloma.
IgA value >5.0 g/dL
· Urine light chain M-component
Fol owing diagnosis, several options are
on electrophoresis >12 g/24h
available for initial or frontline therapy.
Subclassification
For patients who may be candidates for
(either A or B)
· A: relatively normal renal function
high-dose therapy with stem cel transplant,
(serum creatinine value) <2.0 mg/dL
various induction regimens can be
· B: abnormal renal function
considered, including thalidomide with
(serum creatinine value) >2.0 mg/dL
dexamethasone, VELCADE® (bortezomib)
Examples:
with dexamethasone, Revlimid® with
Stage IA (low cel mass with normal renal function)
dexamethasone, dexamethasone alone, other
Stage I IB (high cel mass with abnormal renal
function)
dexamethasone-containing combinations,
or combinations containing other adrenal
*myeloma cel s in the whole body
cortical steroids. The combination of the
alkylating agent melphalan plus prednisone,
8
9
a simple oral therapy, is an option for
What Is Anemia?
patients not considering high-dose melphalan
with autologous stem cel transplant, as are
Anemia is an abnormal y low level of red
combinations of melphalan plus prednisone
blood cel s (RBCs) in your body. RBCs con-
with the novel agents VELCADE®, thalidomide,
tain hemoglobin. Hemoglobin is a protein
or Revlimid®. At the time of relapse, the novel
found in RBCs that contains iron and trans-
agents are frequently required to achieve
ports much-needed oxygen from the lungs
further response. Revlimid® and VELCADE®
to tissues and organs throughout the body.
are important agents available for use in
If the number of RBCs is low, however, then
this set ing.
the hemoglobin count is low, and the body
does not receive the amount of oxygen that
What Is Fatigue?
it needs to function properly. Anemia can
have multiple causes: it may be caused by
In healthy people, fatigue is typical y char-
some underlying disease that interferes with
acterized by extreme exhaustion or feelings
normal RBC production and functioning, or
of tiredness that interfere to some extent with
it may be the result of the negative ef ects of
normal everyday activities. It usual y occurs
chemotherapy on RBC production.
after excessive stimulation or prolonged exer-
tion of some kind and is temporary. Rest and
What Causes Fatigue and Anemia in
refraining from strenuous activity can help
Patients with Multiple Myeloma?
restore energy and make a person feel bet-
ter. Fatigue that is related to cancer, howev-
Fatigue: You're Not Alone
er, is dif erent and more severe than normal
Fatigue associated with multiple myeloma
fatigue and tends to last longer. Simply rest-
usual y is caused by underlying anemia.
ing does not al eviate the fatigue. This type
This type of fatigue severely af ects patients'
of fatigue has been defined by the National
quality of life and everyday functioning. The
Comprehensive Cancer Network as "a dis-
continued interference with normal function-
tressing, persistent, subjective sense of tired-
ing is what sets cancer-related fatigue apart
ness or exhaustion related to cancer or can-
from normal fatigue. Fatigue is very common
cer treatment that is not proportional to recent
in patients with multiple myeloma and is esti-
activity and interferes with usual functioning."
mated to af ect 90%100% of patients with
In patients with multiple myeloma, fatigue
the disease. Patients need to understand that
often is a symptom that anemia is present.
fatigue is a symptom of their disease and is
not necessarily a sign that their condition is
get ing worse. Even though cancer-related
10
11
fatigue is very common in patients with mul-
myeloma also destroys normal RBCs, thus
tiple myeloma, the exact physiologic mecha-
also increasing the chances of developing
nisms that cause the fatigue are not known.
anemia. Anemia is very common in patients
It is known, however, that it is related to the
with multiple myeloma. In fact, at least
patient's anemia, and there are ways to man-
60%70% of patients with multiple myeloma
age it and help you cope.
have anemia at the time they are diagnosed
Anemia: The Case of Missing RBCs
with the disease.
Anemia occurs in patients with multiple
How are Fatigue and Anemia
myeloma because plasma cel s in bone mar-
Diagnosed?
row grow faster than normal, increase in
number, and produce tumors in the marrow.
Fatigue: Give Them Something to Talk About
These tumors interfere with the blood-produc-
It can be dif icult to diagnose fatigue associ-
ing activities of bone marrow, leading to a
ated with multiple myeloma for a number of
shortage of red blood cel s (RBCs). This short-
reasons. There are no laboratory tests that
age is known as anemia.
can be used to diagnose fatigue; hence, infor-
There are a number of causes of anemia in
mation about fatigue provided by patients
patients with multiple myeloma. The disease
is very important. Your healthcare team wil
itself suppresses the body's ability to make
need to evaluate your situation and try to
enough RBCs, resulting in low RBC counts.
identify the source of your fatigue and ways
Unfortunately, the chemotherapy that kil s
to manage it most ef ectively. Patients need
the cancer cel s in patients with multiple
to openly discuss their feelings of fatigue
with members of their healthcare team. Do
not think that your fatigue is not important
enough to mention at your appointments.
Although fatigue is an expected symptom
with multiple myeloma, you do not have to
accept it. There are things that you and your
healthcare team can do that wil help you
feel bet er. Make notes for yourself when you
feel fatigued or when anything in particular
makes you feel bet er or worse. Keep track of
how limiting your fatigue is by noting to what
extent it interferes with your daily activities.
Your healthcare team wil be asking ques-
tions about your fatigue and any input you
12
13
can provide wil be very helpful. In addition
worse. Many factors that contribute to
to their screening, they need your feedback
fatigue are treatable. There are things that
so that they can determine the severity of
can be done to al eviate your fatigue, and
your fatigue and develop strategies to help
your healthcare team can work with you and
you manage it. Based on your feedback,
your family and caregiver(s) to develop a
your healthcare team wil rate your fatigue
plan for you.
on a scale of 0 to 10 (with 0=no fatigue and
Anemia
10=worst fatigue imaginable) and then clas-
If your doctor suspects you have anemia, he
sify your fatigue as one of the fol owing:
or she performs tests for it and determines its
n Mild (0 to 3)
severity. You wil be asked questions about
n Moderate (4 to 6)
your health in general. Remember to report
any of the fol owing symptoms:
n Severe (7 to 10).
n Shortness of breath
Examples of things that you should be looking
n
at and want to report to your healthcare team
Lack of energy and motivation
include (but are not limited to) the fol owing:
n Rapid heartbeat
n Time when fatigue is most noticeable
n Swel ing in the legs, especial y in the
n Medications that you are taking
ankles
n
n Emotional stress, anxiety, or depression
Dizziness
n
n Presence and location of physical pain
Headache
n
n Existence of other conditions or il nesses
Chil s
n
n Sleep disturbances
Change in appetite
n
n Dietary changes
Decreased libido.
n Changes in weight
A physical examination wil be performed.
After the examination, your healthcare team
n Changes in activity or daily routine
wil ask you questions in an at empt to iden-
n Changes in health.
tify and uncover the source of your fatigue.
If there are any changes or other fac-
It is wise to have a family member or care-
tors that you think could be adding to
giver with you at your appointment. He or
your fatigue, do not hesitate to bring
she may be able to add to the information
them to the at ention of your healthcare
you provide.
team. There are factors that may not be
A simple blood test is used to determine what
obvious that could be making your fatigue
your hemoglobin level is. Hemoglobin levels
14
15
are used to measure the number of RBCs in
wil start treating your anemia as soon as it
the body. Low hemoglobin levels indicate
is diagnosed. They wil want to begin restor-
anemia. Severity of anemia is determined
ing your RBC count as soon as possible.
by hemoglobin level, measured in units
Your health and response to other treatments
designated as grams of RBCs per deciliter
depend upon holding these levels to as
(g/dL). Normal hemoglobin levels are 14
near-normal as possible. In some instances,
to 18 g/dL for men and 12 to 16 g/dL
in at empts to increase RBCs before anemia
for women. The National Cancer Institute
ful y develops, treatment may be started in
(NCI) has developed the fol owing scale that
patients identified as being at high risk for
determines the degree of severity of anemia
developing anemia.
through relative levels of hemoglobin.
What Treatments Are Available
Grade
Severity Hemoglobin Level (g/dL)
for Fatigue and Anemia?
0
None
Normal value
There are a number of treatments and things
you can do for fatigue and anemia that
1
Mild
10 to normal value
wil improve your health and make you feel
2
Moderate
8 to 10
bet er. Treatment of your anemia and fatigue
wil be based on the severity of each. Al
3
Severe
6.5 to 7.9
patients are not candidates for al treatments.
4
Life-threatening
Less than 6.5
Your healthcare team wil determine which
treatment regimen is best suited to and safest
for you.
When Should Anemia and Fatigue
Be Treated?
FATIGUE
Your healthcare team wil determine if there
It is important that you discuss your symptoms
are contributing factors to your fatigue.
and how you are feeling with members of
Depending on their findings, they may do
your healthcare team. Do not hesitate to
the fol owing:
mention that you feel tired or aren't feeling
particularly wel . Let them know how much
n Adjust your medications
your fatigue is disrupting your everyday
n Change or modification of your dietary
activities. Fatigue typical y is a sign of some
intake
underlying problem; it needs to be treated
n Improve your fluid and electrolyte
as soon as possible. Left unmanaged, fatigue
(sodium, potassium, calcium, and
can have a dramatic ef ect on your daily life
magnesium) intake
and on your health. Your healthcare team
16
17
n Treat the underlying cause(s) as is
helps to restore normal levels. You should
appropriate
be aware that it may take several weeks for
n Create strategies for coping and manag-
these medications to take ef ect, so you may
ing your fatigue.
not feel bet er right away. Treatment with
erythropoietic agents can also reduce the
ANEMIA
number of transfusions patients need. Thus,
For a number of years, the primary treatment
treatment with this class of drugs may be ini-
option for anemia has been blood transfu-
tiated to increase hemoglobin levels, reduce
sion. Transfusions replace and replenish
or eliminate the need for blood transfusions,
the RBCs that you have lost and are recom-
and make patients who have been suf ering
mended when immediate correction of the
from anemia feel bet er. In some patients, an
anemia is desired. Although transfusions
erythropoietic agent and transfusion may be
have an immediate ef ect that is beneficial
given together. You may also be given iron
for patients, the increase in hemoglobin lev-
supplements to restore your iron levels to as
els may not be very large and may last only
near normal as possible. Iron is needed to
up to a few weeks, so repeated transfusions
produce RBCs, and iron supplements are
may be necessary.
often given during erythropoietic treatment.
Another option for anemia that needs to be
n light of recent reports of shortened over-
treated but that does not have to be cor-
al survival and/or increased risk of tumor
rected immediately involves treatment with
progression or recurrence, as wel as the
a class of medications known as erythro-
risk of serious cardio- and thrombovascular
poiesis-stimulating agents, or ESAs (epoetin
events in some clinical trials for patients with
alfa, epoetin beta, and darbepoetin alfa).
breast, non-smal cel lung, head and neck,
These agents stimulate erythropoiesis, which
lymphoid, and cervical cancers where the
is another name for the formation of new
patients were treated with ESAs, the use of
RBCs, and are used to treat anemia caused
ESAs in cancer patients has been re-evalu-
by a variety of conditions. These drugs
ated by the Food and Drug Administration
have been used to treat anemia associated
(FDA). The FDA has concluded that ESAs
with cancer since the early 1990s. They
should be administered to cancer patients
are biological y equivalent to erythropoi-
only in the context of myelosuppressive che-
etin, a hormone made in the kidney that is
motherapy (drug therapy that causes a drop
found natural y in your body. This hormone
in the number of blood cel s made in the
stimulates your bone marrow to produce
bone marrow).
RBCs. Administering erythropoietic agents
A program cal ed the APPRISE (Assisting
thus signals your body to make RBCs, which
Providers and cancer Patients with Risk
18
19
Information for the Safe use of ESAs)
mended that a caregiver or family member
Oncology Program has been established
drive you to and from the transfusion center.
for patients with cancer receiving an ESA
The entire process can take a few hours.
[Aranesp® (darbepoetin alfa), Epogen® (epo-
etin alfa), or Procrit® (epoetin alfa)].
ERYTHROPOIETIC AGENTS
Erythropoietic agents are administered as
The ESA APPRISE Oncology Program is part
subcutaneous injections by a healthcare
of a Risk Evaluation and Mitigation Strategy
professional. The amount of medication,
(REMS) and is designed for healthcare pro-
frequency of injections, and schedule of
viders treating patients with an ESA for their
your injections wil be determined by your
cancer. The Food and Drug Administration
healthcare team.
has determined that a REMS is necessary
for ESAs to ensure that the benefits of these
IRON SUPPLEMENTS
drugs outweigh the risks. Your physician is
Iron supplements are available in oral and
required to provide documentation that he or
intravenous formulations. However, oral
she has counseled and educated you about
products are used most often. Intravenous
the risks of ESAs prior to ESA administration.
products are helpful in patients who, for vari-
How Are These Treatments
ous reasons, cannot use the oral forms.
Administered?
What Are Some of the Possible
Side Effects of Treatment?
TRANSFUSIONS
Blood transfusions are administered as intra-
POSSIBLE SIDE EFFECTS WITH TRANSFUSIONS
venous infusions in a hospital or other
There are a number of possible side ef ects
healthcare facility. A trained healthcare pro-
that can occur after receiving a blood
fessional wil give the transfusion. It is recom-
transfusion. Some patients may have a mild
fever or develop a rash or hives. These reac-
tions are temporary and usual y not severe.
In very rare instances, patients may experi-
ence serious incompatibility reactions. These
reactions wil be managed immediately by
the healthcare team. Strict screening pro-
cesses are used to prevent the spread of
viral infections transmit ed in blood during
infusions. Such transmissions were more of a
concern in earlier years when screening was
not so common or stringent.
20
21
POSSIBLE SIDE EFFECTS WITH ERYTHROPOIETIC
What Else Can Be Done to Help
AGENTS
Patients with Anemia and Fatigue
Erythropoietic agents general y are wel
Feel Better?
tolerated by patients. The most commonly
reported side ef ects experienced by patients
Along with transfusions, medications, and
treated with these drugs are:
other adjustments, there are also a number of
n Fever
other things you can do to manage and cope
with your fatigue and anemia, including the
n Diarrhea
fol owing:
n Nausea
n Exercise (walking, cycling, swimming)
n Vomiting
n Developing coping strategies
n Swel ing at the injection site
(distractions)
n Fatigue.
n Modification of activities (naps, re-estab-
lishment of priorities, use of labor-saving
Al ergic reactions tend to be rare; when they
devices)
do occur, they tend to be mild in nature.
Remember that not al patients treated with
n Counseling.
erythropoietic agents experience any or al
Patient education can help you understand
of the reactions that have been reported
anemia and fatigue. Ask members of your
by other patients. Similarly, patients do not
healthcare team if they have any information
experience side ef ects to the same degree.
that they can pass on to you or if they can
However, at the first sign of any reaction,
direct you to other sources of information.
patients should contact a member of their
Your healthcare team can also work with you
healthcare team immediately.
to develop a general strategy for managing
Will Treatment for Fatigue and
your fatigue. Involve your family and caregiv-
Anemia Interfere with Treatment
ers. They can be great support. Do not be
ashamed or afraid to talk about your fatigue
for Multiple Myeloma?
and the impact it has on your life.
Treatments chosen by healthcare teams to
For more information on multiple myeloma
manage your fatigue and anemia wil not
and treatment options, contact the IMF.
interfere with treatments for multiple myelo-
ma. Treatments approved to treat anemia
and fatigue can be done safely and in con-
junction with treatment for multiple myeloma.
22
23
About the IMF
The IMF provides programs and services to
aid in the research, diagnosis, treatment,
"One person can make a dif erence,
and management of myeloma. The IMF
Two can make a miracle."
ensures that no one must brave the myeloma
Brian D. Novis
bat le alone.
IMF Founder
We care for patients today, while working
Myeloma is a lit le-known, complex, and
toward tomorrow's cure.
often misdiagnosed bone marrow cancer that
How Can the IMF Help?
at acks and destroys bone. Myeloma af ects
approximately 75,000 to 100,000 people
PATIENT EDUCATION
in the United States, with approximately
INFORMATION PACKAGE
20,000 new cases diagnosed each year.
Our free IMF InfoPack provides comprehensive
Although there is presently no known cure for
information about myeloma, treatment options,
disease management, and IMF services. It includes
myeloma, doctors have many approaches to
our acclaimed Patient Handbook.
help myeloma patients live bet er and longer.
INTERNET ACCESS
The International Myeloma Foundation (IMF)
Log on to myeloma.org for 24-hour access to
information about myeloma, the IMF, education,
was founded in 1990 by Brian and Susie
and support programs.
Novis shortly after Brian's myeloma diagno-
ONLINE MYELOMA FORUM
sis at the age of 33. It was Brian's dream that
Join the IMF Internet Discussion Group at www.
future patients would have easy access to
myeloma.org/listserve.html to share your thoughts
medical information and emotional support
and experiences.
throughout their bat le with myeloma. He
MYELOMA MINUTE
established the IMF with the 3 goals of treat-
Subscribe to this free weekly email newslet er for
ment, education, and research. He sought
up-to-the-minute information about myeloma.
to provide a broad spectrum of services for
PATIENT & FAMILY SEMINARS
patients, their families, friends, and health
Meet with leading experts in myeloma treatment
care providers. Although Brian died 4 years
to learn more about recent advances in therapy
and research.
after his initial diagnosis, his dream didn't.
Today, the IMF reaches out to an interna-
MYELOMA MATRIX
On our website and in print, this document is a
tional membership of more than 195,000.
comprehensive guide to drugs in development for
The IMF was the first organization dedicated
myeloma.
solely to myeloma, and today it remains
MYELOMA TODAY NEWSLETTER
the largest.
Our quarterly newslet er is available free of
charge by subscription.
24
25
SUPPORT
Glossary
MYELOMA HOTLINE: 800-452-CURE (2873)
Adrenal cortical steroid: Any of the steroidal hormones
Tol -free throughout the United States and Canada,
produced by the adrenal cortex or their synthetic equiva-
the IMF Hotline is staf ed by trained information
lents. Also known as adrenocorticoids, glucocorticoste-
specialists and is in frequent interaction with mem-
roid, or corticosteroid.
bers of our Scientific Advisory Board.
Alkylating agent: An agent that prevents the growth and
division of new cancer cel s by inhibiting their ability to
SUPPORT GROUPS
replicate DNA.
A worldwide network of more than 100 myeloma
Anemia: A low level of red blood cel s in the bloodstream.
support groups holds regular meetings for mem-
Antibody: A protein produced by some of the body's white
bers of the myeloma community. The IMF conducts
blood cel s that helps fight infection.
annual retreats for myeloma support group lead-
Bone marrow: A soft spongy tissue found in most large
ers.
bones that produces red and white blood cel s and
platelets.
RESEARCH
Cel : The smal est unit of life. Mil ions of microscopic cel s
BANK ON A CURE®
comprise each body organ.
This DNA bank wil provide genetic data for
Cytokine: A growth factor produced by T-cel s that stimu-
research in new drug development.
lates the growth of T-cel s and B-cel s.
INTERNATIONAL MYELOMA WORKING GROUP (IMWG)
Erythropoiesis: The formation of new red blood cel s.
IMF's International Myeloma Working Group
Hematologic malignancy: A cancer of the blood or bone
consists of 145 leading myeloma researchers
marrow.
from around the world who col aborate on
Immunoglobulin: An antibody.
a broad range of myeloma research projects.
Lytic (lysis): Dissolution or destruction of cel s.
With a goal to improve myeloma treatment
Monoclonal protein (M protein):
An abnormal protein
options and diagnostic systems, their work focus-
produced by myeloma cel s that accumulates in and
es on protocols to provide a more durable
damages bone and bone marrow. A high level of
remission for myeloma patients while improv-
M protein indicates that myeloma cel s are present in
large numbers.
ing quality of life, addressing the needs of
Multiple myeloma: A cancer arising from the plasma cel s
both myeloma patients and the physicians who
in the bone marrow. The plasma cel s in patients with
treat them.
multiple myeloma form abnormal antibodies, possibly
THE INTERNATIONAL STAGING SYSTEM (ISS)
damaging the bone, bone marrow, and other organs.
This updated staging system for myeloma wil
Plasma cel : A type of white blood cel that produces
antibodies.
enhance physicians' ability to select the most
appropriate treatment for each patient.
Plasmacytoma: A tumor made up of cancerous plasma
cel s.
RESEARCH GRANTS
Platelet: An element in the blood that helps with clot ing,
Leading the world in col aborative research and
which in turn helps repair damaged blood vessels.
achieving extraordinary results, the IMF Grant
Proteins: A group of compounds that are the main
Program supports both junior and senior research-
components of a cel .
ers working on a broad spectrum of projects. The
Red blood cel (RBC): A blood cel that carries oxygen from
IMF has at racted many young investigators into
the lungs throughout the body.
the field of myeloma who remain in the field and
White blood cel : A cel made by the bone marrow that
actively pursue a cure for the disease.
helps fight infection and/or disease.
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