Understanding
VELCADE®
(bortezomib)
for Injection
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

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Table of Contents
Introduction
5
WhatIsMultipleMyeloma?
5
TheStagesofMultipleMyeloma?
7
WhatIsVELCADE®and
HowDoesItWork?
9
UseofVELCADE®inClinicalPractice
in2011
14
WhatArethePossibleSideEffects
ofVELCADE®?
15
WillaReductioninDoseofVELCADE®
ChangetheEffectivenessofTreatment?
21
HowIsVELCADE®Given?
22
AbouttheIMF
23
Glossary
27
©2011, International Myeloma Foundation, North Hollywood, California (v11)

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Introduction
You have been given this booklet to learn
more about the drug VELCADE® (bortezo-
mib). After reading this booklet, you should
know:
n What VELCADE® is
n How VELCADE® works
n The possible side effects* of VELCADE®
n How VELCADE® is given.
This booklet is meant to provide you with
general information only. It is not meant to
replace the advice of your doctor or nurse.
Your doctor or nurse can answer questions
related to your specific treatment plan.
What Is Multiple Myeloma?
Multiple myeloma (synonymous with myelo-
ma and plasma cel neoplasm) is a malignan-
cy of bone marrow plasma cel s. It is there-
fore a hematologic malignancy that most
closely resembles leukemia. The malignant
plasma cel s, otherwise known as myeloma
cel s, accumulate in the bone marrow and
only rarely enter the bloodstream as in a true
leukemia. The major features of myeloma
result from this progressive accumulation of
myeloma cel s within the marrow, causing:
n Disruption of normal bone marrow func-
tion, most commonly reflected by 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
*Words appearing in bold are defined in the glossary at the end of the booklet.
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n Damage to surrounding bone
The Stages of Multiple Myeloma
n Release of monoclonal protein (M-protein)
from the myeloma into the bloodstream
Stage I (low cel mass)
600 bil ion
Al of the fol owing:
myeloma cel s*
n Suppression of normal immune function,
· Hemoglobin value >10 g/dL
reflected by reduced levels of normal
· Serum calcium value normal or <10.5 mg/dL
immunoglobulins and increased suscepti-
· Bone X-ray, normal bone structure (scale 0)
bility to infection.
or solitary bone plasmacytoma only
· Low M-component production rates
Myeloma cel s can also grow in the form of
IgG value <5.0 g/dL
localized tumors or plasmacytomas. Such
IgA value <3.0 g/dL
plasmacytomas can be single or multiple
· Urine light chain M-component
and confined within bone marrow and bone
on electrophoresis <4 g/24h
(medul ary), or they can develop outside of
Stage I (intermediate cel mass)
600 to 1,200
bone in soft tissue. Plasmacytomas outside
Fit ing neither stage I nor stage I I
bil ion
bone are cal ed "extramedul ary plasmacy-
myeloma cel s*
tomas." When there are multiple plasmacy-
Stage I I (high cel mass)
>1,200 bil ion
tomas inside or outside bone, this condition
One or more of the fol owing:
myeloma cel s*
is also cal ed multiple myeloma.
· Hemoglobin value <8.5 g/dL
Once a diagnosis of multiple myeloma has
· Serum calcium value >12 mg/dL
· Advanced lytic bone lesions (scale 3)
been made, it is important for a doctor to
· High M-component production rates
determine the stage of the disease. Disease
IgG value >7.0 g/dL
staging wil help determine which parts of
IgA value >5.0 g/dL
the body have been af ected and al ow the
· Urine light chain M-component
doctor to suggest the best treatment options.
on electrophoresis >12 g/24h
Subclassification (either A or B)
· A: relatively normal renal function
(serum creatinine value) <2.0 mg/dL
· B: abnormal renal function
(serum creatinine value) >2.0 mg/dL
Examples:
Stage IA (low cel mass with normal renal function)
Stage I IB (high cel mass with abnormal renal
function)
*myeloma cel s in the whole body
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A prognostic factor staging system cal ed
Fol owing diagnosis, several options, includ-
the International Staging System (ISS) was
ing VELCADE®, are available for initial or
introduced in 2005. It is based upon the
frontline therapy. For patients who may be
levels of two blood proteins: beta-2 micro-
candidates for therapy with transplant, vari-
globulin (2M) and albumin; the levels of
ous induction regimens can be considered
these proteins predict overal outcome with
including VELCADE® with dexamethasone,
myeloma treatment.
dexamethasone alone, or dexamethasone
in combination with other novel agents. The
STAGE
CRITERIA
combination of VELCADE® with the alkylat-
Stage 1
Serum 2 microglobulin <3.5 mg/L
ing agent melphalan plus prednisone, or mel-
Serum albumin 3.5 g/dL
phalan and prednisone alone, is an option
Stage 2
Serum 2 microglobulin < 3.5 mg/L
for patients not considering transplant. At the
and serum albumin < 3.5 g/dL
time of relapse, dif erent options and combi-
or
nations are used to achieve further response.
Serum 2 microglobulin 3.5 - 5.5 mg/L
VELCADE® is an important agent for use in
Stage 3
Serum 2 microglobulin >5.5 mg/L
this set ing as wel .
Both these systems reflect the stage and
What Is VELCADE® and
severity of the myeloma, but are not used
How Does It Work?
as a basis for selection of specific treatment
protocols. With respect to VELCADE®, it is
VELCADE® is the first in a class of drug
important to note the excel ent results have
cal ed proteasome inhibitors. In June 2008,
been achieved in patients with al stages
VELCADE® was approved for use in the
and levels of severity of myeloma, including
front-line set ing. Thus, VELCADE® is avail-
patients with renal impairment and high-risk
able for use throughout the disease course
molecular features such the t(4;14) chromo-
for myeloma patients, from those who are
somal translocation as detected by FISH.
newly diagnosed to those whose myeloma
has become refractory to and/or relapsed
It is important to understand that,
on previous therapies.
although multiple myeloma is a serious
malignancy, it is a treatable disease; many
VELCADE® works by inhibiting enzyme com-
patients experience a series of responses,
plexes, cal ed proteasomes. Both normal cel s
relapses, and remissions. Additional y, the
and cancer cel s contain proteasomes, which
average survival for patients diagnosed
break down damaged and unwanted pro-
with multiple myeloma may potential y be
teins into smal er components. Proteasomes
extended with new treatment options.
also carry out the regulated breakdown of
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How VELCADE® works.
They also stop producing chemicals to stimu-
late other cancer cel s. In addition, inhibition
of proteasomes has caused cancer cel s to
die. Cancer cel s appear to be more sensitive
to these ef ects than normal cel s, so that can-
cer cel s die while normal cel s can recover.
Clinical studies have demonstrated the ef i-
cacy of VELCADE® therapy for patients in the
relapsed/refractory, and more recently, the
front-line set ings.
Melphalan/Prednisone/VELCADE Trial
One study enrol ed newly diagnosed
patients at least 65 years of age (median
for the study population was 75). They were
given VELCADE® at a dose of either 1.0 or
1.3 mg/m2 on days 1, 4, 8, 11, 22, 25, 29,
and 32, fol owed by a ten-day rest period,
for a total of 4 cycles (equivalent to 8 regular
cycles of VELCADE®). This was fol owed by
five maintenance cycles of VELCADE® given
undamaged proteins in the cel , a process
at 1.0 or 1.3 mg/m2 once a week for four
that is necessary for the control of many
weeks fol owed by a 13-day rest period.
critical cel ular functions. These smal er com-
Both series included melphalan at 9 mg/m2
ponents are then used to create new proteins
and prednisone at 60 mg/m2 given on the
required by the cel . Proteasomes can be
first four days of each cycle.
thought of as crucial to the cel 's "recycling"
A total of 89% of the 53 enrol ed patients
of proteins.
had a response, including 32% complete
When VELCADE® inhibits proteasomes, the
responses (CR) and 11% near complete
normal balance within a cel is disrupted.
responses (nCR). Compared with the historic
This disruption results in a number of ef ects
data for 6 cycles of melphalan/prednisone
on the cel , some of which are stil being
(MP) regimen, the overal response rate
studied. When proteasomes are inhibited in
more than doubled (42% to 89%), while the
laboratory tests, cancer cel s stop dividing.
CR/nCR rate improved from 3% to 43% with
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the addition of VELCADE®. Furthermore, 12
evaluable patients, 135 patients (or 43%)
of the 17 patients with complete responses
had at least a partial response, with 27
were tested for evidence of residual disease:
patients experiencing a complete response.
6 of these 12 had molecular remission
These data demonstrates an improvement
as judged by strict laboratory criteria. At
in response from 38% in the initial reported
16 months, 91% of patients were free of
data to 43% with longer fol ow-up. For the
disease progression.
subset of VELCADE®-treated patients that had
APEX Trial
only one prior therapy, 51% had at least a
Another study, updating the results of the
partial response.
previously published APEX trial, showed that
The median time to first response with
the overal median survival rate for patients
VELCADE is 6 weeks. Of the 135 respond-
receiving single agent VELCADE® was 30
ers in the APEX study, 66% of responding
months compared with 24 months for those
patients had maximum M-protein reduction
receiving high-dose dexamethasone. In this
in or after cycle 4. Hence the best response
study, patients received VELCADE® on days
to therapy often comes with continued treat-
1, 4, 8, and 11 fol owed by a 10-day rest
ment (patients who had responses in this
period (the standard VELCADE® cycle) for
study received a median of 10 cycles).
8 cycles fol owed by 3 cycles of maintenance
Duration of response was improved in the
VELCADE® given on days 1, 8, 15, and 22
APEX study for those who had a 100%
fol owed by a 13-day rest. Out of 315
M-protein reduction compared with those
who had a reduction greater than 50%
but less than 100%. Researchers who
conducted the trial, and who now have
data, concluded that patients have a bet-
ter response with longer VELCADE®
therapy duration.
Previously Untreated Myeloma Trial
Fifty patients were enrol ed in a clinical
trial for patients with previously untreated
multiple myeloma. At the time of the study,
50% of the patients were classified at
Durie-Salmon Stage I I. They were given
VELCADE® 1.3 mg/m2 on days 1, 4, 8, and
11 fol owed by a 10-day rest period for a
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maximum of 6 cycles. If there was less than a
dexamethasone (VRD), as wel as other
partial response after two cycles or less than
combinations. It is important to discuss
a complete response after four cycles, 40 mg
with your physician the most appropriate
of dexamethasone was added on the day
combination and strategy in your case.
of, and the day after, each VELCADE® dose.
The choice is determined by several fac-
tors, including plans for auto-transplanta-
The investigators concluded that VELCADE®
tion or not; presence of high-risk chromo-
alone and in combination with dexametha-
some features ( t(4;14); del 17p- ) or not,
sone is an ef ective therapy for newly diag-
and the presence or absence of renal
nosed myeloma. The response rate (with and
problems, underlying neuropathy, or any
without the dexamethasone) was 90%, and
tendency for blood clot formation. In addi-
the total of complete responses and near
tion, personal preference is always a key
complete responses was 19%. Furthermore,
component.
the study showed that VELCADE® is a fea-
sible option for induction therapy; that stem-
n Other disease settings, including consolida-
cel harvest was successful and engraftment
tion, maintenance, and relapse: Likewise
was prompt; and that adverse events were
in these set ings, various combinations and
predictable and manageable, with the most
sequences have been demonstrated to be
frequent being neuropathy (35% at grade
ef ective. Details should be discussed with
2 or 3) and fatigue (20% at grade 2 or 3).
your physician.
Use of VELCADE®
What Are the Possible Side Effects
in Clinical Practice in 2011
of VELCADE®?
A wide range of trials have been conducted
General y, most of the side ef ects associ-
with VELCADE®.
ated with VELCADE® are manageable and
predictable. The most important side ef ects
n In the frontline setting: Numerous stud-
are described here. Your doctor or nurse can
ies have demonstrated the ef icacy of
provide more information in greater detail
VELCADE® not just in combination with
about these and other possible side ef ects.
melphalan/prednisone, but in combina-
tion with dexamethasone; cyclophospha-
Remember, speak with your doctor or nurse if
mide plus dexamethasone (VCD, also
you notice ANY changes in your health.
known as CyBorD); DOXIL® (pegylated
Peripheral Neuropathy
liposomal doxorubicin) plus dexametha-
Peripheral neuropathy is a serious condi-
sone (VDD); thalidomide plus dexametha-
tion in which treatment af ects nerves in the
sone (VTD); lenalidomide (Revlimid®) plus
hands, feet, legs, and/or arms. Symptoms of
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peripheral neuropathy include numbness,
detection and dose modification may pre-
tingling, or even pain in the hands, feet, legs,
vent progression of peripheral neuropathy.
and/or arms. Some patients may have experi-
Notifying your physician also al ows for
enced peripheral neuropathy from the ef ects
appropriate modifications of the VELCADE®
of the monoclonal protein itself and/or from
dose or schedule.
previous treatments for multiple myeloma. If
You should be aware that very detailed
you begin taking VELCADE® with this pre-
recommendations for VELCADE® dose and
existing condition, it is especial y important
schedule modifications are available. These
that you pay particular at ention to the extent
are several key principles:
of your discomfort, so that you can rapidly
n
report a worsening of your condition to your
Avoid progressive neuropathy, especial y
doctor. If detected and managed appropri-
if any significant pain develops (what is
ately, the neuropathy is often reversible.
cal ed grade 2). Although neuropathy
can be reversible, it may be partly but
Prevention and Treatment of Peripheral
not ful y reversible. Prevention is the best
Neuropathy
approach. This requires early/proactive
You are strongly advised to contact your
dose/schedule modifications.
physician if you experience new or wors-
n
ening symptoms of this condition, as early
Discuss options for dose/schedule changes
with your doctor. Two main types of modi-
fication are used:
1. Dose reduction. This is used in stepwise
fashion:
· Ful dose: 1.3 mg/m2 body surface area.
· First dose reduction to: 1.0 mg/m2
· Half dose: 0.7 mg/m2
2. One day per week option: Several recent
studies have shown that using VELCADE®
1 day/week instead of the standard 2
dose/week schedule can retain ful ef ica-
cy (with some of the major combinations
now used) and significantly reduce the
risk of neuropathy of grade 2 or higher.
Another interesting option, reported for
the first time at ASH in December, 2010,
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was the use of VELCADE® in a SQ (sub-
Prevention and Treatment of Nausea
cutaneous) injection fashion. This is an
Precautions should be taken to prevent dehy-
entirely new and not yet ful y approved
dration caused by vomiting. You should drink
approach. The French clinical trial of SQ
a suf icient amount of water and other fluids
VELCADE® presented at ASH, and very
and seek medical advice if you experience
recently published in the journal Lancet
dizziness, light-headedness, or fainting. Your
Oncology, reported that ef icacy was
physician may administer anti-emetic medi-
retained with lesser degrees of neuropa-
cation or intravenous hydration as required.
thy reported. At this writing, the U.S. Food
Diarrhea
and Drug Adminstration (FDA) is consider-
Diarrhea may occur while taking VELCADE®.
ing the approval of SQ VELCADE®.
Dizziness, light-headedness, or fainting may
Fatigue
occur due to dehydration caused by either
Fatigue is a common side effect associated
excessive or persistent diarrhea.
with VELCADE® therapy. Although fatigue
Prevention and Treatment of Diarrhea
is general y not severe, caution is advised if
Precautions should be taken to prevent dehy-
you are operating machinery, including auto-
dration caused by either excessive or persis-
mobiles.
tent diarrhea. You should maintain a proper
Prevention and Treatment of Fatigue
level of hydration by drinking a suf icient
Management of fatigue may include support-
amount of water and seek medical advice if
ive care as determined by your physician.
you experience dizziness, light-headedness,
The effects of fatigue may be minimized by
or fainting. Your physician may adminis-
maintaining:
ter antidiarrheal medication or intravenous
hydration as required.
n A moderate level of activity
n A healthy diet and proper fluid intake
Decreased Platelet Levels
Patients taking VELCADE® often experience a
n A consistent sleeping schedule with
enough rest
condition cal ed thrombocytopenia ­ a low-
ered level of platelets in the blood. Platelets
n Regularly scheduled visits with your
help blood to clot; fewer platelets can lead to
doctor or health care professional.
bruising, bleeding, and slower healing. The
Nausea
platelet level fal s with treatment but should
Nausea may occur while taking VELCADE®
return to the baseline level by the beginning
and may be associated with dizziness, light-
of the next cycle.
headedness, or fainting if it leads to dehydra-
tion. Medical treatment may be required for
dehydration.
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Prevention and Treatment of Decreased
Other Side Effects of VELCADE®
Platelet Levels
Other side ef ects may occur with VELCADE®
You should inform your physician if you
and include headache, insomnia, occasional
experience excessive bruising or bleeding.
rash, fever, cough, back pain, and muscle
Management may include platelet transfu-
cramps. Remember to discuss ANY changes
sions at the discretion of your physician.
in your health with a doctor or nurse on your
healthcare team.
Low Blood Pressure
A drop in blood pressure may occur after
Will a Reduction in Dose
receiving VELCADE®. If you have a history
of VELCADE® Change the
of fainting or low blood pressure or are
Effectiveness of Treatment?
taking medication that can cause low blood
pressure (such as antihypertensive medica-
It is important to communicate openly with
tion), it is important that you tel your doc-
your doctor or healthcare professional and
keep regular appointments to maintain your
tor about your condition before you begin
VELCADE® treatment schedule. Your doc-
receiving VELCADE®. Dizziness, especial y
tor may choose to lower your dose of
when it occurs after rapidly sit ing up or
VELCADE® as part of an overal plan to man-
standing from a lying-down position, may
age a particular side ef ect you experience.
be a sign of low blood pressure.
The recommended initial dose of VELCADE®
Prevention and Treatment of Low Blood
is 1.3 mg/m2. However, a lower dose of
Pressure
1.0 mg/m2, which is the first dose reduction
You should seek medical advice if you
your doctor is likely to try, has also been
experience dizziness, light-headedness, or
found active against multiple myeloma. In
fainting. Caution is advised when operat-
the smal study that examined both of these
ing machinery, including automobiles. You
doses, there was no significant dif erence in
should take precautions to prevent dehydra-
ef ectiveness between the two doses. Your
tion (drinking plenty of water, for example),
doctor may also choose to skip a scheduled
and your physician may administer medica-
dose to reduce the severity of a side ef ect
tion for the treatment of low blood pressure.
before continuing treatment.
It is also important to inform your doctor
Studies have shown that administration of
about any additional medications you are
VELCADE® on a weekly schedule in com-
taking, particularly for the treatment of
bination with other anti-myeloma agents is
hypertension.
associated with a reduction in side ef ects,
particularly peripheral neuropathy, without
significant reduction in ef icacy.
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How Is VELCADE® Given?
About the IMF
VELCADE® is a lyophilized (freeze-dried)
"One person can make a dif erence,
powder, which must be reconstituted before
Two can make a miracle."
injection. VELCADE® may be injected
through either a peripheral or central intra-
Brian D. Novis
IMF Founder
venous line. VELCADE® is injected over a
short period of 3 to 5 seconds. As with al
Myeloma is a lit le-known, complex, and
treatments, a doctor or nurse wil closely
often misdiagnosed bone marrow cancer that
monitor you if you are receiving VELCADE®
at acks and destroys bone. Myeloma af ects
for the first time.
approximately 75,000 to 100,000 people
in the United States, with approximately
VELCADE® is given twice per week for 2
20,000 new cases diagnosed each year.
weeks, fol owed by a 10-day rest period.
Although there is presently no known cure
Patients and their doctors typical y choose a
for myeloma, doctors have many approach-
Monday/Thursday or Tuesday/Friday sched-
es to help myeloma patients live bet er
ule. At least 72 hours is needed between
and longer.
doses, so that normal cel s have a chance
to recover from the ef ects of the drug.
The International Myeloma Foundation (IMF)
Therefore, changes in the administration
was founded in 1990 by Brian and Susie
schedule are limited to delaying an injection
Novis shortly after Brian's myeloma diagno-
for a day, rather than moving the injection
sis at the age of 33. It was Brian's dream that
up one day.
future patients would have easy access to
medical information and emotional support
VELCADE® is frequently given in combina-
throughout their bat le with myeloma. He
tion with other anti-myeloma drugs, includ-
established the IMF with the 3 goals of treat-
ing dexamethasone, Doxil®, and melphalan
ment, education, and research. He sought
plus prednisone. VELCADE® is also being
to provide a broad spectrum of services for
tested in combination with other agents, such
patients, their families, friends, and health
as Revlimid® (lenalidomide). Details about
care providers. Although Brian died 4 years
therapy with dexamethasone, Doxil®, and
after his initial diagnosis, his dream didn't.
Revlimid® are discussed in separate booklets.
Today, the IMF reaches out to an interna-
tional membership of more than 195,000.
The IMF was the first organization dedicated
solely to myeloma, and today it remains
the largest.
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The IMF provides programs and services to
MYELOMA TODAY NEWSLETTER
aid in the research, diagnosis, treatment,
Our quarterly newslet er is available free of
charge by subscription.
and management of myeloma. The IMF
ensures that no one must brave the myeloma
SUPPORT
bat le alone.
MYELOMA HOTLINE: 800-452-CURE (2873)
We care for patients today, while working
Toll-free throughout the United States and
Canada, the IMF Hotline is staf ed by trained
toward tomorrow's cure.
information specialists and is in frequent inter-
action with members of our Scientific Advisory
How Can the IMF Help You?
Board.
PATIENT EDUCATION
SUPPORT GROUPS
INFORMATION PACKAGE
A worldwide network of more than 100 myelo-
Our free IMF InfoPack provides comprehensive
ma support groups holds regular meetings for
information about myeloma, treatment options,
members of the myeloma community. The IMF
disease management, and IMF services. It
conducts annual retreats for myeloma support
includes our acclaimed Patient Handbook.
group leaders.
INTERNET ACCESS
RESEARCH
Log on to www.myeloma.org for 24-hour
BANK ON A CURE®
access to information about myeloma, the IMF,
This DNA bank wil provide genetic data for
education, and support programs.
research in new drug development.
ONLINE MYELOMA FORUM
INTERNATIONAL MYELOMA WORKING GROUP (IMWG)
Join the IMF Internet Discussion Group at
IMF's International Myeloma Working Group
www.myeloma.org/listserve.html to share your
consists of 145 leading myeloma researchers
thoughts and experiences.
from around the world who col aborate on a
MYELOMA MINUTE
broad range of myeloma research projects.
Subscribe to this free weekly email newslet er
With a goal to improve myeloma treatment
for up-to-the-minute information about myeloma.
options and diagnostic systems, their work
PATIENT & FAMILY SEMINARS
focuses on protocols to provide a more durable
Meet with leading experts in myeloma treat-
remission for myeloma patients while improv-
ment to learn more about recent advances in
ing quality of life, addressing the needs of
therapy and research.
both myeloma patients and the physicians who
treat them.
MYELOMA MATRIX
On our website and in print, this document is a
THE INTERNATIONAL STAGING SYSTEM (ISS)
comprehensive guide to drugs in development
This updated staging system for myeloma wil
for myeloma.
enhance physicians' ability to select the most
appropriate treatment for each patient.
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RESEARCH GRANTS
Plasma cel : A type of white blood cel that produces
Leading the world in col aborative research
antibodies.
and achieving extraordinary results, the IMF
Plasmacytoma: A tumor made up of cancerous plasma
Grant Program supports both junior and senior
cel s.
researchers working on a broad spectrum of
Platelet: An element in the blood that helps with clot ing,
projects. The IMF has at racted many young
which in turn helps repair damaged blood vessels.
investigators into the field of myeloma who
remain in the field and actively pursue a cure
Proteasome: A joined group (or complex) of enzymes that
for the disease.
destroy damaged or unwanted proteins and undamaged
proteins that require degradation in the cel . This turnover
or "recycling" of proteins is important to maintain bal-
Glossary
ance within the cel and helps to regulate several functions
Alkylating agent: An agent that prevents the growth and
including cel growth.
division of new cancer cel s by inhibiting their ability to
Proteasome inhibitor: Any drug that interferes with the
replicate DNA.
normal function of the proteasome.
Anemia: A low level of red blood cel s in the bloodstream.
Protein: A group of compounds that are the main compo-
Bone marrow: A soft, spongy tissue found in most large
nents of a cel .
bones that produces red and white blood cel s and
Red blood cel : A blood cel that carries oxygen from the
platelets.
lungs throughout the body.
Cel : The smal est unit of life. Mil ions of microscopic cel s
Side effect: An ef ect caused by treatment with a drug. The
comprise each bodily organ.
term usual y refers to an unwanted ef ect, but some side
Enzyme: A type of protein that causes chemical reactions
ef ects may be beneficial.
of other substances without undergoing change in the
Thrombocytopenia: A low level of platelets in the blood.
process.
These low levels can cause bruising or bleeding as wel
FISH: Fluorescent In Situ Hybridization, a procedure that
as a delay in the injury healing process.
al ows researchers to locate the positions of specific DNA
White blood cel : A cel made by the bone marrow that
sequences on chromosomes.
helps fight infection and/or disease.
Monoclonal protein (M protein): An abnormal protein pro-
duced by myeloma cel s that accumulates in and dam-
ages bone and bone marrow. A high level of M protein
indicates that myeloma cel s are present in large numbers.
Multiple myeloma: A cancer arising from the plasma cel s
in the bone marrow. The plasma cel s in patients with
multiple myeloma form abnormal antibodies, possibly
damaging the bone, bone marrow, and other organs.
Neuropathy: Numbness, tingling, and/or pain in the
hands, feet, legs, and/or arms.
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