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the bone marrow in all bones, producing small holes in the bones and leading to the name, "multiple myeloma." Researchers are trying to understand what causes myeloma. They have identified several risk factors, including age (older than 50), ethnicity (African-Americans are at greater risk), obesity and radiation exposure. Myeloma may not cause symptoms, but when symptoms are present, they can include bone pain, anemia, kidney failure and excessive calcium in the blood. "Because myeloma patients don't make antibodies [infection- fighting proteins] the way that healthy people do, they have a higher risk of infection," Dr. Astrow says. "All blood cancers are associated with some degree of immune system impairment, so anything patients can do to strengthen their immune systems tends to be beneficial." MYELOMA DIAGNOSIS AND TREATMENT Doctors confirm the presence of myeloma through a bone- marrow biopsy, during which a sample of bone marrow is extracted from the patient's bone through a thin needle. Treatment may include a combination of chemotherapy and steroid medications. Immunotherapy, radiation therapy and stem cell transplant are options, too. "Myeloma treatment has improved in recent years," Dr. Astrow says. "The median survival for myeloma patients has increased from three years to nearly ten years during the past decade. I think that the next step will be learning to better combine our use of new medications with drugs that have been available for some time. If we can do that, we may be able to obtain better responses early in the course of the disease, which will lead to long periods of remission." HOPEFUL OUTLOOK Patients and their doctors can be optimistic that the fight against myeloma and all blood cancers is trending in a positive direction. "There is reason for individuals who have these cancers to be optimistic," Dr. Astrow says. "The medical community has made strides in understanding the nature of blood cancers and has developed exciting improvements in treatment. The improved prognoses for many blood cancer patients like those with chronic leukemias and myeloma are proof of how far we've come in the past decade." thrive P H Y S I C I A N RE F E R R A L / / 718 . 49 9. C A RE 21