Note: Estimated new cases and deaths from multiple myeloma in the United States in 2009:
- New cases: 20,580.
- Deaths: 10,580.
Multiple myeloma is a systemic malignancy of plasma cells that is highly treatable but rarely curable. It is potentially curable when it presents as a solitary plasmacytoma of bone or as an extramedullary plasmacytoma. The median survival in the prechemotherapy era was about 7 months. After the introduction of chemotherapy, prognosis improved significantly with a median survival of 24 months to 30 months and a 10-year survival of 3%. Even further improvements in prognosis have occurred because of the introduction of newer therapies such as pulse corticosteroids, thalidomide, bortezomib, and autologous and allogeneic stem cell transplantation, with median survivals of 45 months to 60 months.[2,3,4] The disease is staged by estimating the myeloma tumor cell mass on the basis of the amount of monoclonal (or myeloma) protein (M protein) in the serum and/or urine, along with various clinical parameters, such as the hemoglobin and serum calcium concentrations, the number of lytic bone lesions, and the presence or absence of renal failure. The stage of the disease at presentation is a strong determinant of survival, but it has little influence on the choice of therapy since almost all patients, except for rare patients with solitary bone tumors or extramedullary plasmacytomas, have generalized disease. Treatment selection is influenced by the age and general health of the patient, prior therapy, and the presence of complications of the disease.
The initial approach to the patient is to evaluate the following parameters:
- Detection of an M protein in the serum or urine.
- Detection of greater than 10% of plasma cells on a bone marrow examination.
- Detection of lytic bone lesions or generalized osteoporosis in skeletal x-rays.
- Presence of soft tissue plasmacytomas.
- Serum albumin and beta-2-microglobulin levels.
- Detection of free kappa and lambda serum immunoglobulin light chain.
American Cancer Society.: Cancer Facts and Figures 2009. Atlanta, Ga: American Cancer Society, 2009. Also available online. Last accessed January 6, 2010.
Kumar SK, Rajkumar SV, Dispenzieri A, et al.: Improved survival in multiple myeloma and the impact of novel therapies. Blood 111 (5): 2516-20, 2008.
Ludwig H, Durie BG, Bolejack V, et al.: Myeloma in patients younger than age 50 years presents with more favorable features and shows better survival: an analysis of 10 549 patients from the International Myeloma Working Group. Blood 111 (8): 4039-47, 2008.
Brenner H, Gondos A, Pulte D: Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood 111 (5): 2521-6, 2008.
Rajkumar SV, Kyle RA: Multiple myeloma: diagnosis and treatment. Mayo Clin Proc 80 (10): 1371-82, 2005.
Dispenzieri A, Kyle R, Merlini G, et al.: International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 23 (2): 215-24, 2009.