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General Information
Note: Estimated new cases and deaths from multiple myeloma in the United States in 2008:[1]
- New cases: 19,920.
- Deaths: 10,690.
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 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. 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.[2]
The initial approach to the patient is to establish the diagnosis by:
- 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.
References
-
American Cancer Society.: Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society, 2008. Also available online. Last accessed October 1, 2008.
-
Rajkumar SV, Kyle RA: Multiple myeloma: diagnosis and treatment. Mayo Clin Proc 80 (10): 1371-82, 2005.
[PUBMED Abstract]
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