Multiple myeloma

Not to be confused with Melanoma.

Multiple myeloma
Other namesPlasma cell myeloma, myelomatosis, Kahler's disease, myeloma[1]
Bone marrow sample from a patient with multiple myeloma
SpecialtyHematology and oncology
SymptomsBone pain, fatigue[2]: 653 
ComplicationsAmyloidosis, kidney problems, bone fractures, hyperviscosity syndrome, infections, anemia[3][2]: 653 
Usual onsetAround 60
DurationLong term[3]
CausesUnknown[4]
Risk factorsObesity[5]
Diagnostic methodBlood or urine tests, bone marrow biopsy, medical imaging[6]
TreatmentSteroids, chemotherapy, thalidomide, stem cell transplant, bisphosphonates, radiation therapy[3][6]
PrognosisFive-year survival rate 54% / life expectancy 6 years (USA)[7]
Frequency488,200 (affected during 2015)[8]
Deaths101,100 (2015)[9]

Multiple myeloma (MM), also known as plasma cell myeloma and simply myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies.[6] Often, no symptoms are noticed initially.[10] As it progresses, bone pain, anemia, renal insufficiency, and infections may occur.[10] Complications may include hypercalcemia and amyloidosis.[3]

The cause of multiple myeloma is unknown.[4] Risk factors include obesity, radiation exposure, family history, age and certain chemicals.[5][11][12] There is an increased risk of multiple myeloma in certain occupations.[13] This is due to the occupational exposure to aromatic hydrocarbon solvents having a role in causation of multiple myeloma.[14] Multiple myeloma is the result of a multi-step malignant transformation, and almost universally originates from the pre-malignant stage monoclonal gammopathy of undetermined significance (MGUS). As MGUS evolves into MM, another pre-stage of the disease is reached, known as smoldering myeloma (SMM).[15]

In MM, the abnormal plasma cells produce abnormal antibodies, which can cause kidney problems and overly thick blood.[10] The plasma cells can also form a mass in the bone marrow or soft tissue.[10] When one tumor is present, it is called a plasmacytoma; more than one is called multiple myeloma.[10] Multiple myeloma is diagnosed based on blood or urine tests finding abnormal antibody proteins (often using electrophoretic techniques revealing the presence of a monoclonal spike in the results, termed an m-spike), bone marrow biopsy finding cancerous plasma cells, and medical imaging finding bone lesions.[6] Another common finding is high blood calcium levels.[6]

Multiple myeloma is considered treatable, but generally incurable.[3] Remissions may be brought about with steroids, chemotherapy, targeted therapy, and stem cell transplant.[3] Bisphosphonates and radiation therapy are sometimes used to reduce pain from bone lesions.[3][6] Recently, new approaches utilizing CAR-T cell therapy have been included in the treatment regimes.[16]

Globally, about 175,000 people were diagnosed with the disease in 2020, while about 117,000 people died from the disease that year. In the U.S., forecasts suggest about 35,000 people will be diagnosed with the disease in 2023, and about 12,000 people will die from the disease that year.[17] In 2020, there were an estimated 170,405 people living with myeloma in the U.S.[18]

It is difficult to judge mortality statistics because treatments for the disease are advancing rapidly. Based on data concerning people diagnosed with the disease between 2013 and 2019, about 60% lived five years or more post-diagnosis, with about 34% living ten years or more.[18] People newly diagnosed with the disease now have a better outlook, due to improved treatments.[19]

The disease usually occurs around the age of 60 and is more common in men than women.[6] It is uncommon before the age of 40.[6] The word myeloma is from Greek myelo- 'marrow' and -oma 'tumor'.[20]

  1. ^ "Myeloma Canada | What is Multiple Myeloma?". Myeloma Canada. Archived from the original on 13 May 2020. Retrieved 17 April 2020.
  2. ^ a b Cite error: The named reference :5 was invoked but never defined (see the help page).
  3. ^ a b c d e f g "Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Health Professional Version". NCI. 29 July 2016. Archived from the original on 4 July 2016. Retrieved 8 August 2016.
  4. ^ a b World Cancer Report 2014. World Health Organization. 2014. pp. Chapter 5.13. ISBN 978-92-832-0429-9.
  5. ^ a b World Cancer Report 2014. World Health Organization. 2014. pp. Chapter 2.3 and 2.6. ISBN 978-92-832-0429-9.
  6. ^ a b c d e f g h Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC (July 2009). "Multiple myeloma". Lancet. 374 (9686): 324–339. doi:10.1016/S0140-6736(09)60221-X. PMID 19541364. S2CID 12906881.
  7. ^ Cite error: The named reference SEER2016 was invoked but never defined (see the help page).
  8. ^ Cite error: The named reference GBD2015Pre was invoked but never defined (see the help page).
  9. ^ Cite error: The named reference GBD2015De was invoked but never defined (see the help page).
  10. ^ a b c d e "Plasma Cell Neoplasms (Including Multiple Myeloma)—Patient Version". NCI. 1 January 1980. Archived from the original on 27 July 2016. Retrieved 8 August 2016.
  11. ^ "Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment". National Cancer Institute. 1 January 1980. Archived from the original on 9 January 2021. Retrieved 28 November 2017.
  12. ^ Ferri FF (2013). Ferri's Clinical Advisor 2014 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 726. ISBN 978-0-323-08431-4. Archived from the original on 18 August 2023. Retrieved 23 August 2020.
  13. ^ Georgakopoulou R, Fiste O, Sergentanis TN, Andrikopoulou A, Zagouri F, Gavriatopoulou M, et al. (September 2021). "Occupational Exposure and Multiple Myeloma Risk: An Updated Review of Meta-Analyses". Journal of Clinical Medicine. 10 (18): 4179. doi:10.3390/jcm10184179. PMC 8469366. PMID 34575290.
  14. ^ De Roos AJ, Spinelli J, Brown EB, Atanackovic D, Baris D, Bernstein L, et al. (November 2018). "Pooled study of occupational exposure to aromatic hydrocarbon solvents and risk of multiple myeloma". Occupational and Environmental Medicine. 75 (11): 798–806. doi:10.1136/oemed-2018-105154. PMC 9386620. PMID 30121582.
  15. ^ van de Donk NW, Mutis T, Poddighe PJ, Lokhorst HM, Zweegman S (May 2016). "Diagnosis, risk stratification and management of monoclonal gammopathy of undetermined significance and smoldering multiple myeloma". International Journal of Laboratory Hematology. 38 (Suppl 1): 110–122. doi:10.1111/ijlh.12504. PMID 27161311.
  16. ^ Martino M, Canale FA, Alati C, Vincelli ID, Moscato T, Porto G, Loteta B, Naso V, Mazza M, Nicolini F, Ghelli Luserna di Rorà A, Simonetti G, Ronconi S, Ceccolini M, Musuraca G (27 May 2021). "CART-Cell Therapy: Recent Advances and New Evidence in Multiple Myeloma". Cancers. 13 (11): 2639. doi:10.3390/cancers13112639. ISSN 2072-6694. PMC 8197914. PMID 34072068.
  17. ^ "Multiple Myeloma: Statistics". ASCO Cancer.net. March 2023. Archived from the original on 11 June 2023. Retrieved 10 June 2023.
  18. ^ a b "Cancer Stat Facts: Myeloma". National Cancer Institute. Archived from the original on 7 May 2020. Retrieved 10 June 2023.
  19. ^ "Survival Rates for Multiple Myeloma". American Cancer Society. Archived from the original on 11 June 2023. Retrieved 10 June 2023.
  20. ^ Diepenbrock NH (2011). Quick Reference to Critical Care. Lippincott Williams & Wilkins. p. 292. ISBN 978-1-60831-464-5. Archived from the original on 21 August 2016.