Multiple myeloma natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

If left untreated, most of patients with multiple myeloma may progress to develop fatigue, bone pain, and pallor.[1] Complications that can develop as a result of multiple myeloma are anemia, renal failure,skeletal, and neurological complications.[2] The prognosis of multiple myeloma is good with treatment. Without treatment, multiple myeloma will result in death with a median survival of 7 months. Multiple myeloma is associated with a 10 year survival of 3%. The presence of plasma cell leukemia or soft tissue plasmacytomas is associated with a particularly poor prognosis among patients with multiple myeloma.[3] According to a report published by National Cancer Institute there is a 43.25% chance of 5 year survival.[4]

Natural History

Most patients with multiple myeloma are initially symptomatic. If left untreated, most of patients with multiple myeloma will gradually develop fatigue, bone pain, and pallor.[5]

Complications

Complications that can develop as a result of multiple myeloma are divided into:[6]

  • Local complications:
  • Hematologic complications, usually results from the replacement of normal bone marrow by infiltrating tumor cells and inhibition of normal (hematopoiesis) by cytokines
  • Normocytic and normochromic anemia
  • Bleeding disorders
  • Pancytopenia due to bone marrow failure
  • Skeletal complications
  • Systemic complications:
  • Infections

Prognosis

  • The prognosis of multiple myeloma is good with treatment. Without treatment, multiple myeloma will result in death with a median survival of 7 months. Multiple myeloma is associated with a 10 year survival of 3%. The presence of plasma cell leukemia or soft tissue plasmacytomas is associated with a particularly poor prognosis among patients with multiple myeloma.[7]
  • Overall mortality rates peaked in the mid-1990s and have fallen in recent years with the introduction of better therapeutic interventions.[8]
  • The average survival of multiple myeloma patients is approximately 3 years and approximately 43.5% of patients survive after 5 years.[9]
  • The International Staging System can help to predict survival, with a median survival of 62 months for stage 1 disease, 45 months for stage 2 disease, and 29 months for stage 3 disease.
  • Cytogenetic analysis of multiple myeloma cells may be of prognostic value, with deletion of chromosome 13, non-hyperdiploidy and the balanced translocations t(4;14) and t(14;16) conferring a poorer prognosis. The 11q13 and 6p21 cytogenetic abnormalities are associated with a better prognosis.[10]
  • Prognostic markers such as these are always generated by retrospective analyses, and it is likely that new treatment developments will improve the outlook for those with traditionally 'poor-risk' disease.

References

  1. Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Prognosis
  2. "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
  3. Plasma cell neoplasm. Cancer.gov (2015)http://www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq#link/_40_toc
  4. "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
  5. Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Prognosis
  6. Bladé, J.; Rosiñol, L. (2007). "Complications of multiple myeloma". Hematol Oncol Clin North Am. 21 (6): 1231–46, xi. doi:10.1016/j.hoc.2007.08.006. PMID 17996596. Unknown parameter |month= ignored (help)
  7. Plasma cell neoplasm. Cancer.gov (2015)http://www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq#link/_40_toc
  8. A snapshot of myeloma. National cancer institute(2014)http://www.cancer.gov/research/progress/snapshots/myeloma
  9. "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
  10. Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Prognosis


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