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. Complications that can develop as a result of multiple myeloma are anemia, renal failure, skeletal complications, and neurological complications. The prognosis of multiple myeloma is good with treatment, while 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. According to a report published by National Cancer Institute there is a 43.25% chance of 5 year survival.

Natural History

• Most patients with multiple myeloma are initially asymptomatic. If left untreated, most of the patients with multiple myeloma will gradually develop fatigue, bone pain, and pallor.
• In as many as 30-40% cases the diagnosis may be incidental and is often diagnosed on routine blood screening.
• As the tumor grows larger people may notice one or more of the symptoms.

Complications

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

• 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

• Pathologic fractures
• Spinal cord compression present as back pain, numbness, dysthesias suggestive, loss of bowel or bladder control.

• Systemic complications:

• Hypercalcemia
• Renal insufficiency, may develop both acutely and chronically.
• Neurologic complications

• Intracranial plasmacytomas
• Leptomeningeal involvement
• Retinopathy
• radicular pain
• Carpal tunnel syndrome
• Paraplegia

• Infections

• Pneumonias
• Pyelonephritis

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.
• Overall the 5-year survival rate of multiple myeloma is around 35%.
• The presence of plasma cell leukemia or soft tissue plasmacytomas is associated with a particularly poor prognosis among patients with multiple myeloma.
• Overall mortality rates peaked in the mid-1990s and have fallen in recent years with the development of new therapeutic interventions.
• The average survival of multiple myeloma patients is approximately 3 years and approximately 43.5% of patients survive after 5 years.
• 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.
• 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

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