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==Overview==
==Overview==

Revision as of 00:18, 22 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2] Shyam Patel [3]

Overview

If left untreated, most of patients with multiple myeloma may progress to develop fatigue, bone pain, and pallor.[1] Common complications of multiple myeloma include anemia, renal failure, skeletal complications, and neurological complications.[2] 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.[2][3] Multiple myeloma is associated with a 10 year survival rate of 3%. The presence of plasma cell leukemia or soft tissue plasmacytomas is associated with a particularly poor prognosis among patients with multiple myeloma.[4] According to a report published by the National Cancer Institute there is a 43.25% chance of 5 year survival.[2]

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.[1]
  • In as many as 30-40% cases the diagnosis may be incidental and is often diagnosed on routine blood screening.[1]

The natural history of plasmacytoma involves a risk of progression to active multiple myeloma. After a median follow-up of 58 months, 67% of patients will develop progression to multiple myeloma.[5] Approximately 20% of patients will die from progression of disease.[5]

Complications

Complications that can develop as a result of multiple myeloma are divided into:[6] PMID:24130968

  • Local complications:
  • Hematologic complications, results from the replacement of normal bone marrow by infiltrating tumor cells and inhibition of normal (hematopoiesis) by cytokines
  • 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.[2][3]
  • Overall the 5-year survival rate of multiple myeloma is around 46.6%.[2][1]
  • Overall mortality rates peaked in the mid-1990s and have decreased in recent years with the development of new 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 table below lists common prognostic factors for multiple myeloma:
Prognostic Factor Description
Stage Advanced stages of multiple myeloma are associated with poor prognosis.[10]
Kidney function An elevated level of creatinine is associated with poor prognosis.[10]
Labelling index The labeling index indicates how fast the cancer cells are growing. A high plasma cell labeling index (PCLI) or proliferation (reproduction) rate is associated with poor prognosis.[10]
Age Older patients have worse prognosis than younger patients.[10]
Chromosome changes 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][1]
Assocciated plasma cell disorder The presence of plasma cell leukemia or soft tissue plasmacytoma is associated with a particularly poor prognosis among patients with multiple myeloma.[11]
Performance status Performance status is ranked on a 0–4 scale. The lower the number, the healthier and more active the person is, and the better the prognosis. Performance status is important in multiple myeloma because people who are healthier can withstand more intensive treatment.[10]
Beta-2-microglobulin A higher level of beta-2-microglobulin is associated with poor prognosis.[10]
Albumin level A lower albumin level is associated with poor prognosis.[10]
Lactate dehydrogenase level A higher level of lactate dehydrogenase (LDH) is associated with poor prognosis.[10]
Response to treatment People whose cancer responds to treatment and goes into complete remission have a better prognosis than people whose cancer does not respond to the initial treatment.[10]

The prognosis for solitary plasmacytoma is generally very good. The median survival is 10 years.[5] The 5-year survival rate is 72% and the 20-year survival rate is 37%.[5]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Prognosis Accessed on September, 20th 2015
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Multiple myeloma. National Cancer Institute(2015) www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq#link/_40_toc Accessed on September, 20th 2015
  3. ↑ 3.0 3.1 Multiple myeloma. Librepathology (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_pathophysiology&action=edit&section Accessed on September, 20th 2015=1
  4. ↑ Plasma cell neoplasm. Cancer.gov (2015)http://www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq#link/_40_toc Accessed on September, 20th 2015
  5. ↑ 5.0 5.1 5.2 5.3 Jia R, Xue L, Liang H, Gao K, Li J, Zhang Z (2015). "Surgery combined with radiotherapy for the treatment of solitary plasmacytoma of the rib: a case report and review of the literature". J Cardiothorac Surg. 10: 125. doi:10.1186/s13019-015-0335-5. PMC 4605096. PMID 26464186.
  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. ↑ Rosner, Mitchell H.; Ingelfinger, Julie R.; Perazella, Mark A. (2017). "Acute Kidney Injury in Patients with Cancer". New England Journal of Medicine. 376 (18): 1770–1781. doi:10.1056/NEJMra1613984. ISSN 0028-4793.
  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. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 Multiple myeloma. Canadian cancer society (2015)http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/prognosis-and-survival/?region=mb Accessed on September, 20th 2015
  11. ↑ Plasma cell neoplasm. Cancer.gov (2015)http://www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq#link/_40_toc


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