Multiple myeloma natural history: Difference between revisions
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*'''[[Leukopenia]]''': Impaired granulocyte and lymphocyte progenitor formation leads to decreased mature [[white blood cell]] production, which results in [[leukopenia]]. Patients can experience signs and symptoms including localized infections, fevers, chills, and sepsis. In rare cases, infection can be very severe and lead to severe sepsis. Patients may require treatment with antibiotics. Of note, although the plasma cell burden is increased in multiple myeloma, these plasma cells do not function in a normal manner, and the abnormal paraprotein production in multiple myeloma does not confer adequate humoral immunity. Thus, patient can have normal plasma cell counts but can be functionally immunosuppressed. | *'''[[Leukopenia]]''': Impaired granulocyte and lymphocyte progenitor formation leads to decreased mature [[white blood cell]] production, which results in [[leukopenia]]. Patients can experience signs and symptoms including localized infections, fevers, chills, and sepsis. In rare cases, infection can be very severe and lead to severe sepsis. Patients may require treatment with antibiotics. Of note, although the plasma cell burden is increased in multiple myeloma, these plasma cells do not function in a normal manner, and the abnormal paraprotein production in multiple myeloma does not confer adequate humoral immunity. Thus, patient can have normal plasma cell counts but can be functionally immunosuppressed. | ||
==='''Systemic complications'''=== | |||
: | Systemic complications of multiple myeloma are due to the effects of plasma cells on various non-hematologic organs, such as the kidneys, bones, and nervous system. | ||
*'''Skeletal complications''': Skeletal-related events are diverse and include lytic lesions and pathologic fractures. | |||
:::*[[Spinal cord compression]] present as back pain, numbness, [[dysthesias]] suggestive, loss of bowel or bladder control | :::*[[Spinal cord compression]] present as back pain, numbness, [[dysthesias]] suggestive, loss of bowel or bladder control | ||
Revision as of 06:18, 29 July 2018
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Multiple myeloma Microchapters |
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Multiple myeloma natural history On the Web |
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Risk calculators and risk factors for Multiple myeloma natural history |
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]
- The median overall survival for newly diagnosed multiple myeloma ranges from 2 to 10 years.[6]
Complications
Complications that can develop as a result of multiple myeloma are divided into hematologic complications and systemic complications:[7] PMID:24130968
Hematologic complications
Hematologic complications of multiple myeloma are due to the accumulation of excess numbers of abnormal plasma cells, which impairs normal hematopoiesis. This is referred to as myelophthisis, or the replacement of normal bone marrow by infiltrating tumor cells. This can result in complications such as anemia, thrombocytopenia, and leukopenia.
- Anemia: Impaired erythroid progenitor formation leads to decreased red blood cell production, which results in anemia. The anemia is usually normocytic (mean corpuscular volume of 80-100 femtoliters). Patients can experience signs and symptoms including fatigue, mucosal and conjunctival pallor, shortness of breath, and decreased exercise tolerance. Severe anemia can occur in patients who have concurrent renal dysfunction from multiple myeloma, as erythropoietin production is impaired in patients with renal complications. Patients may require red blood cell transfusion if the hemoglobin level is less than 7 g/dl or if severe symptomatic anemia develops. Complications from transfusion include HIV infection, hepatitis B infection, hepatitis C infection, pulmonary edema from volume overload, alloimmunization to red blood cell products, and hemosiderosis (iron overload state).
- Thrombocytopenia: Impaired megakaryocyte formation leads to decreased platelet production, which results in thrombocytopenia. Patients can experience signs and symptoms including mucosal bleeding, upper and lower gastrointestinal bleeding, bruising, petechiae, and ecchymoses. In rare cases, fatal hemorrhage can occur. Patients may require platelet transfusion if the platelet count is less than 10,000 cells per microliter, or less than 50,000 cells per microliter in the setting of bleeding diathesis.
- Leukopenia: Impaired granulocyte and lymphocyte progenitor formation leads to decreased mature white blood cell production, which results in leukopenia. Patients can experience signs and symptoms including localized infections, fevers, chills, and sepsis. In rare cases, infection can be very severe and lead to severe sepsis. Patients may require treatment with antibiotics. Of note, although the plasma cell burden is increased in multiple myeloma, these plasma cells do not function in a normal manner, and the abnormal paraprotein production in multiple myeloma does not confer adequate humoral immunity. Thus, patient can have normal plasma cell counts but can be functionally immunosuppressed.
Systemic complications
Systemic complications of multiple myeloma are due to the effects of plasma cells on various non-hematologic organs, such as the kidneys, bones, and nervous system.
- Skeletal complications: Skeletal-related events are diverse and include lytic lesions and pathologic fractures.
- Spinal cord compression present as back pain, numbness, dysthesias suggestive, loss of bowel or bladder control
- Systemic complications:
- Hypercalcemia
- Renal insufficiency, which may develop both acutely and chronically
- Neurologic 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.[9]
- The average survival of multiple myeloma patients is approximately 3 years and approximately 43.5% of patients survive after 5 years.[10]
- The table below lists common prognostic factors for multiple myeloma:
| Prognostic Factor | Description |
| Stage | Advanced stages of multiple myeloma are associated with poor prognosis.[11] |
| Kidney function | An elevated level of creatinine is associated with poor prognosis.[11] |
| 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.[11] |
| Age | Older patients have worse prognosis than younger patients.[11] |
| 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.[11][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.[12] |
| 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.[11] |
| Beta-2-microglobulin | A higher level of beta-2-microglobulin is associated with poor prognosis.[11] |
| Albumin level | A lower albumin level is associated with poor prognosis.[11] |
| Lactate dehydrogenase level | A higher level of lactate dehydrogenase (LDH) is associated with poor prognosis.[11] |
| 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.[11] |
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
- ↑ 1.0 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
- ↑ 2.0 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
- ↑ 3.0 3.1 Multiple myeloma. Librepathology (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_pathophysiology&action=edit§ion Accessed on September, 20th 2015=1
- ↑ Plasma cell neoplasm. Cancer.gov (2015)http://www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq#link/_40_toc Accessed on September, 20th 2015
- ↑ 5.0 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.
- ↑ Sonneveld P, Avet-Loiseau H, Lonial S, Usmani S, Siegel D, Anderson KC; et al. (2016). "Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group". Blood. 127 (24): 2955–62. doi:10.1182/blood-2016-01-631200. PMC 4920674. PMID 27002115.
- ↑ 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) - ↑ 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.
- ↑ A snapshot of myeloma. National cancer institute(2014)http://www.cancer.gov/research/progress/snapshots/myeloma
- ↑ "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 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
- ↑ Plasma cell neoplasm. Cancer.gov (2015)http://www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq#link/_40_toc