Sandbox:Haytham

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

Multiple myeloma summary.

Durie-Salmon staging system

First published in 1975, the Durie-Salmon staging system is still in use, but has largely been superseded by the simpler ISS:

• stage 1: all of
  • Hb > 10g/dL
  • normal calcium
  • Skeletal survey: normal or single plasmacytoma or osteoporosis
  • Serum paraprotein level < 5 g/dL if IgG, < 3 g/dL if IgA
  • Urinary light chain excretion < 4 g/24h
• stage 2: fulfilling the criteria of neither 1 nor 3
• stage 3: one or more of
  • Hb < 8.5g/dL
  • high calcium > 12mg/dL
  • Skeletal survey: 3 or more lytic bone lesions
  • Serum paraprotein >7g/dL if IgG, > 5 g/dL if IgA
  • Urinary light chain excretion > 12g/24h

Stage	Hemoglobin level	Calcium level	Skeletal survey	Serum paraprotein level	Urinary light chain excretion
Stage 1	> 10g/dL	8.5-10.2 mg/dL	Normal or single plasmacytoma or osteoporosis	< 5 g/dL if IgG or < 3 g/dL if IgA	< 4 g/24h
Stage 2	8.5-10g/dL	10.2-12 mg/dL	fulfilling the criteria of neither 1 nor 3	5-7 g/dL if IgG or 3-5 g/dL if IgA	4-12 g/24h
Stage 3	< 8.5g/dL	> 12mg/dL	3 or more lytic bone lesions	>7g/dL if IgG or > 5 g/dL if IgA	> 12g/24h

The table below lists the genetic risk factors for multiple myeloma:

Genetic Risk Factor	Description
Age	The chance to develop multiple myeloma increases as patients get older, where only 1% of multiple myeloma cases are diagnosed in patients younger than 35 years.
Gender	Males are more commonly affected with multiple myeloma than females. The male to female ratio is approximately 2 to 1
Lynch Syndrome AKA Hereditary Non-polyposis Colorectal Cancer (HNPCC)	AD inheritance; caused by a defect in one of the mismatch repair genes, most commonly hMLH1, hMSH2, hMSH6, or PMS2; the mean age at initial cancer diagnosis is around 48 years

The table below lists the risk factors for multiple myeloma:

Risk Factor	Description
Age	The chance to develop multiple myeloma increases as patients get older, where only 1% of multiple myeloma cases are diagnosed in patients younger than 35 years
Race	African American and Native Pacific Islanders descents are at increased risk of developing multiple myeloma
Gender	Males are more commonly affected with multiple myeloma than females. The male to female ratio is approximately 2 to 1
Having other plasma cell diseases	Studies have shown that patients with other plasma cell diseases such as monoclonal gammopathy of undetermined significance develop multiple myeloma later in their lives.
Family history	A familial predisposition to myeloma exists due to hyperphosphorylation of specific proteins that may contribute to a higher rates of multiple myeloma in certain groups.
Obesity	A study by the American Cancer Society found that being overweight increases a person's risk of developing multiple myeloma
Workplace exposures	Petroleum workers and farmers tend to have higher incidence of multiple myeloma relative to other occupations
Radiation	Areas with previous history of atoms bombs or nuclear accidents had higher risk of multiple myeloma due to increased rate of radiation exposure

The table below lists the genetic risk factors for multiple myeloma:

Genetic Risk Factor	Description
Age	The chance to develop multiple myeloma increases as patients get older, where only 1% of multiple myeloma cases are diagnosed in patients younger than 35 years.
Gender	Males are more commonly affected with multiple myeloma than females. The male to female ratio is approximately 2 to 1
Lynch Syndrome AKA Hereditary Non-polyposis Colorectal Cancer (HNPCC)	AD inheritance; caused by a defect in one of the mismatch repair genes, most commonly hMLH1, hMSH2, hMSH6, or PMS2; the mean age at initial cancer diagnosis is around 48 years

The table below lists common prognostic factors for multiple myeloma:

Prognostic Factor	Description
Stage	As with most cancers, the higher the stage of multiple myeloma, the more poor is the outcome.
Kidney function	An elevated level of creatinine is considered a poor prognostic factors.
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 a poor prognostic factor.
Age	Older patients have worse prognosis than younger patients.
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.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</ref>
Assocciated plasma cell disorder	The presence of plasma cell leukemia or soft tissue plasmacytomas is associated with a particularly poor prognosis among patients with multiple myeloma.
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.
Blood tests	Abnormal blood tests play an important role in determining prognosis in people with multiple myeloma.
Beta-2-microglobulin	A higher level of beta-2-microglobulin predicts a poorer prognosis.
Albumin level	A lower albumin level predicts poorer prognosis.
Lactate dehydrogenase level	A higher level of lactate dehydrogenase (LDH) predicts a poorer prognosis.
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.