Multiple myeloma natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
A number of organ systems are commonly involved in multiple myeloma including renal failure, hematologic complications, infections, bony and neurological complications; the most common of which being bone pain usually involving the spine and the ribs. Bone involvement leads to pathological fractures and resultant hypercalcemia. Infections such as pneumonias and pyelonephritis are also common complications of multiple myeloma. Renal failure from hypercalcemia and Bence Jones protein filtration, anemia from suppressed bone marrow production and neurological symptoms from brain metastasis are also prominent. According to a report published by National Cancer Institute there is a 43.25 chance of 5 year survival.[1]
Natural History
- Renal failure
Renal failure may develop both acutely and chronically. It is commonly due to hypercalcemia (see above). It may also be due to tubular damage from excretion of light chains, also called Bence Jones proteins, which can manifest as the Fanconi syndrome (type II renal tubular acidosis). Other causes include glomerular deposition of amyloid, hyperuricemia, recurrent infections (pyelonephritis), and local infiltration of tumor cells.
- Neurological symptoms
Common problems are weakness, confusion and fatigue due to hypercalcemia. Headache, visual changes and retinopathy may be the result of hyperviscosity of the blood depending on the properties of the paraprotein. Finally, there may be radicular pain, loss of bowel or bladder control (due to involvement of spinal cord leading to cord compression) or carpal tunnel syndrome and other neuropathies (due to infiltration of peripheral nerves by amyloid). It may give rise to paraplegia in late presenting cases.
Complications
Shown below is a list of common complications associated with multiple myeloma. These include both those caused due to local effects as well as due to distant metastasis and organ damage.[2]
- Hypercalcemia
- Renal insufficiency, may develop both acutely and chronically.
- Hematologic complications, usually results from the replacement of normal bone marrow by infiltrating tumor cells and inhibition of normal (hematopoiesis) by cytokines.
- Normocytic and normochromicanemia
- Bone marrow failure
- Bleeding disorders
- Bone complications
- Pathologic fractures
- Spinal cord compression present as back pain, numbness, dysthesias suggestive, loss of bowel or bladder control.
- Neurologic complications
- Infections
Prognosis
- 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
- ↑ "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
- ↑ 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
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