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.

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.

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.

• Renal insufficiency
• Hematologic complications

• Anemia
• Bone marrow failure
• Bleeding disorders

• Infections
• Bone complications

• Pathologic fractures
• Spinal cord compression
• Hypercalcemia

• Neurologic complications

• Spinal cord and nerve root compression
• Intracranial plasmacytomas
• Leptomeningeal involvement

References

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