Multiple myeloma
Multiple myeloma (MM), a plasma cell neoplasm, accounts for around 10% of hematologic malignancies. Most cases develop from a pre-malignant, asymptomatic stage known as monoclonal gammopathy of undetermined significance (MGUS).
MM predominantly affects older adults, with a median age at diagnosis of 65 years. Approximately 150,000 people are diagnosed with the condition worldwide each year.
What are the typical symptoms of multiple myeloma?
MM commonly presents with bone pain, pathologic fractures, and diffuse osteoporosis. Hematologic manifestations, including anemia, leukopenia, and thrombocytopenia, lead to fatigue, recurrent infections, and bleeding tendencies. Key systemic features include hypercalcemia and renal dysfunction, alongside neurological complications, such as spinal cord compression or peripheral neuropathy.
How is multiple myeloma diagnosed?
Diagnosis of MM involves identifying abnormal proteins through blood tests and urine analysis, which also evaluate organ function and detect markers like serum-free light chains. Bone marrow biopsy confirms clonal plasma cells and plasmacytosis, while imaging methods reveal bone involvement. Cytogenetic testing is used to uncover high-risk genetic abnormalities, including del(17p), to support staging and inform treatment strategies.
What are the treatment options for multiple myeloma?
Treatment for MM depends on whether the patient is newly diagnosed or relapsed, as well as factors like frailty, performance status, and eligibility for autologous stem cell transplantation (ASCT). Key drug classes include proteasome inhibitors, immunomodulatory agents, monoclonal antibodies, bispecific antibodies, and chimeric antigen receptor (CAR) T-cell therapies.
What is the prognosis for multiple myeloma, and what factors influence it?
The prognosis for MM has significantly improved since 2000, with median overall survival exceeding 10 years for newly diagnosed patients. Prognosis varies widely and is influenced by factors including age, tumor burden, and genetic abnormalities. Staging systems like the Revised International Staging System (RISS) integrate markers of disease biology and tumor burden to refine risk stratification and guide treatment decisions.
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