Multiple Myeloma

Abstract

Multiple myeloma is diagnosed in approximately 20,500 people in the USA annually [1] and its incidence has been rising. It is approximately twice as high in blacks as in whites and is higher in men than in women. The disease develops as a malignant proliferation of plasma cells that usually results in the production of a monoclonal protein in the serum and/or urine. Although the disease is systemic at diagnosis and must be differentiated from its less advanced counterparts (e.g., monoclonal gammopathy of unknown significance and solitary plasmacytoma of bone), approximately 20 % of patients with multiple myeloma are considered asymptomatic at diagnosis. For these patients with no evidence of symptomatic disease at diagnosis, there has been no clearly demonstrated survival advantage for early treatment, justifying the delay of therapy until symptomatic disease progression. Survival in this group of patients is usually longer than in their counterparts considered symptomatic at diagnosis. For symptomatic patients, the presence of a more advanced stage has been predictive of shorter survival, and the presence of certain chromosomal abnormalities (i.e., deletion of chromosome 13 or 17p, chromosome 1 abnormalities, and IgH translocations involving chromosome 4 or 16) has indicated a more aggressive course and shorter survival [2].