Multiple Myeloma Treatment Information for Healthcare Professionals

General Information

     Multiple myeloma is a systemic malignancy of plasma cells that is highly treatable but rarely curable. It is potentially curable when it presents as a solitary plasmacytoma of bone or as an extramedullary plasmacytoma. The median survival in the prechemotherapy era was about 7 months. After the introduction of chemotherapy, prognosis improved significantly with median survival of 24 to 30 months and a 10-year survival of 3%. The disease is staged by estimating the myeloma tumor cell mass on the basis of the amount of monoclonal (or myeloma) protein (M-protein) in the serum and/or urine, along with various clinical parameters, such as the hemoglobin and serum calcium concentrations, the number of lytic bone lesions, and the presence or absence of renal failure. The stage of the disease at presentation is a strong determinant of survival, but has little influence on the choice of therapy since almost all patients (except for rare patients with solitary bone tumors or extramedullary plasmacytomas) have generalized disease. Treatment selection is influenced by the age and general health of the patient, prior therapy, and the presence of complications of the disease.^1-3

The initial approach to the patient is to establish the diagnosis by:

1. Detection of an M-protein in the serum or urine.
   
2. Detection of more than 10% plasma cells on a bone marrow examination.
   
3. Detection of lytic bone lesions or generalized osteoporosis in skeletal x-rays.
   
4. Presence of soft tissue plasmacytomas.

References:

1. Bataille R, Harousseau JL: Multiple myeloma. New England Journal of Medicine 336(23): 1657-1664, 1997.
2. Alexanian R, Dimopoulos M: The treatment of multiple myeloma. New England Journal of Medicine 330(7): 484-489, 1994.
3. Malpas JS, Bergsagel DE, Kyle RA, et al. eds.: Myeloma: Biology and Management. 2nd ed., Oxford, England: Oxford University Press, 1998.

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