hematology and oncology
Multiple Myeloma
Introduction
Multiple myeloma is a cancer of plasma cells that produce monoclonal immunoglobulin and invade and destroy adjacent bone tissue. Common manifestations include lytic lesions in bones that cause pain and/or fractures, renal insufficiency, hypercalcemia, anemia, and recurrent infections. Diagnosis typically requires demonstration of M-protein (sometimes present in urine and not serum but rarely absent entirely) and/or light-chain proteinuria, and excessive plasma cells in the bone marrow. Specific treatment most often includes some combination of conventional chemotherapy, corticosteroids, and one or more additional medications such as proteasome inhibitors (eg,bortezomib,carfilzomib,ixazomib), immunomodulating agents (eg,lenalidomide,thalidomide,pomalidomide), or monoclonal antibodies (eg,daratumumab,isatuximab,elotuzumab). Antibody- and T-cell-based approaches to targeting of B-cell maturation antigen have shown efficacy. High-dosemelphalanfollowed by autologous peripheral blood stem cell transplantation may also be used. (See also Overview of Plasma Cell Disorders .) In the United States, the lifetime risk of getting multiple myeloma is 1 in 132 (0.76%) ( General reference ). The median age is about 70 years. Prevalence in Black people is twice that in White people. There is a slight male predominance. Etiology is unknown, although chromosomal and genetic factors, radiation, and chemicals have been suggested. The American Cancer Society estimates that in 2023 in the United States there will be about 35,730 new cases of multiple myeloma diagnosed and about 12,590 deaths are expected to occur ( General reference ). 