Statistics
Worldwide yearly incidences of Multiple Myeloma
What is it
Multiple Myeloma (MM) is a malignant cancer of plasma cells, the cells responsible for antibody production
When there is an expansion of a plasma cell clone in the bone marrow, monoclonal proteins can be produced at high levels. These monoclonal proteins, also referred to as M-proteins or paraproteins, can be intact immunoglobulins or free light chains.
Multiple Myeloma can affect several bony areas of the body, such as the spine, skull, pelvis, and ribs.a The symptoms of MM are caused by both the growth of the tumour itself (and its effects on the bone structure and the bone marrow microenvironment), and the effect of the monoclonal proteins on other organs.b It can lead to bone fractures, kidney damage, anemia and impaired immune function.c
Symptoms and clinical impact of Multiple Myeloma
Can be difficult to diagnose because the symptoms are non-specific and often associated with the effects of ageing
Early referrals to hematologists and cancer care have the potential to improve the overall survival and quality of life for patients, but this requires early recognition of the symptoms and confirmation of the Multiple Myeloma diagnosis.
Most of the symptoms and complications of MM are caused by either the effect of the tumor on the surrounding bone and the bone marrow microenvironment or by the effect of monoclonal proteins on other organs. The most common symptom of MM is pain in bones (usually hips, spine, ribs, and skull).
Changes to the bone marrow microenvironment also affect the production of blood cells, causing anaemia and reduced immune system function with increased infections. Myeloma cells can also heavily damage bone structure, leading to hypercalcemia and an increased risk of fractures.
The monoclonal proteins produced can damage organs, most commonly the kidney. This is why many myeloma patients suffer from renal impairment, including damage so severe it requires dialysis2.
A variety of tests – including a bone marrow biopsy, and blood and skeletal analyses – will confirm if any CRAB symptoms are present
Clinical manifestations
CRAB Symptoms
Evidence of end organ damage that can be attributed to the underlying plasma cell proliferative disorder is part of the diagnostic criteria for multiple myeloma. A mnemonic for remembering this group of symptoms is CRAB.
SLiM Criteria
Historically, myeloma patients had poor physical condition when they were diagnosed due to the presence of this end organ damage. In order to enable treatment before end organ damage occurred, biomarkers were identified to indicate patients who were at high risk of developing end organ damage within a short time. These biomarkers of malignancy are referred to as the SLiM criteria.3
Together, the CRAB and SLiM criteria are referred to as myeloma defining events (MDE). In order to be diagnosed with Multiple Myeloma, a patient must have ≥10% clonal bone marrow plasma cells (or a biopsy-proven bony or extramedullary plasmacytoma) and at least one MDE.
Complications
Complications of Multiple Myeloma
- Frequent infections (immune suppression)
- Bone problems
- Reduced kidney function (cast nephropathy)
- Heart failure/Cardiac damage due to AL Amyloidosisd (AL amyloidosis is another monoclonal gammopathy, which can co-occur with MM
- Low red blood cell count (anemia)1
Multiple Myeloma and Monoclonal Gammopathies
Getting the full picture of monoclonal protein detection
3rd Party Websites
- https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/common-cancers-compared#heading-Zero
- https://www.nhs.uk/conditions/multiple-myeloma/
- https://themmrf.org/multiple-myeloma/
- https://www.amyloidosis.org.uk/about-amyloidosis/al-amyloidosis/symptoms-and-signs-of-al-amyloidosis/
References
- Bird SA & Boyd K. Multiple myeloma: an overview of management. Palliat Care Soc Pract 2019; 13:1178224219868235
- Kariyawasan CC, et al. Multiple myeloma: causes and consequences of delay in diagnosis. QJM 2007; 100:635-640
- Rajkumar SV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014; 15:e538-e548