Focus on multiple myeloma

  • Mitsiades C
  • Mitsiades N
  • Munshi N
  • et al.
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Abstract

Multiple myeloma (MM) is a neoplasia of plasma cells (PCs), hallmarked by tumor cell tropism for the bone marrow (BM) and production of monoclonal immunoglobulin (Ig) detectable in serum and/or urine. Although MM is the 2nd most commonly diagnosed hematologic malignancy in the Western world, it is often viewed inaccurately as a rare disease because the short survival (compared to many other hematologic neoplasias) and uniformly fatal outcome of patients markedly decreases the prevalence of MM in the population. MM incidence is higher in men than women and is higher in African and lower in Asian populations, relative to Caucasians. Despite extensive epidemiological studies, specific modifiable risk factors for MM have not yet been conclusively identified. <br />Multistep temporal evolution of MM<br />MM pathophysiology encompasses a multistage evolution through monoclonal gammopathy of undetermined significance (MGUS), smoldering (asymptomatic) MM, symptomatic (intramedullary) MM, and extramedullary MM/plasma cell leukemia (PCL). MGUS, an asymptomatic premalignant condition present in 1% and 3% of individuals age >50 and >70, respectively, can stochastically progress to MM or related plasma cell dyscrasias, with ~1% annual risk and 25% cumulative probability of progression over 20 years (Kyle et al., 2002). Smoldering MM, an intermediate entity between MGUS and active MM, lacks MM-related symptoms, but often progresses, after variable periods of time, to overt symptomatic MM. The latter can be manifested clinically by anemia, lytic bone lesions (predominantly in axial skeleton) and diffuse osteoporosis, hypercalcemia, renal dysfunction (due to monoclonal Ig deposition), and increased risk for infection. In advanced disease, malignant PCs can form extramedullary lesions (e.g., soft tissue plasmacytomas) and be detected in the circulation as PCL.<br />

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Mitsiades, C. S., Mitsiades, N., Munshi, N. C., & Anderson, K. C. (2004). Focus on multiple myeloma. Cancer Cell, 6(5), 439–444. https://doi.org/10.1016/j.ccr.2004.10.020

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