Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida€¦ · plasmacytoma + 1 of the...

Multiple MyelomaMultiple Myeloma

CP1123175-1

Patient Seminar

International Myeloma Foundation

September 6, 2008

Robert A. Kyle, M.D.

Patient Seminar Patient Seminar

International Myeloma FoundationInternational Myeloma Foundation

September 6, 2008

Robert A. Kyle, M.D.

Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida

CP1123175-2

Multiple MyelomaMultiple Myeloma EpidemiologyEpidemiology

CP1123175-1

• 1% of all malignancies

• 10% of hematologic malignancies

• Incidence

4/100,000 in Caucasians

8/100,000 in African-Americans

• 1% of all malignancies

• 10% of hematologic malignancies

• Incidence

4/100,000 in Caucasians

8/100,000 in African-Americans

10.1-1238%

>1227%>1227%

Multiple MyelomaMultiple Myeloma Mayo Clinic 1985Mayo Clinic 1985--19981998

Hemoglobin at Diagnosis (g/dL)Hemoglobin at Diagnosis (g/dL)

Median 10.9Range 2.7-17Median 10.9Range 2.7-17

8.1-1028%

8.1-1028%

≤87%≤87%

n=1,025n=1,025

CP1123175-3

≤10.173%

10.2-10.914%

10.2-10.914%

Multiple MyelomaMultiple Myeloma Mayo Clinic 1985Mayo Clinic 1985--19981998

Serum Calcium at Diagnosis (mg/dL)Serum Calcium at Diagnosis (mg/dL)

Median 9.6Range 7.2-17.2

Median 9.6Range 7.2-17.2

≥11.013%≥11.013%

n=1,018n=1,018

CP1123175-4

≤1.252%

1.3-1.929%

1.3-1.929%

Multiple MyelomaMultiple Myeloma Mayo Clinic 1985Mayo Clinic 1985--19981998

Serum Creatinine at Diagnosis (mg/dL)Serum Creatinine at Diagnosis (mg/dL)

Median 1.2Range 0.5-18.2

Median 1.2Range 0.5-18.2

≥2.019%≥2.019%

n=1,020n=1,020

CP1123175-5

Serum Protein ElectrophoresisSerum Protein Electrophoresis

AlbAlb α1α1 α2α2 ββ γγCP1123175-6

S +/or U +97%

Multiple MyelomaMultiple Myeloma Mayo Clinic 1985Mayo Clinic 1985--19981998

Serum + Urine at DiagnosisSerum + Urine at Diagnosis

S – U –3%

S – U –3%

n=1,027n=1,027

CP1123175-7

Nonsecretory Myeloma 1985Nonsecretory Myeloma 1985--1998 1998 SurvivalSurvival

0

20

40

60

80

100

0 5 10 15

%%

YearsYears

NonsecretorySecretoryNonsecretorySecretory

CP1123175-8

LightLight--Chain Myeloma 1985Chain Myeloma 1985--1998 1998 SurvivalSurvival

0

20

40

60

80

100

0 5 10 15

%%

YearsYears

Heavy chainLight chainHeavy chainLight chain

CP1123175-9

Multiple Myeloma Multiple Myeloma Complications Complications –– SkeletalSkeletal

CP1123175-10

Lytic/Fx76%

Osteoporosis only3%

Osteoporosis only3%

Multiple MyelomaMultiple Myeloma Mayo Clinic 1985Mayo Clinic 1985--19981998

Skeletal Survey at DiagnosisSkeletal Survey at Diagnosis

Normal21%

Normal21%

n=1,005n=1,005

CP1123175-11

Multiple MyelomaMultiple Myeloma Minimal Criteria for DiagnosisMinimal Criteria for Diagnosis

CP1123175-12

Bone marrow with >10% plasma cells or plasmacytoma + 1 of the following

• M-protein in serum (>3.0 g/dL)• M-protein in urine• Lytic bone lesions

Exclude connective tissue diseases, chronic infection, carcinoma, lymphoma

Bone marrow with >10% plasma cells or plasmacytoma + 1 of the following

• M-protein in serum (>3.0 g/dL)• M-protein in urine• Lytic bone lesions

Exclude connective tissue diseases, chronic infection, carcinoma, lymphoma

Smoldering Multiple Myeloma (SMM)Smoldering Multiple Myeloma (SMM)

CP1123175-13

M-protein in serum >3 g/dLPlasma cells in marrow >10%Anemia NoneCalcium NormalCreatinine NormalLytic lesions NonePlasma cell labeling index Low

M-protein in serum >3 g/dLPlasma cells in marrow >10%Anemia NoneCalcium NormalCreatinine NormalLytic lesions NonePlasma cell labeling index Low

Multiple MyelomaMultiple Myeloma Indications for TherapyIndications for Therapy

CP1123175-15

↑

M-protein in serum

↑

M-protein in urine

↓

hemoglobin

↑

calcium or creatinine

Lytic bone lesions

Extramedullary plasmacytoma

↑

M-protein in serum

↑

M-protein in urine

↓

hemoglobin

↑

calcium or creatinine

Lytic bone lesions

Extramedullary plasmacytoma

EpitaphEpitaph

CP1123175-16

I felt well, but wanted to feel better – therefore, I am here I felt well, but wanted to feel better – therefore, I am here

J. WaldenströmJ. Waldenström

CP1123175-17

Survival from Onset of Treatment of Survival from Onset of Treatment of Multiple MyelomaMultiple Myeloma

0

20

40

60

80

100

0 10 20 30 40 50

Surviving (%)

Surviving (%)

MonthsMonths

PlaceboPlacebo

CP1123175-18Holland, et al., 1966, Blood 27(3):335Holland, et al., 1966, Blood 27(3):335

UrethaneUrethane

Multiple Myeloma Multiple Myeloma Therapy of HypercalcemiaTherapy of Hypercalcemia

•• HydrationHydration

•• PrednisonePrednisone

•• DiureticsDiuretics

•• BisphosphonatesBisphosphonates

Multiple MyelomaMultiple Myeloma Spinal Cord CompressionSpinal Cord Compression

•• Back pain and leg weaknessBack pain and leg weakness

•• IncontinenceIncontinence

•• ParaspinalParaspinal massmass

•• MRIMRI

•• Radiation therapyRadiation therapy

•• Surgical decompressionSurgical decompression

Multiple MyelomaMultiple Myeloma InfectionsInfections

•• Pneumococcal vaccinePneumococcal vaccine

•• Influenza vaccineInfluenza vaccine

•• Antibiotics Antibiotics –– first 2 monthsfirst 2 months

•• Gamma globulin, IVGamma globulin, IV