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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
