90 - Multiple Myeloma and Other Plasma Cell Neoplasms

Abstract

More than 30,000 new cases of multiple myeloma (MM) are diagnosed annually in the United States. MM accounts for 1.4% of all new cancers and 1.9% of cancer-related deaths. The rate in blacks is twice that in whites. Agricultural workers, woodworkers, and paper mill workers have a higher risk than other occupational groups. The etiology of MM remains unknown. This hematological malignant disease with mature plasma cell morphological characteristics evolves from B cells late in development. The diagnosis of myeloma requires the presence of end-organ damage: anemia, elevated creatinine or calcium levels, and lytic bone lesions or myeloma-defining biomarkers. Prognostic factors of most importance for MM are an increased β2-microglobulin level, decreased serum albumin level, increased serum lactate dehydrogenase. and chromosomal abnormalities. Treatment is indicated for patients with symptomatic disease and myeloma-defining biomarkers. The past decade has witnessed a dramatic improvement in the therapeutic options for MM. Several novel biologically targeted agents are in clinical use and have resulted in improved outcomes, including proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies. High-dose therapy with stem-cell transplantation remains a standard of care. For solitary plasmacytoma of bone and extramedullary plasmacytoma, radiotherapy is the treatment of choice, with effective local control rates but high rates of progression to MM. Several promising drug therapy combinations are undergoing evaluation for refractory and relapsing myeloma. Localized radiotherapy is useful in palliation of painful or life-threatening disease.