Multiple myeloma, a rare blood cancer, is associated with favorable or less favorable clinical outcomes. Here are some quick facts culled from the National Comprehensive Cancer Network's (2016) latest guidelines and other sources. This content is for non-curated and for informational purposes only. Please consult a doctor for specific advice. Figures are available as a PowerPoint file upon request (Figure templates from slideteam.net).

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Multiple Myeloma (2016): Quick Facts
Background
Multiple myeloma (MM), which originates in specific types of white blood cells known as
plasma cells, is a rare blood cancer associated with 2.1% of all cancer-related deaths.1
Figure 1. Natural history of multiple myeloma2
This second-most common of all hematologic malignancies is estimated to affect 30,330
Americans in 2016, is slightly more common among men than women, and almost twice as
common among blacks as whites.1,3 Men and women are typically in their early sixties when
diagnosed with this disease.4 Other risk factors apart from race, gender, and age, include a
hereditary predisposition, obesity, radiation exposure and having other plasma cell diseases.5
MM is characterized by proliferatingplasmacytomasandthe subsequentproductionof monoclonal
immunoglobulin(Mprotein). M-proteindeposition inend-organsortissuesandothersymptomssuch as
calciumelevation, renal dysfunction,anemia,andbone destructionformhallmarksof disease
progression (Figure 1).1,2,6
Diagnosis
The following tests are recommended by the National Comprehensive Cancer Network for all or
some patients with hallmarks of MM: (Figures 2A and 2B). 7

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Figure 2A: Diagnostic tests for all patients Figure 2B: Diagnostic tests for some patients
Staging/Prognosis
Although the median overall survival for MM is three to four years, affected individuals may live
less than six months or more than ten years.8 The International Staging System (ISS) which
combines serum beta-2-microglobulin (sβ2M) and albumin levels, fulfilled an unmet need in
providing a systematic and reproducible way of grouping patients according to the severity of
symptoms and extent of the disease. Based on the validated ISS, MM patients are grouped into
three stages and outcomes can be predicted based on the stage of the illness: stage I, sβ2M
less than 3.5 mg/L plus serum albumin > 3.5 g/dL (median survival, 62 months); stage II, neither
stage I nor III (median survival, 44 months); and stage III, sβ2M> 5.5 mg/L (median survival, 29
months).8 Despite the improved staging systemand improved pharmacotherapies, some
patients may for a decade or more, whiles others could succumb from highly refractory illness
within a few months. 9 Experts have attributed this variability partly due to a disregard for MM
heterogeneity at the molecular level. Therefore, the revised ISS also incorporates chromosomal
abnormalities detected by a specified interphase fluorescent in situ hybridization procedure
(iFISH) and serum lactate dehydrogenase (LDH) measures to improve the staging and prognosis
of newly-diagnosed MM:7,10,11
 ISS stage I and standard risk chromosomal abnormalities by iFISH and serum LDH < the
upper limit of normal

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 Not R-ISS stage I or III
 ISS stage III and either high-risk chromosomal abnormalities by iFISH or serum LDH > the
upper limit of normal
For MM, treatment is based on stage and the presence or absence of clinical symptoms. In the
absence of clinical symptoms, patients will be given the diagnosis of smoldering MM, while the
presence of one or more symptoms can be indicative of a solitary plasmacytoma or active MM
(Figure 3).11
Figure 3: Smoldering (asymptomatic) and Symptomatic (active) MM11
Treatment
According to the National Comprehensive Cancer Network, the following general treatment
strategies may be adopted depending on the type of MM:

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TABLE: Treatment options7,11
Smoldering MM Solitary
Plasmacytoma
Symptomatic (Active MM)
 Clinical trial
 Observation with
testing every 3 to 6
months
 Radiation
Therapy
 Surgery
 Chemotherapy, targeted
therapy, and/or steroids
─ Adjunctive treatment for
MM symptoms and side
effects
The current approved MM drug armamentarium is comprised of chemotherapies, steroids,
immunomodulators and targeted therapies:
Figure 4a: Chemotherapies for MM11

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Figure 4b: Targeted therapies for MM11
Figure 4c: Immunomodulators for MM11

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Sources
1. National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER)
Stat Fact Sheets: Myeloma. 2016; http://seer.cancer.gov/statfacts/html/mulmy.html.
Accessed August, 2016.
2. Berenson JR. Merck Manual Professional Version. Multiple Myeloma. Myeloma
(Myelomatosis; Plasma Cell Myeloma). 2016;
http://www.merckmanuals.com/professional/hematology-and-oncology/plasma-cell-
disorders/multiple-myeloma. Accessed August, 2016.
3. Rajkumar SV. UpToDate. Patient information: Multiple myeloma symptoms, diagnosis,
and staging (Beyond the Basics). 2016; http://www.uptodate.com/contents/multiple-
myeloma-symptoms-diagnosis-and-staging-beyond-the-basics. Accessed August, 2016.
4. Epocrates. Multiple Myeloma. 2016;
https://online.epocrates.com/diseases/17923/Multiple-myeloma/Epidemiology.
Accessed August, 2016.
5. American Cancer Society. What are the risk factors for multiple myeloma?
http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-
factors. Accessed August, 2016.
6. Redic KA, Hough SM, Price EM. Clinical developments in the treatment of relapsed or
relapsed and refractory multiple myeloma: impact of panobinostat, the first-in-class
histone deacetylase inhibitor. Onco Targets Ther. 2016;9:2783-2793.
7. National Comprehensive Cancer Network (NCCN) guidelines for patients. Multiple
Myeloma. 2016;
https://www.nccn.org/patients/guidelines/myeloma/files/assets/common/downloads/f
iles/myeloma.pdf. Accessed August, 2016.
8. Greipp PR, Miguel JS, Durie BGM, et al. International Staging System for Multiple
Myeloma. Journal of Clinical Oncology. 2005;23(15):3412-3420.
9. Avet-Loiseau H, Durie BGM, Cavo M, et al. Combining fluorescent in situ hybridization
data with ISS staging improves risk assessment in myeloma: an International Myeloma
Working Group collaborative project. Leukemia. 2013;27(3):711-717.
10. Palumbo A, Avet-Loiseau H, Oliva S, et al. Revised International Staging System for
Multiple Myeloma: A Report From International Myeloma Working Group. J Clin Oncol.
2015;33(26):2863-2869.
11. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Multiple Myeloma
V3.0. 2016; https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf.
Accessed August, 2016.