Multiple myeloma is a hematologic cancer, which arises from blood plasma cells. Plasma cells are a type of white blood cells originating from B lymphocytes. These are responsible for the production of immunoglobulins (Ig) or antibodies. Normally, plasma cells constitute 2-3% of all the cells in the bone marrow; however, in multiple myeloma they make up to 10% of all the cells in the bone marrow. This overcrowding of abnormal plasma cells (myeloma cells) in the bone marrow leads to depletion of other cells, namely, red blood cells, other white blood cells and platelets in the blood. The reduced number of red blood cells in the blood causes severe anemia, reduced white blood cells causes reduction in immunity and prone to infections. In addition, reduced number of platelets leads to thrombocytopenia and easy bruising and bleeding.
How Long A Person Can Live With Multiple Myeloma?
Multiple myeloma is responsible for about 10% of all hematologic cancers and the chances of getting multiple myeloma in a person’s lifetime are around 0.8%. Although, the rates of new multiple myeloma cases remain the same in the past decade, the survival rate of patients with multiple myeloma has improved steadily. According to Surveillance, Epidemiology and End Results (SEER) 2017 the life expectancy of patients with multiple myeloma has improved from 4 to 5.5 years, which had been stagnant for the past 5 years. Some patients can even live up to 10 or 20 years. This can be attributed to the advances in medical technology, screening, early detection and treatment of the cancer. (1)
Multiple myeloma is a very diverse disease and its survival ranges from 1-10 years; however, the median survival is 3 years in unselected patients. The 5-year survival rate of a person with multiple myeloma is 46.6%. Although, survival is dependent on various factors, such as age, and the survival rate for younger patients is more than older patients. The survival rate also reduces in the presence of other systemic diseases, such as diabetes or heart disease. The survival of the patient is reduced in the presence of Bence Jones proteinemia (light chain immunoglobulin in blood) tumor mass, hypercalcemia and renal impairment (creatinine levels >2 mg/dl at the time of diagnosis).
It is very important to educate the patient regarding multiple myeloma and its consequences and complications. Infection is related to higher mortality and early death in patients with multiple myeloma. A study in the United Kingdom revealed that 10% of patients died within 2 months of multiple myeloma diagnosis and out of these 45% of the deaths were related to infections. Another study in Sweden showed that there were 22% deaths within the first year after diagnosis due to infections and these infections have increased in recent times. There is a 7 fold chance of infection in patients with multiple myeloma. The common bacterial infections associated with multiple myeloma are pneumonia, meningitis and septicemia while the common viral infection associated with multiple myeloma are influenza and herpes zoster.
The survival rate of a patient can be calculated by studying tumor burden and proliferation rate of multiple myeloma. One of the methods is by taking into account C reactive protein levels along with beta-2 microglobulin, which is a marker of tumor burden. If the level of both these proteins are <6 mg/l, the median survival rate is calculated as 54 months. If the level of only one protein is <6 mg/l, then median survival rate is around 27 months. If the level of both the proteins are >6 mg/l, then the median survival rate is 6 months.
The survival rate is also dependent on the type of treatment provided. If conventional therapy is used then overall survival is around 3 years with event free survival of less than 2 years. However, if high dose chemotherapy along with stem cell transplantation is provided then the overall 5 year survival rate is more than 50 percent. (1)
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