Multiple myeloma is a rare disease accounting for 1% of all cancers, but second most common hematologic cancer that arises from bone marrow plasma cells. Normally, plasma cells constitute 2-3% of all the cells; in multiple myeloma they make up to 10% of all the cells in bone marrow. The disease has characteristic clinical presentation of hypercalcemia, renal insufficiency, anemia, bone lesions and increased chances of infection. Multiple myeloma is a disease of the elderly and the median age of diagnosis is 66-70 years. The disease is mostly progressive and incurable; however, the main objective of the treatment is to reduce tumor burden and to extend the time of disease progression along with symptomatic treatment.
What Is The Life Expectancy Of A Person With Multiple Myeloma?
Multiple myeloma is responsible for about 10% of all hematologic neoplasms and has an incidence rate of about 5 per 100,000 individuals. Although, the rates of new multiple myeloma cases have not changed much in the past decade, the survival rate of patients with multiple myeloma has improved significantly. This could be attributed to the advancement in effective therapy with newer chemotherapeutic drugs and autologous stem cell transplant (ASCT). According to Surveillance, Epidemiology and End Results (SEER), the 5 year survival rate for multiple myeloma improved to 49% for 2005-2011 from 25% for 1975-1977 and 27% for 1987-1989. For relapsed multiple myeloma cases, the median survival was about a year prior to 2000, which increased to 2 years after 2000. The 10 year survival rate for patients <65 years has also improved significantly, but for patients over 65 years of age, it has not improved to a significant extent.(1)
The introduction of newer drugs including immunomodulatory drugs and proteasome inhibitors, which include thalidomide, lenalidomide and bortezomib coincide with the increased survival rate of multiple myeloma patients, which were approved post 2000. According to 2008 Mayo report, patients who received these newer drugs, their survival from relapse increased from 15 months to 31 months. Patients who have been diagnosed in the past decade have nearly twice the survival rate than before. The approval of more novel drugs, such as carfilzomib, pomalidomide, ixazomib, daratumumab and elotuzumab in the past few years has increased the therapeutic horizon of multiple myeloma further.(2)
The greatest improvement in survival rate was observed in relatively younger adults. For example, studies from Sweden and Netherland only showed improvement in survival rate in patients <65 years. Although, some studies have shown improvement in survival in patients aged 60-79 years, no improvement in survival is seen in patients aged ≥80 years. This finding is again consistent with more potent drugs available for ineligible ASCT patients.
The survival gap between multiple myeloma and healthy individuals has shrunk significantly and their life expectancy has become close to healthy individuals. Multiple myeloma patients who were newly diagnosed in 2012 had 1.25 times greater life expectancy of 2 years than those patients who were diagnosed in 2006. However, the cost of the treatment also increased significantly increasing the burden on the patient, family and society.
Life expectancy is greater for people who are diagnosed with and treated for multiple myeloma after 2010 when compared to those diagnosed and treated earlier. In addition, patients who have received novel chemotherapy have improved survival rate than those who received standard therapy from 2000-2014.
The survival rate is also affected by the presence of other systemic diseases, such as diabetes or heart disease and infections. 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). In addition, ≥60% bone marrow plasma cell burden, involved/uninvolved light chain ratio of ≥100 along with relapse cases. Data also suggests that survival rate is less for people of lower socioeconomic status, those who can’t afford the costly treatment of multiple myeloma.
- Kazandjian D. Multiple myeloma epidemiology and survival: A unique malignancy. Semin Oncol. 2016;43(6):676–681. doi:10.1053/j.seminoncol.2016.11.004 https://www.ncbi.nlm.nih.gov/pubmed/28061985
- Fonseca R, Abouzaid S, Bonafede M, et al. Trends in overall survival and costs of multiple myeloma, 2000-2014. Leukemia. 2017;31(9):1915–1921. doi:10.1038/leu.2016.380 https://www.ncbi.nlm.nih.gov/pubmed/28008176