Explore the evolution, underlying biology and epidemiology of multiple myeloma

Multiple myeloma is a complex disease primarily affecting older adults.1 This page will explore the evolution, underlying biology and epidemiology of multiple myeloma.

The evolution of Multiple myeloma

In the majority of patients, multiple myeloma evolves from an asymptomatic premalignant precursor known as monoclonal gammopathy of undetermined significance (MGUS).2

Adapted from Kyle et al. 2007,3 Rajkumar et al. 20144 and Mateos et al. 20185 
MGUS, monoclonal gammopathy of undetermined significance; MM, multiple myeloma

Smouldering multiple myeloma found in some patients presents an asymptomatic clinical stage that sits between MGUS and active multiple myeloma.2 The incidence of smouldering multiple myeloma is estimated at between 0.4 and 0.9 cases per 100,000 people.6

Rate of progression
While approximately 1% of MGUS cases progress to multiple myeloma per year, the rate of progression for smouldering multiple myeloma is a lot higher – overall about 10% of patients per year progress within 5 years of diagnosis.3,4 The risk of progression from smouldering multiple myeloma to active disease varies between patients, and they can be grouped as being at low-, intermediate- or high-risk of progression.5

Complexity of Multiple myeloma

The proliferating clonal plasma cells also produce an excess of either κ or λ light immunoglobulin chains, which circulate freely in the serum, unbound to heavy chains.9 This over-production of one free light chain (FLC) – known as the involved FLC – leads to an abnormal FLC ratio.4,9 Some patients with MGUS or smouldering multiple myeloma show altered FLC ratio, which is related to risk of progression of multiple myeloma.4

The development of genetic abnormalities leads to the proliferation of abnormal plasma cells that may result in heterogeneous tumour cell clusters at multiple sites.10,11

Pathogenesis of multiple myeloma

Multiple myeloma is a significant burden

Multiple myeloma represents 1% of all cancers diagnosed in Europe and approximately 10% of haematological malignancies.2,12

Even though survival rates are increasing, multiple myeloma remains an incurable disease.13 Between 2010 and 2016, 5-year relative survival rates for multiple myeloma in the US reached 53.9%.14

Mulitple myeloma is a significant burden

Mulitple myeloma is a significant burden

Mulitple myeloma is a significant burden

Worldwide, around 106,000 people die each year from this disease – that is 12 people every hour.15 In 2018, 30,900 people died from multiple myeloma in Europe alone.12

Median age
The median age at diagnosis for multiple myeloma is 69 years.16 The majority of people are first diagnosed when they are 65 years of age or older, while about one-third of newly-diagnosed patients are at least 75 years of age.1

Men vs women

Mortality rates due to multiple myeloma are higher for men than women and data from the US indicate that it is twice as high for black patients as it is for white patients.12,14–18

Age at diagnosis of multiple myeloma1

Men are at a slightly increased risk of developing multiple myeloma compared with women, and it is approximately twice as common among black people as white people.12,14–18

Age at diagnosis

Find out more

Focusing on diagnosis

Find out more about the patient’s journey to a diagnosis of multiple myeloma.
DIAGNOSTIC JOURNEY

References

  1. Howlader N et al. SEER Cancer Statistics Review, 1975–2017. Available at: https://seer.cancer.gov/csr/1975_2017/results_merged/topic_age_dist.pdf (last accessed August 2020).
  2. Moreau P et al. Ann Oncol  2017; 28(Suppl_4):iv52–iv61.
  3. Kyle RA et al. N Engl J Med  2007; 356(25):2582–2590.
  4. Rajkumar S et al. Lancet Oncol  2014; 15(12):e538–e548.
  5. Mateos MV, González-Calle V. Blood Adv  2018; 2(21):3045–3049.
  6. Ravindran A et al. Blood Cancer J  2016; 6(10):e486.
  7. Palumbo A, Anderson K. N Engl J Med  2011; 364:1046–1060.
  8. International Myeloma Working Group. Br J Haematol  2003; 121(5):749–757.
  9. Dispenzieri A et al. Leukemia  2009; 23(2):215–224.
  10. Bolli N et al. Nat Commun  2014; 5:2997.
  11. Khotskaya Y et al. J Biol Chem  2009; 284:26085–26095.
  12. Ferlay J et al. Eur J Cancer  2018; 103:356–387.
  13. Costa LJ et al. Blood Adv  2017; 1(4):282–287.
  14. Howlader N et al. SEER Cancer Statistics Review, 1975–2017. Available at: https://seer.cancer.gov/csr/1975_2017/results_single/sect_01_table.04_2p... (last accessed August 2020).
  15. Bray F et al. CA Cancer J Clin  2018; 68:394–424.
  16. Howlader N et al. SEER Cancer Statistics Review, 1975–2017. Available at: https://seer.cancer.gov/csr/1975_2017/results_merged/topic_med_age.pdf (last accessed August 2020).
  17. Howlader N et al. SEER Cancer Statistics Review, 1975–2017. Available at: https://seer.cancer.gov/csr/1975_2017/results_single/sect_01_table.05_2p...  (last accessed August 2020).
  18. Howlader N et al. SEER Cancer Statistics Review, 1975–2017. Available at: https://seer.cancer.gov/csr/1975_2017/results_single/sect_01_table.06_2p... (last accessed August 2020).

ITEM CODE: CP-198293 | DATE OF PREPARATION: December 2020