Kidney injury complicated 50% of patients with multiple myeloma and is associated with increased morbidity and mortality.
In general, I find lists of facts and statistics to be boring. Unless you are talking about multiple myeloma. This incurable blood cancer is rare, complicated and it makes sense to understand your diagnosis. Experience has taught me that MMers don’t know what they don’t know. At least I didn’t when I was diagnosed with MM in 2/94.
MM has a chicken-and-the-egg problem. We are compelled to make a series of life or death decisions in the days, weeks and years following our diagnosis. Yet not even clinical oncologists really know that much about this incurable blood cancer. The list below is intended to give the MM patient information about MM and kidney involvement.
In my research and experience since my diagnosis in 1994, I have learned that MM patients need the best of both conventional and evidence-based non-conventional therapies.
I am both a long-term MM survivor and MM Cancer Coach. I work with MMers to understand their MM diagnosis as well as conventional (FDA approved) and evidence-based non-conventional therapies.
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
“Dr. Stephen Cohen- Have you ever wanted to read the notes and observations of a practicing compassionate and empathetic doctor who has cared for cancer patients for over 40 years? Well, now you can! Dr. Stephen Cohen, a medical oncologist and hematologist practicing in San Antonio, Texas, has kept a daily journal of interesting medical info and tidbits he encounters day to day from his personal experiences with patient care, professional journals he reads, and medically relevant information on all subjects that he comes across.
- Estimated 33,000 new cases diagnosed in 2021, and an estimated 13,650 deaths.
- Represent 1.8% of all new cancer cases.
- Projected to be the fastest rising hematologic cancer by 2030.
- Increasing numbers of patients with MM due to an aging population.
- Ranks as the 15th most common type of cancer in the United States.
- Estimated that approximately 96,000 patients are living with multiple myeloma.
- Accounts for 1% of new cancers.
- Accounts or 2% of all cancer deaths in the U.S.
- The median age at death is 75 years, with mortality rate increasing as age increases.
- Fewer than 4% of patients younger than 45 years.
- Disease biology is reflected in the molecular subtype of myeloma and the presence or absence of secondary cytogenetic abnormalities.
- A five-year survival rate of greater than 70% is present in transplant-eligible patients, 50% in elderly transplant in eligible patients.
- Unfortunately, approximately 25% of patients have a median survival of 2 years or less.
- Recent diagnostic criteria have included specific biomarkers such as clonal bone marrow plasma cells equal or greater than 60%, serum free light chain ratio equals greater than 100, and one focal lesion on MRI imaging which was added to markers of end-stage organ damage- hypercalcemia renal insufficiency, anemia, or bone lesions.
- Exposure to ionizing radiation, benzene, solvents and occupational links such as farming associated in the etiology of myeloma.
- Prognostic factors B2 microglobulin, LDH, serum albumin, CRP are less discerning compared with genetic aberrations.
- Treatment is challenging due to the fact that patients are usually of advanced age, have disease-related factors including comorbidities conditions such as cardiac processes, renal impairment and have had cardiac events.
- Poor prognosis associated with decreased serum albumin, increased beta 2 microglobulin, the presence of abnormal cytogenetics, increased interleukin 6, increased C reactive protein, high lactate dehydrogenase, extramedullary disease, renal insufficiency, high serum free light chains, abnormal kappa/lambda ratio, increased plasma cell labeling index, cytogenetic changes and the presence of circulating plasma cells.
- Renal impairment occurs in 20 to 40% of newly diagnosed patients.
- Acute renal injury in myeloma is a medical emergency and antimyeloma therapy needs to be initiated immediately.
- Kidney injury complicated 50% of patients with multiple myeloma and is associated with increased morbidity and mortality.
- Renal insufficiency limits treatment options as it disqualifies patients with stem cell transplantation.
- Multiple myeloma disqualifies patients for kidney transplants for renal failure.
- Patients with multiple myeloma who do not recover renal function have a higher risk of death.
- All patients with myeloma at diagnosis should have serum creatinine, estimated GFR, electrolyte measurements as well as free light chain and urine electrophoresis of a sample from a 24-hour urine collection.
- When these abnormal proteins are carried into the kidney they can block urine flow or form deposits that damage the kidney tissue.
- The damage that forms prevents toxins other on wanted multiple from passing into the urine and must accumulate in the blood.
- To diagnosed kidney disease or myeloma requires definitively a biopsy, but this has been used sparingly.
- The presence of renal impairment is associated with shorter overall survival and increased early death rates compared to patients with normal kidney function.
- The median survival of patients with renal involvement is less than two years.
- Renal impairment in patients with myeloma is caused mainly by the toxic effects of the monoclonal light chain on basement membranes of the glomeruli and or the renal tubule.
- The presence of renal impairment with a creatinine of 2 mg per deciliter or greater is defined as having substage B for stages, I,II, and III Durie-Salmon multiple myeloma staging system.
- Patients with a creatinine of 2 mg per deciliter or greater are categorized as stage III in ISS staging system, as 82% of such patients have a Beta2-microglobulin value of greater than 5.5 mg per liter.