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Chapter 106. Plasma Cell Disorders (Part 3)

Incidence and Prevalence About 19,900 cases of myeloma were diagnosed in 2007, and 10,790 people died from the disease in the United States. Myeloma increases in incidence with age. The median age at diagnosis is 68 years; it is uncommon under age 40. The yearly incidence is around 4 per 100,000 and remarkably similar throughout the world. Males are more commonly affected than females, and blacks have nearly twice the incidence of whites. Myeloma accounts for ~1% of all malignancies in whites and 2% in blacks; 13% of all hematologic cancers in whites and 33% in blacks. The incidence of. | Chapter 106. Plasma Cell Disorders Part 3 Incidence and Prevalence About 19 900 cases of myeloma were diagnosed in 2007 and 10 790 people died from the disease in the United States. Myeloma increases in incidence with age. The median age at diagnosis is 68 years it is uncommon under age 40. The yearly incidence is around 4 per 100 000 and remarkably similar throughout the world. Males are more commonly affected than females and blacks have nearly twice the incidence of whites. Myeloma accounts for 1 of all malignancies in whites and 2 in blacks 13 of all hematologic cancers in whites and 33 in blacks. The incidence of myeloma is highest in African-American and Pacific islanders intermediate in Europeans and North American Caucasians and lowest in developing countries including Asia. The higher incidence in more developed countries may result from the combination of a longer life expectancy and more frequent medical surveillance. Incidence of multiple myeloma in other ethnic groups including native Hawaiians female Hispanics American Indians from New Mexico and Alaskan natives is higher relative to U.S. Caucasians in the same geographic area. Chinese and Japanese populations have a lower incidence than Caucasians. Immunoproliferative small intestinal disease with alpha heavy chain disease is most prevalent in the Mediterranean area. Despite these differences in prevalence the characteristics response to therapy and prognosis of myeloma are similar worldwide. Pathogenesis and Clinical Manifestations Table 106-1 Multiple myeloma MM cells bind via cell-surface adhesion molecules to bone marrow stromal cells BMSCs and extracellular matrix ECM which triggers MM cell growth survival drug resistance and migration in the bone marrow milieu Fig. 106-3 . These effects are due both to direct MM cell-BMSC binding and to induction of various cytokines including IL-6 insulin-like growth factor-1 IGF-1 vascular endothelial growth factor VEGF and stromal cell-derived growth factor