While bone marrow cancer may seem like a rare diagnosis, the sobering reality is that over 35,000 Americans are expected to hear the words "multiple myeloma" this year alone, a number that brings this complex disease out of the shadows and into the light.
Key Takeaways
- Approximately 35,730 new cases of multiple myeloma (a bone marrow cancer) are expected to be diagnosed in the US in 2024.
- Multiple myeloma accounts for about 1.6% of all new cancer cases and 10% of hematologic malignancies in the US.
- The lifetime risk of developing multiple myeloma is about 0.8% (1 in 132) for American men and women.
- Family history increases multiple myeloma risk by 2-4 fold.
- African American race is associated with 2x higher risk of multiple myeloma.
- Monoclonal gammopathy of undetermined significance (MGUS) precedes 1% per year to multiple myeloma.
- About 50% of patients experience bone pain at diagnosis.
- Anemia is present in 70% of multiple myeloma patients at diagnosis.
- High levels of M protein detected in blood or urine in 97% of cases.
- Stem cell transplant is used in 50-60% of eligible patients under 70.
- Bortezomib-based regimens achieve 80% response rate.
- Lenalidomide maintenance extends PFS by 50% post-transplant.
- 5-year OS for transplant-eligible is 60%.
- Median OS for multiple myeloma is 71 months currently.
- 5-year relative survival rate is 59.8% overall.
Multiple myeloma is a relatively common bone marrow cancer with varying global risk factors.
Incidence and Prevalence
- Approximately 35,730 new cases of multiple myeloma (a bone marrow cancer) are expected to be diagnosed in the US in 2024.
- Multiple myeloma accounts for about 1.6% of all new cancer cases and 10% of hematologic malignancies in the US.
- The lifetime risk of developing multiple myeloma is about 0.8% (1 in 132) for American men and women.
- In 2020, there were an estimated 176,404 people living with multiple myeloma in the US.
- Globally, multiple myeloma incidence is around 160,000 new cases per year.
- Age-adjusted incidence rate of multiple myeloma in the US is 7.1 per 100,000 people.
- Multiple myeloma is more common in men than women (incidence rate 8.6 vs 6.0 per 100,000).
- African Americans have nearly twice the risk of multiple myeloma compared to whites (14.2 vs 7.0 per 100,000).
- Median age at diagnosis for multiple myeloma is 69 years.
- Multiple myeloma represents 1.8% of all new cancer cases in the US.
- In Europe, the age-standardized incidence rate for multiple myeloma is 5.5 per 100,000.
- Prevalence of multiple myeloma in the US has increased by 144% from 1990 to 2020.
- Annual incidence of multiple myeloma in the UK is about 5,800 cases.
- Multiple myeloma incidence in Asia is lower at 1-2 per 100,000 compared to 4-7 in Western countries.
- In Australia, 2,016 new cases of multiple myeloma were diagnosed in 2022.
- Multiple myeloma is the 14th most common cancer worldwide.
- Incidence rate of multiple myeloma increases with age, peaking at 40 per 100,000 in those over 85.
- About 12,660 deaths from multiple myeloma expected in the US in 2024.
- Mortality rate for multiple myeloma in the US is 2.6 per 100,000.
- Multiple myeloma prevalence in Canada is about 20 per 100,000.
- In India, multiple myeloma accounts for 1% of all malignancies.
- US incidence of multiple myeloma rose 3.3% annually from 2014-2018.
- Multiple myeloma is diagnosed in about 7 per 100,000 men annually in the US.
- Global 5-year prevalence of multiple myeloma is 513,880 cases.
- In Japan, multiple myeloma incidence is 3.5 per 100,000.
- Multiple myeloma comprises 10-15% of hematologic cancers in the US.
- Estimated 160,069 new multiple myeloma cases worldwide in 2020.
- Incidence in Hispanic populations is 6.4 per 100,000 in the US.
- Multiple myeloma mortality has declined 1.6% per year from 2013-2022.
- About 1,718 new cases in England in 2017-2019.
- Acute myeloid leukemia (AML), a bone marrow cancer, has 20,380 new US cases in 2024.
- AML incidence rate 4.1 per 100,000 US population.
- Chronic lymphocytic leukemia (CLL) 18,740 new cases US 2024.
- Non-Hodgkin lymphoma (NHL) affecting marrow in 80,620 new cases US 2024.
Incidence and Prevalence Interpretation
While these numbers show multiple myeloma is a relatively rare cancer by the percentage game, its staggering 144% rise in prevalence screams that it's a formidable, stealthy adversary that we can't afford to ignore.
Risk Factors and Etiology
- Family history increases multiple myeloma risk by 2-4 fold.
- African American race is associated with 2x higher risk of multiple myeloma.
- Monoclonal gammopathy of undetermined significance (MGUS) precedes 1% per year to multiple myeloma.
- Obesity (BMI >30) increases multiple myeloma risk by 11%.
- Exposure to radiation increases risk, as seen in atomic bomb survivors.
- Older age (>65) is the strongest risk factor for multiple myeloma.
- Male sex has 1.5x higher risk than females for multiple myeloma.
- Chronic exposure to pesticides doubles multiple myeloma risk.
- First-degree relatives have 3.4x increased risk.
- Smoking is not strongly linked, but heavy smoking may increase risk by 10-20%.
- Working in agriculture increases risk by 1.5-2x.
- MGUS risk of progression to myeloma is 1% per year overall.
- High-risk MGUS progresses at 5-10% per year.
- Obesity linked to 20% higher risk in meta-analysis.
- Exposure to benzene associated with 2-3x risk.
- Genetic factors account for 15-20% of multiple myeloma heritability.
- Low vitamin D levels may increase risk by 1.5x.
- Firefighting occupation linked to 1.6x risk.
- Sickle cell trait carriers have higher risk in African Americans.
- Asbestos exposure mildly increases risk (OR 1.4).
- Hyperinsulinemia associated with 2x risk.
- 40% of multiple myeloma patients have MGUS history.
- Hair dyes (dark) use increases risk by 1.5x in women.
- Chronic inflammation from autoimmune diseases raises risk.
- Alcohol consumption shows inverse association (20% lower risk).
- Physical activity reduces risk by 25-30%.
Risk Factors and Etiology Interpretation
While you can't pick your ancestors, your race, or your age, you can certainly choose to put down the cigarettes, pick up a vegetable, and go for a walk, because the recipe for dodging multiple myeloma seems to be a grim cocktail of bad luck mixed with a generous pour of lifestyle choices you actually control.
Survival Rates and Prognosis
- 5-year OS for transplant-eligible is 60%.
- Median OS for multiple myeloma is 71 months currently.
- 5-year relative survival rate is 59.8% overall.
- High-risk cytogenetics (del17p) have median OS 36 months.
- Stage I (ISS) 5-year survival 82%.
- Stage III (ISS) 5-year survival 40%.
- Post-relapse survival improving to 40 months median.
- R-ISS stage III has 3-year OS of 56%.
- Triple-class refractory median OS 11.1 months.
- With CAR-T, median PFS 13.3 months.
- Elderly (>75) 5-year survival 47%.
- African Americans have similar survival to whites after adjustments.
- Median OS improved from 4.4 to 8.6 years 2000-2019.
- t(4;14) translocation worsens OS to 48 months.
- Gain(1q) present in 40%, reduces PFS by 20 months.
- MRD negativity predicts >80% 5-year PFS.
- Penta-refractory OS 5.4 months with selinexor.
- 10-year OS 35% for standard risk.
- Renal failure at diagnosis halves median survival.
- Bispecific antibodies extend OS to 15 months in RRMM.
- Localized disease (rare) 5-year survival 75%.
- Distant mets (most) 5-year survival 59%.
- Overall survival doubled in last 20 years due to novel agents.
- Median PFS first line 35 months with quadruplet therapy.
- In 2023 estimates, 12,660 deaths project 5-year survival improvements.
- Regional stage 5-year survival 74%.
- Hypodiploidy linked to 50% reduced OS.
- With maintenance, PFS >50 months post-ASCT.
- Overall 10-year survival 42% in recent cohorts.
Survival Rates and Prognosis Interpretation
Despite the sobering odds stacked against high-risk cases, the collective climb from a median survival of 4.4 to 8.6 years proves we're not just fighting this disease but actually winning, one novel therapy and stubborn patient at a time.
Symptoms and Diagnosis
- About 50% of patients experience bone pain at diagnosis.
- Anemia is present in 70% of multiple myeloma patients at diagnosis.
- High levels of M protein detected in blood or urine in 97% of cases.
- Bone lesions found in 80% via skeletal survey or MRI.
- Hypercalcemia occurs in 25% of patients at diagnosis.
- Renal insufficiency in 50% of newly diagnosed patients.
- Fatigue reported by 60-70% of patients.
- Serum protein electrophoresis detects monoclonal protein in 82%.
- Urine protein electrophoresis positive in 75%.
- Bone marrow plasmacytosis >10% in 90% of cases.
- CRAB features (hyperCalcemia, Renal failure, Anemia, Bone lesions) in 75% at diagnosis.
- Back pain in 58% due to fractures or lesions.
- Free light chain assay abnormal in 97% of patients.
- PET/CT detects lesions with 90% sensitivity.
- Weight loss in 40% of advanced cases.
- Infections occur in 10-15% due to immune suppression.
- Neurological symptoms from cord compression in 5-10%.
- Beta-2 microglobulin >3.5 mg/L indicates advanced disease in 60%.
- LDH elevated in 40% correlating with poor prognosis.
- Flow cytometry shows clonal plasma cells in 95% of marrow samples.
- MRI shows marrow infiltration in 90% of symptomatic patients.
- Biopsy confirms diagnosis in 100% with adequate sample.
- Amyloidosis associated in 10-15% of cases.
- Cytogenetic abnormalities detected in 40-50% via FISH.
- Frequent infections like pneumonia in 20% at presentation.
- Pathologic fractures in 30% within first year.
Symptoms and Diagnosis Interpretation
The data paints a chillingly predictable blueprint of this disease: while it announces its arrival in a patient’s body through a near-perfect biochemical signature, its real cruelty lies in the brutal symphony of CRAB features—calcium poisoning the blood, kidneys faltering, bones crumbling, and blood thinning—that ravages the person long before the lab tests confirm what the body already knows.
Treatment Options and Efficacy
- Stem cell transplant is used in 50-60% of eligible patients under 70.
- Bortezomib-based regimens achieve 80% response rate.
- Lenalidomide maintenance extends PFS by 50% post-transplant.
- Daratumumab added to VRd improves CR rate to 42% vs 32%.
- CAR-T therapy (idecabtagene vicleucel) achieves 73% ORR in relapsed patients.
- Bisphosphonates reduce skeletal events by 50%.
- Radiation therapy used for palliation in 20-30% of patients.
- Proteasome inhibitors effective in 70% of newly diagnosed.
- IMiDs like pomalidomide have 30% response in refractory disease.
- Selinexor + dexamethasone 26% ORR in penta-refractory patients.
- Autologous SCT improves OS by 12 months median.
- Teclistamab (bispecific) 63% ORR in relapsed/refractory.
- Denosumab non-inferior to zoledronate, reduces renal toxicity.
- Quadruplet therapy (Dara-VRd) PFS not reached vs 41 months.
- 90% of patients receive immunomodulators in first line.
- BCMA-targeted therapies in 50% of triple-class refractory.
- Erythropoietin corrects anemia in 60%.
- Plasmapheresis used in 10% for hyperviscosity.
- Allogeneic SCT in 5% high-risk cases, GVHD in 40%.
- Elranatamab 61% ORR in heavily pretreated.
Treatment Options and Efficacy Interpretation
The field of bone marrow cancer treatment is a chessboard where we're steadily advancing our pieces—from transplant foundations still used by over half of eligible patients to a growing arsenal of targeted strikes achieving deep responses, yet the endgame still hinges on managing the inevitable counterattacks of relapse and complications.
Sources & References
- Reference 1CANCERcancer.orgVisit source
- Reference 2GCOgco.iarc.who.intVisit source
- Reference 3SEERseer.cancer.govVisit source
- Reference 4LLSlls.orgVisit source
- Reference 5ECISecis.jrc.ec.europa.euVisit source
- Reference 6PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 7CANCERRESEARCHUKcancerresearchuk.orgVisit source
- Reference 8AIHWaihw.gov.auVisit source
- Reference 9GCOgco.iarc.frVisit source
- Reference 10CANCERcancer.caVisit source
- Reference 11CANCERcancer.govVisit source
- Reference 12NCBIncbi.nlm.nih.govVisit source
- Reference 13MAYOCLINICmayoclinic.orgVisit source
- Reference 14NEJMnejm.orgVisit source
- Reference 15COCHRANELIBRARYcochranelibrary.comVisit source
- Reference 16THELANCETthelancet.comVisit source