Mayo Clin Proc, January 2003, Vol 78 Newly Diagnosed Multiple Myeloma 21 Mayo Clin Proc. 2003;78:21-33 21 © 2003 Mayo Foundation for Medical Education and Research Original Article Review of 1027 Patients With Newly Diagnosed Multiple Myeloma ROBERT A. KYLE, MD; MORIE A. GERTZ, MD; THOMAS E. WITZIG, MD; JOHN A. LUST, MD, PHD; MARTHA Q. LACY, MD; ANGELA DISPENZIERI, MD; RAFAEL FONSECA, MD; S. VINCENT RAJKUMAR, MD; JANICE R. OFFORD, BS; DIRK R. LARSON, MS; MATTHEW E. PLEVAK, BS; TERRY M. THERNEAU, PHD; AND PHILIP R. GREIPP, MD From the Division of Hematology and Internal Medicine (R.A.K., M.A.G., T.E.W., J.A.L., M.Q.L., A.D., R.F., S.V.R., P.R.G.) and Divi- sion of Biostatistics (J.R.O., D.R.L., M.E.P., T.M.T.), Mayo Clinic, Rochester, Minn. This study was supported by grant CA62242 from the National Cancer Institute. Address reprint requests and correspondence to Robert A. Kyle, MD, Division of Hematology, Mayo Clinic, 200 First St SW, Roches- ter, MN 55905 (e-mail: kyle.robert@mayo.edu). • Objective: To determine the clinical and laboratory features of newly diagnosed multiple myeloma. • Patients and Methods: Records of all patients in whom multiple myeloma was initially diagnosed at the Mayo Clinic in Rochester, Minn, from January 1, 1985, to De- cember 31, 1998, were reviewed. • Results: Of the 1027 study patients, 2% were younger than 40 years, and 38% were 70 years or older. The me- dian age was 66 years. Anemia was present initially in 73% of patients, hypercalcemia (calcium level ≥11 mg/dL) in 13%, and a serum creatinine level of 2 mg/dL or more in 19%. The β 2 -microglobulin level was increased in 75%. Serum protein electrophoresis revealed a localized band in 82% of patients, and immunoelectrophoresis or immuno- fixation showed a monoclonal protein in 93%. A mono- clonal light chain was found in the urine in 78%. Non- AL = primary amyloidosis; MGUS = monoclonal gammop- athy of undetermined significance; M-protein = monoclonal protein secretory myeloma was recognized in 3% of patients, whereas light-chain myeloma was present in 20%. Con- ventional radiographs showed an abnormality in 79%. The plasma cell labeling index was 1% or more in 34% of patients. Multivariate analysis revealed that age, plasma cell labeling index, low platelet count, serum albumin value, and the log of the creatinine value were the most important prognostic factors. • Conclusion: The median duration of survival was 33 months and did not improve from 1985 through 1998. Mayo Clin Proc. 2003;78:21-33 M ultiple myeloma (plasma cell myeloma, plasmacytic myeloma, myelomatosis, Kahler disease) is a neo- plastic disorder characterized by proliferation of a single clone of plasma cells derived from B cells. This clone of plasma cells proliferates in the bone marrow and frequently invades the adjacent bone, producing skeletal destruction that results in bone pain and fractures. Occasionally, plasma cells infiltrate multiple organs and produce other symptoms. The excessive production of a monoclonal protein (M-pro- tein) may lead to renal failure from Bence Jones proteinuria or hyperviscosity from excessive amounts of M-protein in the blood. The diagnosis depends on identification of abnor- mal monoclonal plasma cells in the bone marrow, M-protein in the serum or urine, osteolytic lesions, and a clinical picture consistent with multiple myeloma. Multiple myeloma accounts for about 1% of all types of malignancy and slightly more than 10% of hematologic malignancies. In the United States, the incidence of mul- tiple myeloma increased from 0.8 per 100,000 population in 1949 to 1.7 per 100,000 in 1963 and to 3.5 per 100,000 for males and 3.1 per 100,000 for females in 1988. 1 In Olmsted County, Minnesota, the incidence was 3.1 per 100,000 from 1945 to 1964, 2.7 per 100,000 from 1965 to 1977, and 4.1 per 100,000 from 1978 to 1990. 2 The re- ported increased incidence during the past few decades is probably related more to the increased availability of medi- cal facilities for elderly patients and to improved diagnostic techniques than to an actual increased incidence. Multiple myeloma occurs in all races, but rates are higher in African Americans and lower in Asian populations. For editorial comment, see page 15. Multiple myeloma has most likely been present for centuries, but the first well-documented patient, Sarah Newbury, was reported by Samuel Solley in 1844. Six years later, William Macintyre described the illness of Thomas Alexander McBean, who had severe bone pain and at autopsy was found to have cells in the bone marrow consistent with those of multiple myeloma. Macintyre noted that the urine was found to “abound in animal mat- ter” when heated but it “underwent complete solution” when boiled and then reappeared on cooling. He sent a sample of the urine to Henry Bence Jones, a 31-year-old For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.