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Review of 1027 Patients With Newly Diagnosed Multiple Myeloma

      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 December 31, 1998, were reviewed.

      Results

      Of the 1027 study patients, 2% were younger than 40 years, and 38% were 70 years or older. The median 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 β2-microglobulin level was increased in 75%. Serum protein electrophoresis revealed a localized band in 82% of patients, and immunoelectrophoresis or immunofixation showed a monoclonal protein in 93%. A monoclonal light chain was found in the urine in 78%. Nonsecretory myeloma was recognized in 3% of patients, whereas light-chain myeloma was present in 20%. Conventional 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.
      AL (primary amyloidosis), MGUS (monoclonal gammopathy of undetermined significance), M-protein (monoclonal protein)
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      Linked Article

      • Multiple Myeloma: How Far Have We Come?
        Mayo Clinic ProceedingsVol. 78Issue 1
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          In 1975, Dr Robert A. Kyle,1 the world's leader in the clinical investigation of monoclonal gammopathies, published a classic article in the Mayo Clinic Proceedings on the presenting symptoms and signs as well as the natural history of multiple myeloma (MM) at a time when the combination of melphalan and prednisone was the only available therapy. Generations of both clinicians and laboratory researchers have relied on this landmark article for understanding clinical manifestations and disease pathogenesis.
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