Multiple Myeloma

A 28-year-old woman reported that she was in good health before experiencing generalized weakness; exhaustion; and pain in her legs, shoulders, and back for the past 3 months. She also complained of shortness of breath with minimal activity, irregular menstrual periods, and occasional episodes of nose and gum bleeding.

Results of the physical examination were unremarkable except for the patient's marked pallor. Laboratory findings included white blood cell count, 5,500/µL; hemoglobin, 4 g/dL; hematocrit, 12%; and platelet count 150,000/µL. The patient's total protein level was 14.3 g/dL; albumin measured 2.2 g/dL; and blood urea nitrogen and creatinine levels were 43 mg/dL and 3.9 mg/dL, respectively. A peripheral smear demonstrated normocytic and normochromic anemia with rouleaux formation.

Drs Hesham Taha, Leveleen Gill, Gamil Kostandy, and David Dosik of New York Methodist Hospital in Brooklyn write that serum protein electrophoresis showed the patient's albumin level was 31.3% (normal range, 47.5% to 60%); the gamma globulin level was 51.3% with monoclonal spike. Immunoelectrophoresis indicated that IgG measured 9,963 mg/dL; IgA, 11.7 mg/dL; IgM, 14 mg/dL; and k and l Bence Jones protein levels were 4,358 mg/dL and 385 mg/dL, respectively. Bone marrow examination showed heavy infiltration with sheets of plasma cells (A). A skeletal survey, including the radiograph pictured here (B), revealed multiple lytic areas in the skull scattered through the parietal bone and some in frontal and occipital bones as well. The clinical picture and laboratory findings were consistent with a diagnosis of multiple myeloma.

Multiple myeloma, a malignant plasma cell disorder, accounts for 1% of malignant diseases and 2% of deaths from all malignant neoplasms. The disease is age-related, and its incidence peaks in persons between ages 69 and 70 years. Approximately 2% of patients with multiple myeloma are younger than 40 years, but the disorder is extremely rare in persons who are younger than 30.¹

Most of the data on multiple myeloma in young persons come from reports of single or very few cases; however, the clinical presentation is similar in all age groups. Younger patients respond better to conventional chemotherapy than older patients, and they are more tolerant of high-dose chemotherapy.² Survival for younger persons with multiple myeloma is between 80 and 90 months, while average survival time for the general population stands at 24 to 36 months. This patient was treated with combination chemotherapy-vincristine, doxorubicin, and dexamethasone-which was followed by autologous bone marrow transplantation. She has been in complete remission for the last 2 years.

REFERENCES:1. Bergsagel D. The incidence and epidemiology of plasma cell neoplasms. Stem Cells (Dayt). 1995;13(suppl 2):1-9.
2. Blade J, Kyle RA, Greipp PR. Multiple myeloma in patients younger than 30 years. Report of 10 cases and review of literature. Arch Intern Med. 1996;156:1463-1468.