Epidemiology, Biology, and Outcome in Multiple Myeloma Patients in different Geographical Areas of the World
Multiple myeloma has an incidence rate of 102,000 and death rate of 72,000 people per year worldwide. The incidence varies by ethnicity with highest rates observed in African Americans followed by people from industrialized nations. Consistent risk factors for MM include increasing age, male gender, black race, MGUS, and family history with familial aggregates seen globally. Chromosome abnormalities commonly seen include hyperdiploidy, translocations involving the immunoglobulin heavy chain, monosomy of chromosome 13, gains of chromosome 1q, and deletion of 17p. These chromosome abnormalities have also been observed in Asian and South American countries, although mild variability in frequencies has been seen. The International Staging System (ISS) was first validated in MM patients from North America and Europe and has shown significant correlation to survival in cohorts from South America and Asia. High-dose chemotherapy followed by autologous stem cell transplant (ASCT) and the novel agents, thalidomide, lenalidomide, and bortezomib are recent advances that have improved response rates and survival. The original studies proving efficacy were primarily performed in the United States and European countries. Although, African Americans were seen to be 23% less likely to receive chemotherapy, similar response rates and survival were seen when given equal access to care. Recent data from several countries in South America and Asia have also shown similar advances in response rates and survival to ASCT and novel agents. The parallel improvements signify that monitoring adequate and equal access to care is critically important in order to improve the long term outcome of MM globally.
Journal of Advances in Internal Medicine. 2012; 1(1): 20-32