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Myeloma (cont.)

What Are the Types of Myeloma?

Different types of myeloma are classified by the type of immunoglobulin produced by the abnormal plasma cells.

Immunoglobulins (Ig) are made up of two structural components: light chains and heavy chains and further classified by the type of light (kappa or lambda) or heavy (alpha [IgA], gamma [IgG], mu [IgM], delta [IgD], and epsilon [IgE]) chains.

  • The most common monoclonal protein in myeloma is the IgG type. This means that the immunoglobulin is comprised of two IgG heavy chains and two light chains, either two kappa or two lambda. When the abnormal M protein is identified in myeloma, it is most often an IgG kappa type. However, any other combination is possible.
  • In myeloma of any type, the production of the other normal immunoglobulins is suppressed. Thus, in IgG kappa myeloma, the normal levels of IgM and IgA will be abnormally low, while the IgG levels are elevated.
  • Less common, but still prevalent, are IgA-producing myeloma cells.
  • IgM myeloma is much less common. In this entity, better known as Waldenström's macroglobulinemia (WM), the plasma cells have a different appearance from those typically seen in multiple myeloma. They are described as lymphoplasmacytic.
  • IgD and IgE myelomas are very rare.
  • Some myelomas produce an incomplete immunoglobulin consisting of light chains only, known as Bence-Jones proteins, which are not identified by blood tests but readily identified in urine.
  • Some rare diseases are associated with plasma cell overproduction of heavy chains only. These are referred to as heavy chain diseases. Heavy chain diseases may or may not be similar to myeloma in their characteristics.
  • Nonsecretory myeloma occurs in about 1% of myelomas and represents malignant plasma cells that do not produce any immunoglobulin chains, heavy or light.

A plasma cell disorder related to myeloma is called monoclonal gammopathy of undetermined significance, or MGUS. MGUS is not cancerous. MGUS is believed to be a premyeloma condition, although not all patients with MGUS develop myeloma. About 30%-40% of people with MGUS, given sufficient time, may progress to develop myeloma.

  • People with MGUS produce small amounts of monoclonal protein, but they have none of the symptoms or complications of myeloma.
  • MGUS is much more common than myeloma. The incidence of MGUS increases with age. It is uncommon in young individuals and reaches an incidence of approximately 3% in people 70 years of age and older.

Incidence of Myeloma

Myeloma is the second most common blood cancer, but it is not a common cancer. An estimated 30,330 new patients will be diagnosed with myeloma in the United States in 2016, and men are diagnosed with the condition slightly more frequently than women. The mortality statistic in the U.S. is estimated to be about 12,650 in 2016.

  • Myeloma is predominantly a cancer of older people. The median age at diagnosis is 69.
  • Myeloma is nearly twice as common in African Americans as in Americans of European, Hispanic, or Asian descent.
Medically Reviewed by a Doctor on 6/1/2016
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