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Wednesday, 4 December 2013

Multiple myeloma- The Risk Factors

Multiple myeloma, also known as plasma cell myeloma or Kahler’s disease, is a types of abnormal growth of plasma cells collected in the bone marrow where they grow and multiple to interfere with the production of normal blood cells. Paraprotein, an abnormal antibody produced by the plasma cell myeloma not only can cause kidney problem but also interference with the Roche automated total bilirubin assay by precipitate formation of that can lead to clinical confusion, according to the study by the Harvard Medical School, Boston(1). Other study indicated that the production of paraproteins caused spurious results on individual analytes including total bilirubin (TBIL), direct bilirubin (DBIL), or HDL-cholesterol (HDL-C)(b). There is also a report of a 50 years old
chloride resistant metabolic alkalosis in a patient with hypercalcemia related to Multiple Myeloma (MM)(c).
B. Risk Factors
1. Age
The risk of Multiple myeloma increase with Age and multiple myeloma (MM) is the second most common hematological malignancy in China. According to the study by the Beijing Chaoyang Hospital, Capital Medical University, in the retrospectively analyzed  study of  264 newly diagnosed MM patients from the Beijing Chaoyang Hospital showed that the median patient age was 59 years (range, 28-84) and the most common monoclonal protein (42%) was the IgG subtype(12).
2. Gender
In the study to to characterize gender disparities in myeloma, showed that
a. Genetic lesions (13q- trisomy 1q, and an IGH)
Disparities were found in the prevalence of primary genetic lesions with immunoglobulin heavy chain gene (IGH) translocations being more common in women (50% of female patients vs. 38% of male patients, P < 0.001).
b.  Hyperdiploidy 
Hyperdiploidy is being more common in men (50% female vs. 62% male, P < 0.001)(13).
3. Excess body weight
Excess body weight is a risk factor for multiple myeloma. According to the stdy by the National Institute of Environmental Medicine suggested that excess risk of multiple myeloma (MM) among obese persons could be the result of altered circulating levels of adipokines, polypeptide hormones with pro- and anti-inflammatory properties secreted by adipose tissue as adiponectin may play an important role in obesity-related myelomagenesis(14).
4. Body build or nutritional status
In an exploratory study conducted of common clinical conditions as predictors of subsequent cancer in 143,574 outpatients of a health maintenance organization (in California, USA), suggest that body build or nutritional status may be involved in the development of MM by mechanisms that are presently unknown(15).
5. Race
Epidemiological data have suggested that African Americans (AA) are twice as likely to be diagnosed with multiple myeloma (MM) as compared to European Americans (EA)(16).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/12521367
(b) http://www.ncbi.nlm.nih.gov/pubmed/18251580
(c) http://www.ncbi.nlm.nih.gov/pubmed/22073517 
(12) http://www.ncbi.nlm.nih.gov/pubmed/23420708
(13) http://www.ncbi.nlm.nih.gov/pubmed/21680536
(14) http://www.ncbi.nlm.nih.gov/pubmed/23007407
(15) http://www.ncbi.nlm.nih.gov/pubmed/7999970
(16) http://www.ncbi.nlm.nih.gov/pubmed/23422747