Epidemiology and Biology of Multiple Myeloma

There have been large increases in the incidence of multiple myeloma over the past thirty years, especially with regard to older individuals and blacks. The most striking epidemiologic finding is the two-fold higher incidence in blacks compared to whites. Among hematopoietic malignancies, multiple myeloma is the only one with increased incidence and mortality rates among blacks. In a workshop sponsored by the National Cancer Institute in March last year, the epidemiology of multiple myeloma was covered in depth. The papers included in this volume address differences in immunologic factors and in risk factors for multiple myeloma between blacks and whites, describe the monoclonal gammopathies and their progression to myeloma, and speculate on hypotheses regarding the etiology and pathogenesis of this challenging malignancy. Ques- tions that are addressed include whether neoplastic change occurs at the level of the plasma cell or earlier in the B-cell lineage, the role of inappropriate gene expression, the importance of IL-6 production, and new findings regarding the cytogenetics of this malignancy. Key directions for new research on multiple myeloma and related malignancies are suggested.