AMPANG, March 25 — Multiple myeloma, which can be a more severe form than other blood cancers and typically found in the elderly, is increasingly being diagnosed among younger people in Malaysia, say haematologists1.
Dr Goh Kim Yen – a consultant haematologist, stem cell transplant physician, and consultant physician (internal medicine) at KPJ Ampang Puteri Specialist Hospital – said the classical age of someone presenting with multiple myeloma is 60 to 70 years.
“But now, we pick up multiple myeloma among someone who is as young as 35 years or 40 plus years old,” Dr Goh told CodeBlue in a recent interview here.
Based on the Malaysia National Cancer Registry Report 2012-20162, a total of 429 multiple myeloma cases were reported among males, while a total of 347 multiple myeloma cases were reported among females.
Dr Goh said Malaysia doesn’t have a comprehensive cancer registry that records the incidence of certain rare blood cancers like multiple myeloma, a relatively rare condition.
She also revealed that the majority of multiple myeloma cases in Malaysia are actually picked up not by haematologists, but doctors from other specialties like orthopaedic surgeons who see a patient with pathological fractures (fracture with very little trauma or fracture at an unusual body size) or a physician who sees a very anaemic patient.
The CRAB mnemonic is used for diagnosis of multiple myeloma: Calcium elevation, Renal failure, Anaemia, and Bone lesions.
“It’s hard to diagnose multiple myeloma,” Dr Goh said, pointing out that some patients may not present with fractures, but simply complain about low back ache that may be dismissed by their doctors.
“They have pain from the bone,” she added. “If the doctor is not aware, they think that their patient is having a simple low back ache or exaggerating the symptoms.”
Dr Goh stressed that medical professionals should be alerted to the possibility of myeloma if a patient presents with unexplained bone pain, anaemia, and kidney failure, which are very common signs of multiple myeloma.
Multiple myeloma can be a cause of kidney failure. Malaysia has a very high incidence of diabetes mellitus (DM) that is the most common cause of end-stage renal failure.
Only in Malaysia, she said, is kidney failure associated with diabetes because of a “very high” diabetes rate, compared to other countries where renal failure is very rare. According to the National Health and Morbidity Survey (NHMS) 20233, about 3.6 million adults in Malaysia have diabetes, or 15.6 per cent prevalence.
Patients Can Survive Multiple Myeloma After A Decade Of Treatment
Dr Tengku Ahmad Hidayat Tengku K. Aziz – a consultant clinical haematologist and internal medicine physician at Beacon Hospital in Petaling Jaya, Selangor – said multiple myeloma is reported in Malaysia at between 0.4 and 0.7 cases per 100,000 population; as such, this particular blood cancer is not in the top 10 cancers in the country4, unlike lymphoma and leukaemia.
However, multiple myeloma causes major problems like bone or spine fractures that aren’t found with leukaemia or lymphoma.
“I have a patient who has a sternal fracture – the chest bone, they have rib fractures – it can be very painful. In the spine, it can displace and actually cause paralysis. So it causes neurological problems. That’s how serious it is,” Dr Tengku Ahmad Hidayat told CodeBlue in a recent interview.
“In other instances, it affects the kidney many ways because it can infiltrate the kidney, and it can cause electrolyte abnormalities that can harm the kidney, so the patient may present with kidney failure. Some even present at the point that requires dialysis.”
Multiple myeloma5 affects your plasma cells, which are white blood cells and part of your immune system. Plasma cells make antibodies that help fight infection. Multiple myeloma happens when healthy cells turn into abnormal cells that multiply and produce abnormal antibodies called M proteins. It is this change that starts a cascade of medical issues and conditions.
Dr Tengku Ahmad Hidayat explained that as these abnormal plasma cells proliferate in the bone marrow, normal white and red blood cells are suppressed; insufficient red blood cells can cause anaemia.
Bones weakened or damaged by the cancer may release too much calcium into your bloodstream (hypercalcemia), causing abnormal heart rhythm (arrhythmia).
The haematologist said multiple myeloma is more common in those aged 65 years and older, although he also has patients ranging from 26 to 40 years old.
According to the Department of Statistics Malaysia (DOSM)6, Malaysia is set to become an aged nation sooner than expected, as 17.3 per cent of the population, or 6.4 million people, will be aged 60 years or older by 2040. Currently, 11.6 per cent of the population is in that age group.
“It’s very debilitating when you have renal failure, bone fracture, and paralysis. As I mentioned, this mainly affects the elderly. Imagine that you are already old, your children are not home, there is no caregiver. You may need dialysis, you cannot walk. Who will take care of you?” said Dr Tengku Ahmad Hidayat.
“Even if you’re young, if you get all these fractures or you get paralysis, you are not able to work. Dialysis is a burden, economically and logistically.
“So it is a burden that is very unique to myeloma. You won’t see this as much in lymphoma or leukaemia.”
Dr Tengku Ahmad Hidayat said, however, that multiple myeloma patients can achieve very good remission. “There are patients who survive myeloma after 10 years of treatment.”
References
- Malaysia National Cancer Registry Report 2012-2016. Ministry of Health Malaysia. Retrieved from link.
- CodeBlue (2024, May 28). Over Two Million Adults In Malaysia Live With Three NCDs: NHMS 2023. Retrieved from link.
- Interview by Boo Su-Lyn with Dr Goh Kim Yen at KPJ Ampang Puteri Specialist Hospital in Ampang, Selangor, on January 23, 2025.
- Summary of the Malaysia National Cancer Registry Report 2017-2021. National Cancer Institute, Ministry of Health Malaysia. Retrieved from link.
- Multiple myeloma (2022, May 4). Cleveland Clinic. Retrieved from link.
- Yunus, A. (2024, Sept 7). Aged nation sooner than later. The Star. Retrieved from link.
