Risk for second primary malignancies in patients with multiple myeloma: a systematic review and meta-analysis

Area of Science:

• Oncology
• Epidemiology
• Cancer Research

Background:

• Improving survival in multiple myeloma (MM) necessitates understanding long-term care issues.
• Second primary malignancies (SPMs) are a significant concern for MM survivors.
• This study investigates the risk and patterns of SPMs in individuals diagnosed with MM.

Purpose of the Study:

• To assess the risk of SPMs in patients with multiple myeloma (MM).
• To identify specific types of SPMs that occur with increased or decreased frequency in MM survivors.
• To inform tailored surveillance strategies for MM patients.

Main Methods:

• Systematic literature search of EMBASE, PubMed, and Cochrane Library up to August 15, 2025.
• Pooled analysis of standardized incidence ratios (SIRs) to compare SPM risks in MM patients versus the general population.
• Inclusion of 15 studies with 279,894 MM patients.

Main Results:

• Overall SPM and solid tumor risks were not significantly elevated in MM patients compared to the general population.
• A markedly increased risk of hematologic SPMs was observed (SIR = 2.91).
• Specific malignancies with higher risks included non-Hodgkin lymphoma, myelodysplastic syndromes, acute myeloid leukemia, mesothelioma, skin cancer, endocrine tumors, and thyroid cancer. Reduced risks were noted for chronic lymphocytic leukemia, lung cancer, and breast cancer.

Conclusions:

• Multiple myeloma patients exhibit a distinct pattern of second primary malignancies.
• Surveillance strategies should prioritize hematologic SPMs and specific solid tumors.
• The unexpectedly lower incidence of breast cancer warrants further investigation to guide future research and follow-up protocols.