Q. How does one typically die from cancer of the bone marrow, such as leukemia or multiple myeloma?
A. People diagnosed with leukemia and multiple myeloma, both cancers originating in the bone marrow, are living much longer than they did just a few decades ago. In 1975, somebody diagnosed with leukemia in the United States had a 33 percent chance of being alive five years later, a common cutoff point to measure cancer survival; by 2010, that survival rate had doubled, to almost 66 percent. For multiple myeloma, those rates were 26 percent in 1975 and 53 percent in 2010. The gains are largely a result of better therapies and more effective supportive care, including antibiotics and anti-nausea medications.
For example, patients with chronic myeloid leukemia treated with a class of drugs called tyrosine kinase inhibitors now have a life expectancy approaching that of their peers who never had leukemia. Those with multiple myeloma may be treated initially with combinations of three or four drugs that can reduce the risk of the disease worsening or of dying by 50 percent compared to earlier treatments.
For many patients, though, even the best available therapies are not a cure. As cancerous leukemia or multiple myeloma cells grow unchecked, they fill precious bone marrow space and cause the normal cells there to die. Consequently, the bone marrow loses its capacity to make red blood cells, which provide oxygen to tissues; white blood cells, which fight infections; and platelets, which help stop bleeding.
With the bone marrow’s function compromised, patients can die from a variety of causes. Studies show that for leukemia patients, infections were the most common cause of death, most often bacterial infections but also fungal infections or a combination of the two. Bleeding was also a fairly common cause of death, often in the brain, lungs or digestive tract.
Similarly, for multiple myeloma, a British study of over 3,100 patients treated from 1980 to 2002 found that 10 percent died within 60 days of starting therapy. Infections contributed to almost half of the deaths. Kidney failure contributed to 28 percent of deaths, while heart attack or stroke were responsible for 8 percent of deaths. Other causes of death can include blood clots and heart failure.