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Multiple myeloma

Última revisión: 20 Aug 2025
Última actualización: 12 Sep 2025

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • anemia
  • bone pain
  • monoclonal gammopathy of undetermined significance (MGUS)
Todos los datos

Otros factores de diagnóstico

  • hypercalcemia
  • infections
  • fatigue
  • renal impairment
Todos los datos

Factores de riesgo

  • monoclonal gammopathy of undetermined significance (MGUS)
  • abnormal free light-chain ratio
  • male sex
  • black ethnicity
  • family history of MM
  • radiation exposure
  • petroleum products exposure
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • serum quantitative immunoglobulins
  • serum/urine protein electrophoresis
  • serum/urine immunofixation
  • serum free light-chain assay
  • whole-body low-dose CT (WBLD-CT)
  • whole-body 18F-fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT)
  • bone marrow evaluation
  • serum calcium
  • CBC with differential
  • peripheral blood smear
  • serum creatinine, BUN, electrolytes
  • serum uric acid
  • liver function tests
  • C-reactive protein (CRP)
  • serum lactate dehydrogenase (LDH)
  • serum beta2-microglobulin
  • serum albumin
  • N-terminal prohormone of brain natriuretic peptide (NT-proBNP) or BNP
Todos los datos

Pruebas diagnósticas que deben considerarse

  • whole-body MRI
  • skeletal survey
  • cytogenetic analysis
  • mass spectrometry
  • genetic testing
  • serum viscosity
  • viral infection screening
  • clonotype identification
  • renal biopsy
Todos los datos

Algoritmo de tratamiento

Agudo

newly diagnosed transplant candidates

newly diagnosed nontransplant candidates

En curso

patients responding to initial treatment

relapsing or refractory disease

Colaboradores

Autores

Matthew M. Lei, PharmD

Clinical Pharmacist Medical Oncology

Massachusetts General Hospital

Boston

MA

Divulgaciones

MML has received honoraria for consultancy and speaker fees from Genentech and MJH Life Sciences, and for consultancy from Genmab, Astra Zeneca, CX4D, SERB Pharmaceuticals, and Sanofi. MML is an author of a reference cited in this topic.

Diana Cirstea, MD

Medical Oncologist

Center for Multiple Myeloma

Massachusetts General Hospital

Harvard Medical School

Boston

MA

Divulgaciones

DC is on the advisory board for Sanofi.

E. Bridget Kim, PharmD, BCPS, BCOP

Clinical Pharmacist

Massachusetts General Hospital

Boston

MA

Divulgaciones

EBK declares that she has no competing interests.

Noopur Raje, MD
Noopur Raje

Director of Multiple Myeloma Program

Massachusetts General Hospital

Harvard Medical School

Boston

MA

Divulgaciones

NR has served on steering committees for Amgen and Roche; has held membership on an entity's boards of directors or advisory committees for Novartis, Takeda Pharmaceuticals USA Inc, Merck, Celgene, Onyx Pharmaceuticals, Immuneel Therapeutics, Bristol Myers Squibb, Janssen Biotech, Caribou Biosciences, and Bluebirdbio; and has received research funding from Bluebirdbio. NR is an author of several references cited in this topic.

Agradecimientos

Dr Matthew M. Lei, Dr Diana Cirstea, Dr E. Bridget Kim, and Dr Noopur Raje would like to gratefully acknowledge Dr Loredana Santo and Dr Sonia Vallet, previous contributors to this topic.

Divulgaciones

LS and SV declare that they have no competing interests.

Revisores por pares

Shaji Kumar, MD

Associate Professor of Medicine

Mayo Clinic

Rochester

MN

Divulgaciones

SK declares that he has no competing interests.

Faith Davies, MD

Institute of Cancer Research

Sutton

Surrey

UK

Divulgaciones

FD declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014 Nov;15(12):e538-48.Texto completo  Resumen

Dimopoulos MA, Moreau P, Terpos E, et al. Multiple myeloma: EHA-ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. Ann Oncol. 2021 Mar;32(3):309-22.Texto completo  Resumen

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: multiple myeloma [internet publication].Texto completo

Sive J, Cuthill K, Hunter H, et al. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Br J Haematol. 2021 Apr;193(2):245-68.Texto completo  Resumen

Mikhael J, Ismaila N, Cheung MC, et al. Treatment of multiple myeloma: ASCO and CCO joint clinical practice guideline. J Clin Oncol. 2019 May 10;37(14):1228-63.Texto completo  Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Multiple myeloma images
  • Diferenciales

    • Monoclonal gammopathy of undetermined significance
    • Solitary plasmacytoma
    • Waldenström macroglobulinemia
    Más Diferenciales
  • Guías de práctica clínica

    • NCCN clinical practice guidelines in oncology: multiple myeloma
    • NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation
    Más Guías de práctica clínica
  • Patient information

    Multiple myeloma

    More Patient information
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