Multiple myeloma
Summary
Definition
Multiple myeloma (MM) is a plasma cell dyscrasia characterised by terminally differentiated plasma cells, infiltration of the bone marrow by plasma cells, and the presence of a monoclonal immunoglobulin (or immunoglobulin fragment) in the serum and/or urine.[1][2] It is usually associated with osteolytic bone disease, anaemia, and renal failure.[2][Figure caption and citation for the preceding image starts]: A: serum protein electrophoresis demonstrating the M component. B: serum and urine immunofixation electrophoresisCourtesy of Dr M Murali and the Clinical Immunology Laboratory, Massachusetts General Hospital; used with permission [Citation ends].
History and exam
Key diagnostic factors
- anaemia
- bone pain
- monoclonal gammopathy of undetermined significance (MGUS)
Other diagnostic factors
- infections
- fatigue
- renal impairment
Risk factors
- monoclonal gammopathy of undetermined significance (MGUS)
- abnormal free light-chain ratio
- family history of MM
- radiation exposure
- petroleum products exposure
Diagnostic investigations
1st investigations to order
- serum/urine electrophoresis
- whole-body, low-dose CT (WBLD-CT)
- skeletal survey
- serum free light-chain assay
- bone marrow aspirate and biopsy
- serum calcium
- FBC
- creatinine, urea
- serum beta2-microglobulin
- serum albumin
Investigations to consider
- whole-body MRI
- 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)/FDG-PET-CT
- CRP
- LDH
- cytogenetics and fluorescence in situ hybridisation analysis
Treatment algorithm
newly diagnosed transplant candidates (<65-70 years, good performance status)
newly diagnosed non-transplant candidates (>65-70 years and/or poor performance status)
previously diagnosed patients responding to non-transplant therapy and/or transplant therapy
relapsing or refractory patients
Contributors
Authors
Loredana Santo, MD
Research Fellow
Massachusetts General Hospital
Harvard Medical School
Boston
MA
Disclosures
LS is an author of one reference cited in this topic.
Matthew M. Lei, PharmD
Clinical Pharmacist Medical Oncology
Massachusetts General Hospital
Boston
MA
Disclosures
MML has consulted for Heron Therapeutics, Fresenius Kabi USA, and Intervention Insights and has received honoraria from AbbVie and Epizyme. MML is an author of some references cited in this topic.
Noopur Raje, MD
Director of Multiple Myeloma Program
Massachusetts General Hospital
Harvard Medical School
Boston
MA
Disclosures
NR has consulted for Celgene, Takeda, Amgen, Bristol Myers Squibb, Janssen Pharmaceutica, Karyopharm Therapeutics, Bluebird Bio, and Novartis. She has received research funds from Eli Lilly and AstraZeneca. NR is an author of several references cited in this topic.
Acknowledgements
Dr Loredana Santo, Dr Matthew M. Lei, and Dr Noopur Raje would like to gratefully acknowledge Dr Sonia Vallet, a previous contributor to this topic.
Disclosures
SV declares that she has no competing interests.
Peer reviewers
Shaji Kumar, MD
Associate Professor of Medicine
Mayo Clinic
Rochester
MN
Disclosures
SK declares that he has no competing interests.
Faith Davies, MD
Institute of Cancer Research
Sutton
Surrey
UK
Disclosures
FD declares that she has no competing interests.
Differentials
- Monoclonal gammopathy of undetermined significance
- Solitary plasmacytoma
- Waldenström's macroglobulinaemia
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: multiple myeloma
- Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group
More GuidelinesPatient leaflets
Multiple myeloma
More Patient leaflets
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