Multiple myeloma

A haematological cancer characterised by clonal proliferation of plasma cells in the bone marrow, typically associated with a monoclonal component in the serum and/or urine.

The most common presenting features are bone pain and anaemia; the condition may also be identified through investigation of fatigue, infections, hypercalcaemia, or renal impairment.

Diagnosis is made on serum and urine protein electrophoresis, bone marrow examination, and skeletal survey.

Non-chemotherapy agents are replacing the use of conventional chemotherapy.

Younger patients are candidates for high-dose chemotherapy and autologous transplantation strategies.

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]Hallek M, Bergsagel PL, Anderson KC. Multiple myeloma: increasing evidence for a multistep transformation process. Blood. 1998 Jan 1;91(1):3-21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901996/ http://www.ncbi.nlm.nih.gov/pubmed/9414264?tool=bestpractice.com [2]Kyle RA, Rajkumar SV. Multiple myeloma. N Engl J Med. 2004 Oct 28;351(18):1860-73. http://www.ncbi.nlm.nih.gov/pubmed/15509819?tool=bestpractice.com It is usually associated with osteolytic bone disease, anaemia, and renal failure.[2]Kyle RA, Rajkumar SV. Multiple myeloma. N Engl J Med. 2004 Oct 28;351(18):1860-73. http://www.ncbi.nlm.nih.gov/pubmed/15509819?tool=bestpractice.com [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].