Last reviewed: 16 Apr 2021
Last updated: 07 May 2021

Summary

Definition

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

Contributors

Research Fellow

Massachusetts General Hospital

Harvard Medical School

Boston

MA

Disclosures

LS is an author of one reference cited in this topic.

Clinical Pharmacist Medical Oncology

Massachusetts General Hospital

Boston

MA

Disclosures

MML has consulted for Heron Therapeutics, Fresenius Kabi USA, and Intervention Insights. He has stock and other ownership interests in Bristol Myers Squibb and Bluebird Bio. MML is an author of some references cited in this topic.

Noopur Raje

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.

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 reviewersVIEW ALL

Associate Professor of Medicine

Mayo Clinic

Rochester

MN

Disclosures

SK declares that he has no competing interests.

Institute of Cancer Research

Sutton

Surrey

UK

Disclosures

FD declares that she has no competing interests.

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