Multiple myeloma

Last reviewed: 2 Nov 2022
Last updated: 23 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • anaemia
  • bone pain
  • monoclonal gammopathy of undetermined significance (MGUS)
More key diagnostic factors

Other diagnostic factors

  • infections
  • fatigue
  • renal impairment
Other diagnostic factors

Risk factors

  • monoclonal gammopathy of undetermined significance (MGUS)
  • abnormal free light-chain ratio
  • family history of MM
  • radiation exposure
  • petroleum products exposure
More risk factors

Diagnostic investigations

1st investigations to order

  • serum/urine protein electrophoresis
  • serum/urine immunofixation
  • whole-body, low-dose CT (WBLD-CT)
  • serum free light-chain assay
  • bone marrow aspirate and biopsy
  • serum calcium
  • FBC
  • creatinine, urea
  • serum beta2-microglobulin
  • serum albumin
More 1st investigations to order

Investigations to consider

  • whole-body MRI
  • skeletal survey
  • 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)/FDG-PET-CT
  • CRP
  • lactate dehydrogenase (LDH)
  • cytogenetic analysis and fluorescence in situ hybridisation
  • mass spectrometry
More investigations to consider

Treatment algorithm

ACUTE

newly diagnosed transplant candidates (<65-70 years, good performance status)

newly diagnosed non-transplant candidates (>65-70 years and/or poor performance status)

ONGOING

transplant eligible and ineligible patients responding to initial treatment

relapsing or refractory patients

Contributors

Authors

Loredana Santo, MD

Research Fellow

Massachusetts General Hospital

Harvard Medical School

Boston

MA

Disclosures

Not disclosed.

Matthew M. Lei, PharmD

Clinical Pharmacist Medical Oncology

Massachusetts General Hospital

Boston

MA

Disclosures

MML declares that he has no competing interests. MML is an author of a reference cited in this topic.

Noopur Raje, MD
Noopur Raje

Director of Multiple Myeloma Program

Massachusetts General Hospital

Harvard Medical School

Boston

MA

Disclosures

NR has received institutional research funding from Amgen, bluebird bio, Janssen, Caribou, Bristol Myers Squibb, and Celgene. 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.

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