Multiple myeloma

Multiple myeloma is a haematological cancer characterised by clonal proliferation of plasma cells in the bone marrow, and 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.

Tests used to establish a diagnosis include serum and urine protein electrophoresis, serum and urine immunofixation, serum free light-chain assay, bone marrow examination, and whole-body low-dose computed tomography or skeletal survey.

Treatment includes conventional chemotherapy-based regimens and non-chemotherapy regimens. In many institutions, non-chemotherapy regimens have replaced the use of conventional chemotherapy-based regimens.

Younger patients without comorbidities are potential 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].