Multiple myeloma

Last reviewed: 4 Jun 2022
Last updated: 26 Aug 2021

Summary

Definition

History and exam

Key diagnostic factors

  • anemia
  • 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 electrophoresis
  • whole-body, low-dose CT (WBLD-CT)
  • skeletal survey
  • serum free light-chain assay
  • bone marrow aspirate and biopsy
  • serum calcium
  • CBC
  • creatinine, BUN
  • serum beta2-microglobulin
  • serum albumin
More 1st investigations to order

Investigations to consider

  • whole-body MRI
  • 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)/FDG-PET-CT
  • CRP
  • LDH
  • cytogenetics and fluorescence in situ hybridization analysis
More investigations to consider

Treatment algorithm

ACUTE

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

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

ONGOING

previously diagnosed patients responding to nontransplant 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
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.

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.

  • Multiple myeloma images
  • Differentials

    • Monoclonal gammopathy of undetermined significance
    • Solitary plasmacytoma
    • Waldenström macroglobulinemia
    More Differentials
  • Guidelines

    • Multiple myeloma: EHA-ESMO clinical practice guidelines for diagnosis, treatment and follow-up
    • Treatment of relapsed and refractory multiple myeloma: recommendations from the International Myeloma Working Group
    More Guidelines
  • Patient leaflets

    Multiple myeloma

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer