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Multiple myeloma

Last reviewed: 4 Oct 2024
Last updated: 16 Aug 2024

Summary

Definition

History and exam

Key diagnostic factors

  • anemia
  • bone pain
  • monoclonal gammopathy of undetermined significance (MGUS)
Full details

Other diagnostic factors

  • hypercalcemia
  • infections
  • fatigue
  • renal impairment
Full details

Risk factors

  • monoclonal gammopathy of undetermined significance (MGUS)
  • abnormal free light-chain ratio
  • male sex
  • black ethnicity
  • family history of MM
  • radiation exposure
  • petroleum products exposure
Full details

Diagnostic tests

1st tests to order

  • serum quantitative immunoglobulins
  • serum/urine protein electrophoresis
  • serum/urine immunofixation
  • serum free light-chain assay
  • whole-body, low-dose CT (WBLD-CT)
  • 18F-fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT)
  • bone marrow evaluation
  • serum calcium
  • CBC with differential
  • peripheral blood smear
  • serum creatinine, BUN, electrolytes
  • serum uric acid
  • liver function tests
  • C-reactive protein (CRP)
  • serum lactate dehydrogenase (LDH)
  • serum beta2-microglobulin
  • serum albumin
  • N-terminal prohormone of brain natriuretic peptide (NT-proBNP) or BNP
Full details

Tests to consider

  • whole-body MRI
  • skeletal survey
  • cytogenetic analysis
  • mass spectrometry
  • genetic testing
  • serum viscosity
  • viral infection screening
Full details

Treatment algorithm

ACUTE

newly diagnosed transplant candidates

newly diagnosed nontransplant candidates

ONGOING

patients responding to initial treatment

relapsing or refractory disease

Contributors

Authors

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.

Diana Cirstea, MD

Medical Oncologist

Center for Multiple Myeloma

Massachusetts General Hospital

Harvard Medical School

Boston

MA

Disclosures

DC is on the advisory board for Sanofi.

E. Bridget Kim, PharmD, BCPS, BCOP

Clinical Pharmacist

Massachusetts General Hospital

Boston

MA

Disclosures

EBK declares that she has no competing interests.

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 Matthew M. Lei, Dr Diana Cirstea, Dr E. Bridget Kim, and Dr Noopur Raje would like to gratefully acknowledge Dr Loredana Santo and Dr Sonia Vallet, previous contributors to this topic.

Disclosures

LS and SV declare that they have 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
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  • Guidelines

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    • NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation
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  • Patient information

    Multiple myeloma

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