Multiple myeloma
Summary
Definition
Multiple myeloma (MM) is a plasma cell dyscrasia characterized 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][2] It is usually associated with osteolytic bone disease, anemia, and renal failure.[2][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].
History and exam
Key diagnostic factors
- anemia
- 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 protein electrophoresis
- serum/urine immunofixation
- whole-body, low-dose CT (WBLD-CT)
- serum free light-chain assay
- bone marrow aspirate and biopsy
- serum calcium
- CBC
- creatinine, BUN
- serum beta2-microglobulin
- serum albumin
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 hybridization
- mass spectrometry
Treatment algorithm
newly diagnosed transplant candidates (<65-70 years, good performance status)
newly diagnosed nontransplant candidates (>65-70 years and/or poor performance status)
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
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.
Differentials
- Monoclonal gammopathy of undetermined significance
- Solitary plasmacytoma
- Waldenström macroglobulinemia
More DifferentialsGuidelines
- ACR-ARS practice parameter for the performance of total body irradiation
- Consensus guidelines and recommendations for infection prevention in multiple myeloma
More GuidelinesPatient leaflets
Multiple myeloma
More Patient leaflets
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