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Mieloma múltiplo

Last reviewed: 5 Aug 2025
Last updated: 18 Jul 2025

Summary

Definition

History and exam

Key diagnostic factors

  • anemia
  • dor óssea
  • gamopatia monoclonal de significado indeterminado (MGUS)
Full details

Other diagnostic factors

  • hipercalcemia
  • infecções
  • fadiga
  • comprometimento renal
Full details

Risk factors

  • gamopatia monoclonal de significado indeterminado (MGUS)
  • relação anormal entre cadeias leves livres
  • sexo masculino
  • etnia negra
  • história familiar de MM
  • exposição à radiação
  • exposição a derivados de petróleo
Full details

Diagnostic tests

1st tests to order

  • imunoglobulinas quantitativas séricas
  • eletroforese de proteínas séricas/urinárias
  • imunofixação sérica/urinária
  • técnica de detecção de cadeias leves livres no soro
  • tomografia computadorizada de baixa dose do corpo inteiro (WBLD-TC)
  • tomografia por emissão de pósitrons com fluordesoxiglucose-18F/TC (FDG-PET/TC)
  • avaliação da medula óssea
  • cálcio sérico
  • Hemograma completo com diferencial
  • esfregaço de sangue periférico
  • creatinina sérica, ureia, eletrólitos
  • ácido úrico sérico
  • testes da função hepática
  • proteína C-reativa
  • lactato desidrogenase (LDH) sérica
  • microglobulina beta-2 sérica
  • albumina sérica
  • Fragmento N-terminal do pró-hormônio do PNB (NT-proPNB) ou peptídeo natriurético do tipo B
Full details

Tests to consider

  • RNM do corpo inteiro
  • radiografia do esqueleto
  • análise citogenética
  • espectrometria de massa
  • teste genético
  • viscosidade sérica
  • rastreamento para infecção viral
Full details

Treatment algorithm

ACUTE

candidatos a transplante recém-diagnosticados

não candidatos a transplante recém-diagnosticados

ONGOING

pacientes com resposta clínica ao tratamento inicial

doença recidivada ou refratária

Contributors

Authors

Matthew M. Lei, PharmD

Clinical Pharmacist Medical Oncology

Massachusetts General Hospital

Boston

MA

Disclosures

MML has received honoraria for consultancy and speaker fees from Genentech and MJH Life Sciences, and for consultancy from Genmab, Astra Zeneca, CX4D, SERB Pharmaceuticals, and Sanofi. 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 served on steering committees for Amgen and Roche; has held membership on an entity's boards of directors or advisory committees for Novartis, Takeda Pharmaceuticals USA Inc, Merck, Celgene, Onyx Pharmaceuticals, Immuneel Therapeutics, Bristol Myers Squibb, Janssen Biotech, Caribou Biosciences, and Bluebirdbio; and has received research funding from Bluebirdbio. 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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014 Nov;15(12):e538-48.Full text  Abstract

Dimopoulos MA, Moreau P, Terpos E, et al. Multiple myeloma: EHA-ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. Ann Oncol. 2021 Mar;32(3):309-22.Full text  Abstract

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: multiple myeloma [internet publication].Full text

Mikhael J, Ismaila N, Cheung MC, et al. Treatment of multiple myeloma: ASCO and CCO joint clinical practice guideline. J Clin Oncol. 2019 May 10;37(14):1228-63.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Mieloma múltiplo images
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    • Macroglobulinemia de Waldenström
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  • Guidelines

    • NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation
    • NCCN clinical practice guidelines in oncology: multiple myeloma
    More Guidelines
  • Patient information

    Mieloma múltiplo

    More Patient information
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