Summary
Definition
O MM é uma neoplasia maligna de plasmócitos. As células do mieloma proliferam-se e acumulam-se na medula óssea e secretam imunoglobulinas anormais (monoclonais) ou fragmentos de imunoglobulina (conhecidos como paraproteína ou proteína M). Isso pode resultar em complicações como hipercalcemia, doença óssea osteolítica, insuficiência renal, anemia e infecção.[1][2][Figure caption and citation for the preceding image starts]: A: eletroforese de proteínas séricas demonstrando uma imunoglobulina monoclonal. B: eletroforese com imunofixação no soro e na urina demonstrando uma imunoglobulina monoclonal e de cadeia leve livre (proteína de Bence Jones [PBJ])Cortesia do Dr. M Murali e do Clinical Immunology Laboratory, Massachusetts General Hospital; usado com permissão [Citation ends].
History and exam
Key diagnostic factors
- anemia
- dor óssea
- gamopatia monoclonal de significado indeterminado (MGUS)
Other diagnostic factors
- hipercalcemia
- infecções
- fadiga
- comprometimento renal
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
Diagnostic investigations
1st investigations 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
Investigations to consider
- RNM do corpo inteiro
- radiografia do esqueleto
- análise citogenética
- espectrometria de massa
- teste genético
- viscosidade sérica
- rastreamento para infecção viral
Treatment algorithm
candidatos a transplante recém-diagnosticados
não candidatos a transplante recém-diagnosticados
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
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
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.
Differentials
- Gamopatia monoclonal de significado indeterminado
- Plasmacitoma solitário
- Macroglobulinemia de Waldenström
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation
- NCCN clinical practice guidelines in oncology: multiple myeloma
More GuidelinesPatient information
Mieloma múltiplo
More Patient information
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