Highlights & Basics
- Multiple myeloma (MM) is an incurable hematologic cancer that is characterized by proliferation of clonal plasma cells in the bone marrow.
- The most common presenting features are bone pain and anemia; the condition may also be identified through investigation of fatigue, infections, hypercalcemia, or renal impairment.
- Tests used to establish a diagnosis include serum and urine protein electrophoresis, serum and urine immunofixation, serum free light-chain assay, bone marrow exam, and imaging studies (e.g., whole-body low-dose computed tomography).
- Initial treatment includes combination regimens that may include an immunomodulatory drug, a proteasome inhibitor, an anti-CD38 monoclonal antibody, a corticosteroid, and in some cases chemotherapy.
- Younger patients without comorbidities are potential candidates for autologous stem cell transplantation.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
A: serum protein electrophoresis demonstrating a monoclonal immunoglobulin. B: serum and urine immunofixation electrophoresis (IFE) demonstrating a monoclonal immunoglobulin and free light chain (Bence Jones [BJ] protein)
A: serum protein electrophoresis (SPEP) of normal serum. B: SPEP of multiple myeloma serum showing a monoclonal immunoglobulin (M-protein) in the gamma region. C: densitometry tracing of normal serum (A) showing the 5 zones of the high resolution agarose electrophoresis. D: densitometry tracing of multiple myeloma serum (B) showing a monoclonal spike (M spike)
Bone marrow biopsy
Bone marrow biopsy after histochemical analysis for kappa light chain
Bone marrow biopsy after histochemical analysis for lambda light chain
Aspirate showing plasma cell infiltrate
Citations
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.[Abstract][Full Text]
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.[Abstract][Full Text]
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: multiple myeloma [internet publication].[Full Text]
Sive J, Cuthill K, Hunter H, et al. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Br J Haematol. 2021 Apr;193(2):245-68.[Abstract][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.[Abstract][Full Text]
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118. Gay F, Musto P, Rota-Scalabrini D, et al. Carfilzomib with cyclophosphamide and dexamethasone or lenalidomide and dexamethasone plus autologous transplantation or carfilzomib plus lenalidomide and dexamethasone, followed by maintenance with carfilzomib plus lenalidomide or lenalidomide alone for patients with newly diagnosed multiple myeloma (FORTE): a randomised, open-label, phase 2 trial. Lancet Oncol. 2021 Dec;22(12):1705-20.[Abstract]
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