Multiple Myeloma


A neoplastic proliferation characterized by plasma cell accumulation in the bone marrow with presence of monoclonal protein in the serum and/or urine.

Signs & Symptoms

Bone pain and pathological fractures, lethargy, weakness, dyspnea, pallor, tachycardia, recurrent infections, related organ or tissue impairment such as bone disease, renal impairment, hypercalemia, hyperviscosity, amyloidosis.

Risk Factors

Mainly in those over 40 years old with a peak incidence around 70 years old. Common in Afro-Carribeans.

Peripheral blood characteristics

Normochromic, normocytic anemia or macrocytic anemia. Rouleaux formation. Neutropenia and thrombocytopenia.

Bone marrow characteristics

Increased plasma cells.

Important investigations & related results

Monoclonal protein in serum and/or urine. Immunophenotype of malignant plasma cells: CD38high, CD138high and CD45low. Increased serum calcium and normal serum alkaline phosphatase. Increased serum creatinine in certain cases. Low serum albumin in advanced disease. Raised serum β2-microglobulin.

Treatment & management

Allogeneic stem cell transplantation. Intensive therapy for patients aged less than 65 – 70 years old. It is a combination of several courses of chemotherapy. Non-intensive therapy for older patients involves oral alkylating agent melphalan, sometimes in combination with prednisolone. Other treatments are thalidomide, bortezomib, α-interferon and radiotherapy with other supportive care.

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