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Overview
Multiple myeloma is a bone marrow disease characterized by
the presence of malignant plasma cells, and abnormal serum and/or urine
immunoglobulin (Ig) secondary to clonal plasma cell expansion as stated in the Introduction section.
Multiple Myeloma_Disease SummaryMultiple myeloma accounts for 1-2% of all cancers worldwide. Incidence and prevalence of the disease can be found in the Epidemiology section.
There are two processes being considered to be the root cause of multiple myeloma, the premalignant stage or the appearance of monoclonal gammopathy of undetermined significance (MGUS) and the disease progression from MGUS to multiple myeloma. These processes are discussed in the Pathophysiology and Etiology sections.
The Risk Factors section discusses the different factors that can contribute to the development of multiple myeloma.
In the Classification section, the differences between smoldering and active multiple myeloma are discussed.
History and Physical Examination
Multiple myeloma patients usually present with bone pain and
fatigue due to anemia. The Clinical
Presentation section enumerates the other non-specific symptoms
of patients suspected to have multiple myeloma.
As stated in the Physical
Examination section, patients usually have no obvious
abnormalities upon examination, although pallor may be present due to anemia.
Diagnosis
Tests used to assess patients suspected of having multiple
myeloma are enumerated and discussed in the Laboratory
Tests and Ancillaries and
Imaging sections.
Diagnostic criteria for diagnosing smoldering and active
multiple myeloma are enumerated in the Diagnosis
or Diagnostic Criteria section.
The Differential
Diagnosis section enumerates the plasma cell proliferative
disorders that have to be ruled out in diagnosing multiple myeloma.
Management
The Evaluation
section mentions that the International Staging System (ISS) risk
stratification is the preferred and most widely used staging system for determining
prognosis in patients with multiple myeloma and it is discussed further in this
section. The Durie-Salmon Staging System is also featured in this section.
Distinguishing active multiple myeloma from other types of
multiple myeloma is essential for proper management planning and prognosis of
multiple myeloma. Therapeutic strategies in managing patients with smoldering,
active, relapsed, refractory or progressive multiple myeloma are discussed in
the Principles of Therapy
section.
The Pharmacological Therapy
section includes the discussion of therapeutic regimens used in hematopoietic
cell transplantation-eligible and ineligible patients. There are also
discussions on maintenance and palliative therapies as well as therapies used
in patients with relapsed, refractory or progressive multiple myeloma.
Recommendations for patients with smoldering multiple
myeloma who will undergo observation are enumerated in the Nonpharmacological section.
The Surgery
section discusses the different types of hematopoietic cell transplantation used
in the management of patients with multiple myeloma.
Recommendations for the assessment of treatment response
after every treatment cycle are in the Monitoring
section.
