Multiple myeloma: an update

Abstract

Multiple myeloma is a rare, largely incurable malignant disease of plasma cells. Patients usually present with hypercalcemia, renal insufficiency, anemia and/or lytic bony lesions along with a monoclonal protein in the serum and/or urine in addition to an increase in the number of clonal plasma cells in the bone marrow. Patients with myeloma live on an average for five to seven years, with their survival dependent on the presence or absence of different prognostic markers. Treatment of younger fit patients is with induction therapy consisting of steroids with one or more novel anti-myeloma agents followed by high dose melphalan and autologous stem cell transplantation, while older and less fit patients are treated with melphalan-based combination chemotherapy. Supportive care is of paramount importance and includes the use of bisphosphonates, prophylactic antibiotics, thrombosis prophylaxis and the use of hematopoietic growth factors along with the treatment of complications of disease and its therapy. As more progress is being made and deeper responses are being attained, the disease might turn into a potentially curable one in the near future.

Keywords: Monoclonal gammopathy; Multiple myeloma; Myeloma; Plasma cell dyscrasia; Plasma cell myeloma.

Figure 1

Pathophysiology of MM. PCs: plasma cells, RANKL: receptor activator of nuclear factor Kappa B ligand; OPG: osteoprotegrin; MIP-1: macrophage inflammatory protein-1 alpha; IL: inter-leukine; Igs: immunoglogulins.

Figure 2

Some of the clinical findings seen in patients with multiple myeloma. A: Rouleaux formation on the peripheral blood film. B: Increased numbers of plasma cell on a BM aspirate. C. Lateral X-ray of the skull showing multiple lytic lesions; D, E, and F: Detection of monoclonal proteins on PEP and IF (D: normal pattern of SPEP; E: abnormal monoclonal peak in the gamma region on SPEP; F: Immunofixation identifying the M-protein as IgG kappa).