Multiple myeloma (MM) is a malignancy of clonal plasma cells that accumulate in the bone marrow, producing abnormal monoclonal immunoglobulin (M protein) and ca…
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Multiple myeloma (MM) is a malignancy of clonal plasma cells that accumulate in the bone marrow, producing abnormal monoclonal immunoglobulin (M protein) and causing end-organ damage. It accounts for approximately 10% of hematologic malignancies, with approximately 35,000 new cases and 12,000 deaths annually in the United States. MM is characterized by the CRAB criteria: hyperCalcemia, Renal insufficiency, Anemia, and Bone disease. While still incurable in most cases, the advent of proteasome inhibitors, immunomodulatory drugs (IMiDs), anti-CD38 monoclonal antibodies, and CAR-T cell therapy has transformed MM into a manageable chronic disease with median survival now exceeding 5–7 years from diagnosis.
This information is for educational purposes only. Always consult a qualified healthcare professional for diagnosis and personalized treatment.
Bone pain (especially back, ribs, hips) — most common presenting symptom
Fatigue from normocytic anemia
Hypercalcemia: constipation, nausea, polyuria, polydipsia, confusion
Renal insufficiency or failure (myeloma cast nephropathy, hypercalcemia, amyloid)
Recurrent infections (impaired humoral immunity — low normal immunoglobulins)
Pathologic fractures and vertebral compression fractures
Spinal cord compression (oncologic emergency)
Peripheral neuropathy (disease-related or treatment-related)
Hyperviscosity syndrome (rare): blurred vision, headache, bleeding
Serum protein electrophoresis (SPEP) and serum immunofixation — identify M protein type
Serum free light chains (FLC) ratio — elevated kappa or lambda
24-hour urine protein electrophoresis (UPEP) for Bence Jones protein
Bone marrow biopsy: ≥10% clonal plasma cells (MM) or ≥60% (ultra-high risk smoldering MM)
Whole-body low-dose CT or PET-CT — lytic lesions, plasmacytomas
MRI spine/pelvis — bone marrow infiltration pattern, spinal cord compression
Cytogenetics: FISH panel for high-risk features (del17p, t(4;14), t(14;16), 1q21 gain)
Diagnosis requires: clonal BM plasma cells ≥10% OR biopsy-proven plasmacytoma PLUS one or more CRAB criteria OR biomarker of malignancy (SLiM criteria)
Bortezomib + Lenalidomide + Dexamethasone (VRd)
Standard induction for transplant-eligible and transplant-ineligible patients (SWOG S0777). Daratumumab-VRd (Dara-VRd) is now preferred first-line for transplant-eligible per PERSEUS trial.
Autologous Stem Cell Transplant (ASCT)
Standard of care for transplant-eligible patients after induction. Melphalan 200 mg/m² conditioning. Significantly extends progression-free survival. Tandem ASCT for high-risk disease.
Daratumumab (Darzalex)
Anti-CD38 monoclonal antibody. Now incorporated into multiple first-line and relapsed regimens. Dara-VRd (PERSEUS) and Dara-Rd (MAIA) established as frontline standards.
Carfilzomib + Pomalidomide + Dexamethasone
KPd for lenalidomide-refractory relapsed MM. Carfilzomib (next-gen proteasome inhibitor) less neurotoxic than bortezomib but requires cardiac monitoring.
CAR-T Cell Therapy (Idecabtagene Vicleucel / Ciltacabtagene Autoleucel)
Anti-BCMA CAR-T for heavily pre-treated relapsed/refractory MM. Deep responses including MRD negativity. Requires specialized center. Cytokine release syndrome and neurotoxicity monitoring essential.
Stay hydrated (2–3 L/day) to protect kidneys from light chain toxicity
Avoid NSAIDs and nephrotoxic agents (contrast dye if creatinine elevated — prehydrate)
Bisphosphonates (zoledronic acid) or denosumab to reduce skeletal events — given monthly for 2 years
Weight-bearing exercise as tolerated to maintain bone density and muscle strength
Vaccinations: pneumococcal, influenza, shingles (Shingrix), RSV — before and during treatment
Infection vigilance: report fevers ≥38°C promptly (infection is leading cause of MM mortality)
VTE prophylaxis when on IMiD-based therapy (aspirin or LMWH based on risk score)
Pain management: analgesics, radiation, vertebroplasty/kyphoplasty for compression fractures
Prognosis
Prognosis depends on cytogenetics, disease stage (ISS/R-ISS), fitness, and response to treatment. Standard risk MM: median OS >8–10 years with modern therapy. High-risk MM (del17p, t(4;14), t(14;16), 1q21 gain, high LDH): median OS 2–4 years despite aggressive treatment. MRD negativity (10^-5 or deeper by next-gen sequencing or flow cytometry) is associated with significantly prolonged PFS and OS. CAR-T and bispecific antibodies are reshaping outcomes in relapsed/refractory disease.
Multiple Myeloma is a medical condition classified under Oncology. Multiple myeloma (MM) is a malignancy of clonal plasma cells that accumulate in the bone marrow, producing abnormal monoclonal immunoglobulin (M protein) and causing end-organ damage. It accounts for approximately 10% of hematologic malignancies, with approximately 35,000 new cases and 12,000 deaths annually in the United States. Understanding Multiple Myeloma is essential for patients, families, and healthcare providers to ensure timely diagnosis, appropriate treatment, and optimal outcomes.
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The information on this page is for educational purposes only and is not intended as medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions about a medical condition.