SHM's Clinical Quick Talks-Multiple Myeloma

Pdf Summary

Multiple Myeloma (MM) is a hematological cancer characterized by the abnormal proliferation of plasma cells that produce immunoglobulins. Diagnosis requires the presence of clonal bone marrow plasma cells of 10% or more, or a biopsy-confirmed plasmacytoma, along with evidence of end-organ damage (hypercalcemia, renal insufficiency, anemia, or bone lesions, known as CRAB symptoms) or specific biomarkers indicating disease progression.<br /><br />Clinical symptoms of MM typically include bone pain due to lytic lesions, fatigue from anemia and kidney dysfunction, infections due to compromised immunity, and neurological issues such as incontinence or weakness from spinal cord compression. Evaluation includes a history and physical exam along with lab tests such as complete blood count, serum calcium, creatinine, and protein markers.<br /><br />Treatment is stratified based on risk—standard or high ascertained via fluorescence in situ hybridization (FISH)—and involves chemotherapy, maintenance immunotherapy, and possibly autologous hematopoietic stem cell transplantation. The goals of treatment are to mitigate organ damage, improve quality of life, and prolong survival.<br /><br />Management of complications such as lytic bone lesions involves bisphosphonate therapy or denosumab, while avoidance of nephrotoxic medications and dose adjustment is crucial for kidney disease. Preventative measures like vaccinations and VTE risk assessment can help manage infection and venous thromboembolism risks, respectively.<br /><br />For initial screening, important lab tests include serum protein electrophoresis (SPEP), free light chain assay, and quantitative immunoglobulins. Abnormal findings like anemia, hypercalcemia, or an increased serum FLC ratio warrant further tests such as bone marrow biopsy or imaging to confirm diagnosis.<br /><br />Early detection and tailored treatment approaches based on patient risk levels are essential for improving patient outcomes in multiple myeloma.

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Nikita Thakur, Katherine DiPastina

Keywords

Multiple Myeloma

hematological cancer

plasma cells

CRAB symptoms

bone lesions

chemotherapy

immunotherapy

stem cell transplantation

bisphosphonate therapy

diagnosis