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Overview of the management of multiple myeloma

S Vincent Rajkumar, MD
Section Editor
Robert A Kyle, MD
Deputy Editor
Rebecca F Connor, MD


Multiple myeloma (MM) is characterized by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. This clone of plasma cells proliferates in the bone marrow and often results in extensive skeletal destruction with osteolytic lesions, osteopenia, and/or pathologic fractures. Additional disease-related complications include hypercalcemia, renal insufficiency, anemia, and infections.

This topic reviews the overall treatment strategy for patients with MM. Further details regarding the selection of initial therapy, the treatment of relapsed/refractory disease, the use of hematopoietic cell transplantation (HCT), and the management of complications of MM are discussed separately. (See "Selection of initial chemotherapy for symptomatic multiple myeloma" and "Autologous hematopoietic cell transplantation in multiple myeloma" and "Treatment of relapsed or refractory multiple myeloma" and "Treatment of the complications of multiple myeloma" and "The use of osteoclast inhibitors in patients with multiple myeloma" and "Management of multiple myeloma in resource-poor settings" and "Treatment and prognosis of kidney disease in multiple myeloma and other monoclonal gammopathies".)


The first step in approaching a potential new patient with MM is to verify the diagnosis since the premalignant stages of myeloma, namely monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM), do not require therapy and may be easily misdiagnosed as MM (table 1 and algorithm 1). Unlike persons with MGUS and SMM, patients with MM require treatment [1]. Without effective therapy, symptomatic patients die within a median of six months [2]. (See "Clinical features, laboratory manifestations, and diagnosis of multiple myeloma", section on 'Evaluation'.)

The diagnosis of MM requires the presence of ≥10 percent bone marrow plasma cells and/or biopsy proven plasmacytoma in the setting of disease-related end organ damage and/or the identification of a biomarker associated with near inevitable progression to end-organ damage (table 1) [3]. The following findings are considered evidence of end-organ damage, if attributable to the underlying plasma cell disorder:

Anemia (ie, hemoglobin <10 g/dL [<100 g/L] or >2 g/dL [>20 g/L] below normal)

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Literature review current through: Nov 2017. | This topic last updated: Dec 23, 2016.
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