Myeloma
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"multiple myeloma"[MeSH Terms]
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multiple myeloma NCI symptoms diagnosis treatment
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https://www.cancer.gov/types/myeloma/patient/myeloma-treatme…
Multiple myeloma is a cancer of plasma cells, antibody-producing immune cells in the bone marrow. The abnormal cells produce a monoclonal antibody or light chain, often called an M protein, and can crowd out normal marrow and damage bone and kidneys. It is distinct from MGUS and smoldering myeloma, which may be monitored when there is no myeloma-related organ damage. Goldman-Cecil Medicine, p. 1977.
Typical features
Often remembered as CRAB:
- Calcium elevated: thirst, constipation, nausea, confusion
- Renal impairment: rising creatinine, reduced kidney function
- Anemia: fatigue, breathlessness, pallor
- Bone disease: persistent back or rib pain, lytic lesions, fractures
Other possible features are recurrent infections, easy bruising, weight loss, and peripheral neuropathy. The NCI patient information lists bone pain, easily broken bones, fatigue, infections, bleeding, and neurologic weakness among important symptoms.
Diagnosis
Diagnosis usually combines:
- Blood count, calcium, creatinine, albumin, LDH
- Serum protein electrophoresis and immunofixation
- Serum free light-chain assay
- Urine protein testing, sometimes 24-hour urine studies
- Bone-marrow biopsy with cytogenetic/FISH risk testing
- Whole-body low-dose CT, PET-CT, or MRI to assess bone and marrow lesions
Active myeloma is generally diagnosed when clonal marrow plasma cells and/or a plasmacytoma are present along with CRAB organ damage or a defining biomarker of imminent progression. Goldman-Cecil Medicine, p. 1977.
Treatment
Treatment is individualized by a hematologist-oncologist and depends on fitness, kidney function, cytogenetic risk, prior therapy, and transplant eligibility. Initial treatment commonly uses combination therapy involving:
- A proteasome inhibitor, such as bortezomib
- An immunomodulatory drug, such as lenalidomide
- Dexamethasone
- Often an anti-CD38 antibody, such as daratumumab
For eligible people, induction treatment may be followed by autologous stem-cell transplant and maintenance therapy. Relapsed disease has additional options including antibody therapy, CAR-T cell therapy, and bispecific antibodies. The NCI treatment summary describes these treatment classes.
Seek urgent medical care for
New leg weakness or numbness, loss of bladder/bowel control, severe sudden back pain, fever during treatment, confusion, marked dehydration, or very low urine output. These can indicate spinal cord compression, infection, hypercalcemia, or acute kidney injury.
If you mean a particular aspect, I can explain diagnosis criteria, staging, treatment regimens, bone disease, or MGUS versus smoldering versus active myeloma.
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