Abstract
Multiple myeloma (MM) is a B-cell malignancy arising from neoplastic proliferation of monoclonal plasma cells. The majority of patients are men, and the median age at diagnosis is 71 years. Information provided by laboratory and radiologic assessments and bone marrow biopsy and aspirate is used for diagnosis, staging, risk stratification, and prognostication. The International Staging System is used to determine disease stage. Plasma cell neoplasms progress from monoclonal gammopathy of undetermined significance to asymptomatic/smoldering MM to symptomatic MM. Treatment is indicated only for symptomatic MM. Selection of initial therapy depends on whether the patient is a candidate for autologous stem-cell transplantation. Combination regimens are generally used, and excellent overall response rates have been achieved with incorporation of the novel agents bortezomib, lenalidomide, and thalidomide. Several new therapies for MM are also being investigated in clinical trials. Treatment-emergent toxicity, such as peripheral neuropathy and thrombosis, is a frequent reason for discontinuation of therapy. Early detection of side effects, prompt intervention, and education of patients and health-care providers can improve adherence to therapy and quality of life. Disease-related complications, particularly renal dysfunction and bone destruction, occur in a large percentage of patients and are important considerations in management.
