Summary
Multiple myeloma is the second most common hematologic malignancy and one of the most common paraproteinemias. The disease is defined by accumulation of neoplastic plasma cells in the bone marrow, presence of monoclonal immunoglobulin in serum and (or) urine and myeloma-related organ impairment. Multiple myeloma is known to arise from monoclonal gammopathy of undetermined significance (MGUS) - a premalignant condition highly prevalent among the elderly.
The most common features of multiple myeloma are anemia, bone disease (osteopenia, lytic lesions, pathologic fractures), impaired renal function, hypercalcemia. Clinical manifestations often include increased susceptibility to infections, coagulation abnormalities, whereas neurologic complications and hyperviscosity are considered uncommon. Valuable diagnostic clues are increased erythrocyte sedimentation rate, hyperproteinemia, rouleaux formation, hypercalcemia. However, these features (with the exception of hypercalcemia) are not found in light chain myeloma. In order to establish the diagnosis serum and urine should be assessed with methods that detect monoclonal immunoglobulin: electrophoresis and immunofixation. Neoplastic bone marrow plasmacytosis that exceeds 10% is obligatory to confirm the diagnosis. Furthermore, an x-ray examination of the axial skeleton, humeri, femurs and any symptomatic bones must be performed.
The prognosis of the patient depends upon many factors. The stage of the dispathogenesis of multiple myeloma and ease, established after having assessed serum levels of P2 microglobulin and albumin, in conjunction with chromosomal number and structure abnormalities of the neoplastic plasma cells are considered the strongest predictors. Although the introduction of thalidomide, bortezomib and lenalidomide for the treatment of multiple myeloma has significantly improved overall survival, the disease remains incurable.
Current issues in multiple myeloma in - clude studies of pathogenetic mechanisms, the role of various prognostic factors and clinical trials aimed at determining safety and efficacy of different treatment options.
Keywords: multiple myeloma, monoclonal immunoglobulin, free light chains, electrophoresis, immunofixation, plasma cells, cytogenetic markers.
