Multiple myeloma: diagnosis and treatment
Konrad C Nau1, William D Lewis
1West Virginia University, Department of Family Medicine, Eastern Division, Harpers Ferry, West Virginia 26425, USA. nauk@rcbhsc.wvu.edu
American Family Physician
|October 10, 2008
Summary
Multiple myeloma, a common bone cancer in older adults, presents with bone pain and anemia. Early diagnosis via protein electrophoresis and bone marrow analysis is key for effective treatment and improved survival rates.
Area of Science:
- Oncology
- Hematology
- Internal Medicine
Background:
- Multiple myeloma is the most common bone malignancy, increasingly affecting older individuals.
- Common symptoms include bone pain, malaise, anemia, renal insufficiency, and hypercalcemia.
- Incidental discovery during routine laboratory testing is frequent.
Purpose of the Study:
- To review the diagnosis, staging, and treatment of multiple myeloma.
- To highlight the role of various imaging modalities in myeloma evaluation.
- To discuss the differential diagnosis of monoclonal gammopathies and management strategies.
Main Methods:
- Diagnosis relies on serum/urine protein electrophoresis or immunofixation and bone marrow aspirate analysis.
- Skeletal radiographs are crucial for staging and identifying lytic lesions.
- Magnetic resonance imaging (MRI) is preferred for acute spinal cord compression evaluation.
Main Results:
- Monoclonal gammopathy of uncertain significance and smoldering myeloma require close monitoring without immediate treatment.
- Symptomatic multiple myeloma is treated with chemotherapy and potentially autologous stem cell transplantation.
- Various chemotherapeutic agents including bortezomib and lenalidomide show success.
Conclusions:
- Family physicians must recognize and manage multiple myeloma complications, including bone pain, hypercalcemia, and infections.
- Avoidance of nephrotoxic nonsteroidal anti-inflammatory drugs is recommended.
- Five-year survival rates are approximately 33%, with a median survival of 33 months.
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