Multiple myeloma: an overview of diagnosis and management

Multiple myeloma, a lethal disease resulting from proliferation of immunoglobulin-secreting cells, accounts for approximately 1% of malignant neoplasms in the United States and affects blacks twice as often as whites.

To review the historic, epidemiologic, diagnostic, and therapeutic features of multiple myeloma.

Multiple myeloma is often diagnosed when a monoclonal protein is found in the serum or urine or both. No single test differentiates benign from malignant plasma cell proliferation. The clinical features of multiple myeloma develop from tissue damage secondary to the monoclonal gammopathy, plasma cells, and cytokines excreted by the cells. Increased vulnerability to infection is due to depressed normal immunoglobulins. The melphalan-and-prednisone regimen improves median survival from 7 months to 3 years in the 50% to 60% of patients who respond. Cure is exceedingly rare. Refractory and resistant multiple myeloma patients should be treated on investigational protocols.

There has been substantial advancement in our understanding of the biology of multiple myeloma and related plasma cell neoplasms over the past two decades. We can reasonably hope that improvements in treatment will ensue.