Current Topic:
Management of Multiple Myeloma
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Abstract
Multiple Myeloma (MM) is a haematological malignant disease of plasma cells manifest by one or more of the following triad: osteolytic bone lesions, a monoclonal protein in the blood or urine, and disease in the bone marrow. The yearly incidence of MM is around 4 per 100,000; males are more commonly affected than females. It is essential to distinguish MM from pre-myelomatous conditions like monoclonal gammopathy of unknown significance (MGUS) and solitary plasmacytoma. Smouldering myeloma and. plasma cell leukaemia are variant of MM.
Substantial advances have also been made in our understanding of the biology of MM leading to the availability in the last four years of three new approved targeted therapies that are now in common usage, namely Thalidomide, Lenalidomide and Bortezomib. Thus, treatment for patients with MM has changed unrecognisably and includes a sequence of treatments using the new targeted therapy, along with infusional chemotherapy. For younger patients (less than 75 years) the use of high-dose melphalan and an autologous stem cell transplant remains central to any planned treatment pathway. State of the art supportive therapy with blood products, cytokines, bisphosphonates, vertabroplasty and quality of life optimization is mandatory. Patients can now expect a doubling of median survival to 5 years, a 30% chance of surviving longer than 10 years and a 50% chance of complete remission; and for the majority of these patients they are symptom-free.
Patients may present as acute medical emergencies with for example spinal cord compression, hyperviscosity, hypercalcemia, septic shock, renal failure, pathological fracture and bone marrow failure. In this module, we will deal with all aspects of management of multiple myeloma. The reader will be able to gain an understanding of the treatment decisions faced by a patient with MM and the multidisciplinary team that advises them.
