- Multiple myeloma (MM) involves a malignant proliferation of a single clone of plasma cells.
- The malignant plasma cells produce monoclonal protein (immunoglobulin [Ig]) in the blood and urine as it is filtered in the kidneys.
- MM is characterized by bony lytic lesions, hypercalcemia, increased susceptibility to infections, and renal impairment.
- Monoclonal gammopathy of undetermined significance (MGUS) is a common disorder with limited monoclonal plasma cell proliferation that can progress to smoldering MM (SMM) or symptomatic MM at rate of ~1% per year.
- MM affect the older adults with a median age of 65 to 74 years.
- Accounts for nearly 2% of all cancers and 17% of hematologic malignancies in the United States.
- African Americans about 2 to 3 times more commonly affected than Caucasians; less common in Asians
7 cases per 100,000 in the United States annually
Etiology and Pathophysiology
- It is most likely related to genetic alteration involving chromosomal abnormalities and sporadic mutations.
- Genetic damage in developing B lymphocytes occur at time of isotype switching.
- Chromosomal abnormalities involve Ig heavy chain translocations, with cyclin D1 t(11;14) the most common and deletion of 17p13 (p53 locus) (2)[C].
It occurs rarely in familial clusters. A rare form of paratarg-7 protein might have pathogenic role.
- Most cases have no known risks associated.
- Old age; immunosuppression; and exposure to chemicals, heavy metals, and ionizing radiation increase the risk of MM.
Commonly Associated Conditions
Secondary amyloidosis commonly due to MM and polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes (POEMS)
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Domino, Frank J., et al., editors. "Multiple Myeloma." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688751/all/Multiple_Myeloma.
Multiple Myeloma. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688751/all/Multiple_Myeloma. Accessed May 29, 2023.
Multiple Myeloma. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688751/all/Multiple_Myeloma
Multiple Myeloma [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 29]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688751/all/Multiple_Myeloma.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Multiple Myeloma ID - 1688751 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688751/all/Multiple_Myeloma PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -