Multiple myeloma: from diagnosis to treatment.

Multiple myeloma is characterised by the proliferation of malignant plasma cells within the bone marrow, which produce an abnormal monoclonal paraprotein and evidence of end organ damage. Multiple myeloma can pose a diagnostic challenge and this article highlights issues in diagnosis and provides an overview of management. Multiple myeloma can present with a wide constellation of symptoms including hypercalcaemia, anaemia, renal impairment and/or bony pain. A combination of these symptoms, particularly if unexpected or unexplained, should prompt diagnostic evaluation for myeloma. Work up of plasma cell disorders involves establishing the presence of a monoclonal paraprotein, baseline bloods and radiological investigations. Haematology referral is required for bone marrow biopsy and ongoing management. Newer treatments such as the immunomodulators thalidomide or lenalidomide, or the proteasome inhibitor bortezomib, administered in combination with steroids and occasionally cytotoxic agents have improved outcomes in patients with myeloma. Autologous stem cell transplant is offered to younger patients with few comorbidities. Some patients are offered maintenance therapy with thalidomide or lenalidomide.