Multiple myeloma is a malignant clonal proliferation of plasma cells in the bone marrow that causes lytic bone lesions. It most commonly affects people aged 50-60 and is more common in men. Symptoms include bone pain, pathological fractures, fatigue, and susceptibility to infection. Investigations show anemia, elevated proteins, monoclonal band, and bone marrow plasmacytosis. Treatment involves chemotherapy, radiotherapy, stem cell transplant, and bisphosphonates to manage complications and extend survival to 2-3 years.

1. MULTIPLE
MYELOMA

2. Most common primary malignant tumor of bone.
Multiple myeloma is a malignant clonal proliferation of
plasma cells in the bone marrow with lytic bone leisions.

3. TYPES
Multiple myeloma (50%)
Solitary myeloma (25%)
Myelomatosis (15%)
Plasma cell leukemia (1%)
Extra skeletal - nasopharyngeal / oral cavity

4. EPIDEMIOLOGY
Age group : 50 – 60 yrs
Sex : M:F- 3:1
Site : common in axial skeleton & flat bones than long
bones.
- spine , skull, pelvis , ribs , sternum,
proximal femur

5. CLINICAL FEATURES
Bone pain is the most common symptom , which is relieved
by rest.
Persistent localised bone pain signifies pathological
fracture.
No swelling / deformity unless there is pathologic al #
Compressive myelopathy due to vertebral collapse .

6. CLINICAL
HALLMARKS OF MM
Weight loss , pallor, bleeding tendencies, fatigue
Susceptibility to bacterial infections
Hypercalcemia
Renal failure
Bone destructions lytic lesions)
Presence monoclonal antibody

7. INVESTIGATIONS
Haemogram shows anaemia , leucopenia ,
thrombocytopenia
ESR is very high
Peripheral smear – NCNA with increased rouleaux formation.
Leucoerythroblastic picture.
Total protein increased with A:G reversal.
S.Ca is increased, ALP normal.

8. Electrophoresis on serum or urine shows ‘M’ band in the
region of gamma globulin.
Urine may show Bence Jones protein.
Bone marrow – hypercellular with increased no. of plasma
cells & myeloma cells.
Mature & Immature plasma cells
with eccenteric nuclei and ‘cart-
wheel appearance’ of nuclear
chromatin

9. RADIOLOGICAL
FINDINGS
Multiple punched out lesions in skull & other flat bones.

10. M M with
pathological
#

11. Pathological wedge collapse of vertebra, commonly thoracic
spine. Pedicles usually spared.
Diffuse severe rarefaction of bones.
Erosion of borders of ribs.

12. CT & MRI
Bone scan in solitarybone lesions helps to detect other sites
of involvement.
S. beta 2 microglogulin is the single most powerful
predictor of survival.

13. DIAGNOSTIC CRITERIA
(DURIE & SALMON)
Major criteria
1.BM plasmacytosis ( > or = 30% BM
plasma cells)
2.Monoclonal globulin spike Ig G or Ig A
3.Light chain excretion in urine ; > or = 1g/24
hrs.
4.Biopsy proven plasmacytoma

14. Minor criterias
1.BM plasmacytosis ; 10-30 % BM plasma cells
2.Monoclonal globulin spike gut < for major criteria.
3.Lytic bone lesions
4.Decrease in normal Ig level.
Diagnosis - I major + 1 minor criteria
3 minor criteria that must include no. 1& no.2

15. TREATMENT
“Watchful waiting", where the progress of the disease is
monitored .
Chemotherapy
• Melphalan, prednisone, thalidomide (MPT)
• Bortezomib (Velcade), melphalan, prednisone (VMP)
• Lenalidomide plus low-dose dexamethasone
• Every 3-4 weeks for 6-12 cycles.

16. Radiotherapy
• Severe bone pain , pathological # , tumor
lesions.
Bone marrow transplantation
Bisphosphonates (e.g. pamidronate or zoledronic acid) are
routinely administered to prevent fractures and
erythropoietin to treat anemia.

17. Pathological # prevented by internal splinting of affected
part.
#s managed surgically by internal fixation .
Treatment of other complications.
In established cases survival is 2-3 yrs