Myeloma, also known as multiple myeloma, is a type of cancer that affects plasma cells in the bone marrow. These abnormal plasma cells produce an excess of antibodies, leading to weakened bones, anemia, and impaired immune function. Treatment may involve chemotherapy, targeted therapy, stem cell transplant, and supportive care to manage symptoms and improve quality of life. Multiple myeloma Also termed plasma cell myeloma, is a neoplastic disease characterized by plasma cell accumulation in the bone marrow, the presence of monoclonal protein in the serum or urine or both and, in symptomatic patients, related tissue damage. Almost all cases of myeloma occur over the age of 40 years, with a peak incidence between 65 and 70 years. The disease is twice as common in individuals of African compared to those of European or Asian origin. Smouldering myeloma The term asymptomatic or smouldering myeloma is used for cases with similar laboratory findings to multiple myeloma, but no organ or tissue damage causing clinical features. There is about a 10% chance each year of these cases becoming symptomatic and requiring therapy. Diagnosis Symptomatic myeloma is diagnosed if there is: 1 Monoclonal protein in serum, urine, or both. 2 Increased clonal plasma cells in the bone marrow. 3 Disease-related organ or tissue impairment. (CRAB) A useful acronym for myeloma-associated tissue damage is CRAB (hypercalaemia, renal impairment, anaemia, bone disease.) Amyloidosis, serum hyperviscosity, recurrent infections, peripheral neuropathy and deep vein thrombosis are other clinical complications of myeloma, which are less frequently presenting feature Clinical features 1 Bone pain (especially backache) resulting from vertebral collapse and pathological fractures. 2 Features of anaemia, such as lethargy or dyspnea. 3 Recurrent infections related to deficient antibody production, abnormal cell-mediated immunity and neutropenia. 4 Features of renal failure or hypercalcaemia: polydipsia, polyuria, anorexia, vomiting, constipation and mental disturbance. 5 Abnormal bleeding tendency: myeloma protein may interfere with platelet function and coagulation factors; thrombocytopenia occurs in advanced disease. 6 Amyloidosis (light chain) occurs in 5% with features such as macroglossia, carpal tunnel syndrome, heart failure, periorbital purpura and diarrhoea. 7 In approximately 2% of cases there is a hyperviscosity syndrome, with purpura, haemorrhages, visual changes, central nervous system (CNS) symptoms, neuropathies and heart failure. Figure the pathogenesis of clinical features of MM Laboratory diagnosis 1 Presence of a paraprotein. Serum and urine should be screened by immunoglobulin electrophoresis. The paraprotein is immunoglobulin (Ig) G in 60% of cases, IgA in 20% and light chain only in almost all the rest. Fewer than 1% have IgD or IgE paraprotein, and a similar number are non-secretory, where neither intact immunoglobulin nor light chain can be

1. Multiple myeloma
Nawsherwan S Mohammad
Assis. Prof. and Consultant Hematopathologist
HMU-College of Medicine
Pathology Dept
nawsherwan.sadiq@hmu.edu.krd
1. http://www.ksp-association.org/
2. https://hmu.edu.krd/profile?lecturer_id=2006921
3.Google Scholar
4.Research Gate

2. MM
• Neoplastic disease characterized by plasma
cell accumulation in the bone marrow,
• the presence of monoclonal protein in the
serum or urine or both and,
• in symptomatic patients, related tissue
damage.

3. • The term Asymptomatic or Smouldering
myeloma is used for cases with similar
laboratory findings to multiple myeloma, but
no organ or tissue damage causing clinical
features.
• There is about a 10% chance each year of
these cases becoming symptomatic and
requiring therapy.

4. Diagnosis
• Symptomatic myeloma is diagnosed if there is:
• 1 Monoclonal protein in serum, urine, or both.
• 2 Increased clonal plasma cells in the bone
marrow.
• 3 Disease-related organ or tissue impairment.
(CRAB)
• A useful acronym for myeloma-associated tissue
damage is CRAB (hypercalaemia, renal
impairment, anaemia, bone disease.)

6. Clinical features
• 1 Bone pain (especially backache)
• 2 Features of anaemia
• 3 Recurrent infections related to deficient
antibody production,
• 4 Features of renal failure or hypercalcaemia:
polydipsia, polyuria, anorexia, vomiting,
constipation and mental disturbance.
• 5 Abnormal bleeding tendency
• 6 Amyloidosis (light chain) occurs in 5%

7. • 7 In approximately 2% of cases there is a
hyperviscosity syndrome,

8. Lab Dx
• 1 Presence of a paraprotein. Serum and urine
The paraprotein is (Ig) G in 60% of cases, IgA in
20% and light chain only in almost all the rest.
• 2 Elevated serum immunoglobulin free light
chains.
• 3 Normal serum immunoglobulin levels (IgG,
IgA and IgM) are reduced, a feature known as
immunoparesis

9. • 4 There is usually a normochromic
normocytic or macrocytic anaemia. Rouleaux
formation is marked in many cases.
• There is a high erythrocyte sedimentation
rate (ESR)
• 6 increased plasma cells in the bone marrow.
The characteristic immunophenotype of
malignant plasma cells is CD 38 high, CD138
high and CD45 low.

10. • 7 Radiological investigation of the skeleton
reveals bone lesions
• 8 Serum calcium elevation.
• 9 The serum creatinine is raised in >20% of cases.
• 10 Serum lactate dehydrogenase (LDH) elevation
occurs in advanced disease.
• 11 Low serum albumin
• 12 Serum β2-microglobulin is often raised

11. Treatment
• This may be divided into specific and
supportive.
• The life expectancy of patients with myeloma
has improved markedly in recent years with
the introduction of new drugs such as
proteasome inhibitors and
immunomodulatory agents

12. Other plasma cell neoplasms :

13. Solitary plasmacytoma
• These are isolated plasma cell neoplasms, usually
involving bones (where they arise from
underlying bone marrow) or soft tissue such as
the mucosa of the upper respiratory and
gastrointestinal tracts or the skin.
• An associated paraprotein, if present, disappears
following radiotherapy to the primary lesion.
• Many patients will never develop myeloma.

14. Plasma cell leukaemia
• This rare disease is characterized by a high
number of circulating malignant plasma cells.
• The clinical features tend to be a combination of
those found in acute leukaemia (pancytopenia
and organomegaly) with features of myeloma
(hypercalcaemia, renal involvement and bone
disease).
• Treatment is with supportive care and systemic
chemotherapy, but prognosis is poor.

15. Monoclonal gammopathy of
undetermined significance
• A persistent serum paraprotein may be
sometimes be detected without any evidence
of myeloma or other underlying disease and is
termed monoclonal gammopathy of
undetermined significance (MGUS).
• It is increasingly common with age, being
present in 3–4% of persons older than 50
years and more than 10% by age 80 years.

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