Clinical Review

Multiple myeloma

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3863 (Published 26 June 2013) Cite this as: BMJ 2013;346:f3863
  1. Dean Smith, myeloma research fellow,
  2. Kwee Yong, haematology consultant
  1. 1Department of Haematology, University College Hospital, London NW1 2PG, UK
  1. Correspondence to: D Smith deansmith{at}doctors.org.uk

Summary points

  • In the past decade, the use of immunomodulatory drugs and proteasome inhibitors has improved the outlook for patients with myeloma, but myeloma remains an incurable cancer

  • Triple drug combinations are now standard induction regimens, followed by autologous stem cell transplantation in patients who are young and fit enough

  • Early aggressive management of patients presenting in renal failure is vital to preserve renal function

  • Treatment paradigms for spinal disease are changing, with radiotherapy and vertebral augmentation sometimes preferred over surgery

  • Bone morbidity, organ failure, and side effects of treatment contribute to a high burden of disease, and early engagement with palliative care and symptom control teams is vital to optimise treatment outcomes and quality of life

Multiple myeloma is the second most common (10-15% of all) haematological cancer.1 It is responsible for 15-20% of deaths from haematological cancer and about 2% of all deaths from cancer.1 Recent improved understanding of the pathogenesis of myeloma has led to the development of new treatments. Although myeloma remains an incurable cancer, survival is improving, and newly diagnosed patients are now projected to live for around five years.2 With an increasing number of survivors, it important for health professionals to understand the disease and current treatments. We have summarised guidelines, meta-analyses, and randomised controlled trials to give an up to date review of myeloma.

Sources and selection criteria

We searched Medline and the Cochrane collaboration, using the terms “myeloma” and “multiple myeloma”. Wherever possible, we used evidence from randomised controlled trials, systemic reviews, and meta-analyses, focusing mainly on articles published in the past five years, to provide an up to date summary. We have also referenced expert review articles and included opinion based on clinical experience.

What is myeloma and who gets it?

In myeloma, neoplastic plasma cells accumulate in the bone marrow (fig 1) and produce a monoclonal protein that is …

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