multiple myeloma review

multiple myeloma review

Multiple myeloma

It is one of the malignant tumors of plasma cells that affect the bone marrow, which is the component of blood cells, and it often causes multiple tumors in different bones such as the vertebrae, pelvic bones, and ribs.[1]


Multiple myeloma is considered one of the uncommon tumors between the sexes, with an estimated 86,000 cases per year, and it increases in certain regions than others, for example, it records many cases in industrial areas in Australia and Europe. Oncology, it is believed that the tumor is related to environmental factors, but what has been proven is that the rate of infection increases in people with hepatitis C or HIV.[2]

Predisposing factors

Many factors are associated with multiple myeloma, the most important of which are

Patients with monoclonal gammopathy of unknown significance (MGUS)

Adults over the age of 60 are affected more often, while the incidence is almost non-existent under the age of 40

Blacks and Africans in greater proportions than Asians.[1]


In the primitive stages do not show symptoms for tumor but when it reaches the size of a real problem can begin the emergence of symptoms, the symptoms are concentrated in the tumor on orthopedic and malfunction in the manufacture of blood cells

Bone pain: It is a lightweight that is increasingly increasing by movement but continues, affects pelvic bones and ribs

Pathological bone fracture: which usually occur because of the spread of the tumor, causing severe fragility in bones and therefore exposed to the fracture

High blood calcium level is a result of bone cracking

Anemia is a result of the direction of the bone marrow to configure cancer cells that occupy the marrow within the bones, more cancerous cells and a great decrease in the manufacture of other cells

Repeated infections and pressure on the spinal cord which causes pain. [3]


When bone pain and back pain appear for a month at an old age, including comprehensive examinations, and therefore we can diagnose the tumor through preventive examination and blood tests:-[4]

Presence of Serum M-protein level above 3 grams per DL (30 grams per liter)

Serum and urine protein immunofixation tests are important

Clonal plasma cells test in bone marrow or plasmacytoma (usually > 10%) in patient with myeloma

Gross picture

The tumor appears in the fragile bone tissue in the form of "fish flesh" as it is a soft, hemorrhagic tissue with a gelatinous shape. [5]

Microscopic picture

scattered Sheets of plasma cells with areas of normal bone marrow with a lack of proper tissue in the production of plasma cells and blood cells and Prominent osteoclastic activity.[5]


Several treatments for multiple myeloma cancer have recently been developed as a result of scientific research and the emergence of failure to treat it before for some cases, which helped to conduct research and interest in reaching an appropriate treatment. Treatment is provided based on the stage at which the cancer is discovered, which includes the following

High categories according to genetic bases such as those with 17p deletion, t (14;16), and t (14;20)

Intermediate groups according to genetic bases such as those infected with t (4;14) [6]

The duration of treatment is determined, and then stem cells can be transplanted into the marrow, but not only for healing, to help it produce healthy blood cells again to live with.[6]

Often one of two treatment regimens is chosen, either two or three drugs, depending on the cases and the elements used for treatment

anti-myeloma medicines which fight and eliminate cancer cells and reduce it when it relapses

Chemotherapy, which is taken in the form of tablets, fights cancer cells and prevents their division

Steroids, which are used to increase the effectiveness of chemotherapy against cancer cells


Bortezomib, which causes the protein to accumulate inside the cancer cell and thus get rid of it

Stem cell transplantation helps to recover faster

Medicines that treat complications such as pathological fractures of the bones, severe anemia, or persistent pain

Pain relievers to reduce pain

Blood transfusion to treat severe anemia caused by cancer

Radiation therapy to relieve bone pain

exchange plasma.[7]


Because of the lack of cases and rates of infection in multiple myeloma disease, the study of the disease and research related to it is somewhat behind that of other tumors. It can also be said that treatment methods are not feasible for all patients, despite all this, almost a quarter of them live 3 years after treatment.[8]


N. Becker, Epidemiology of multiple myeloma. Multiple myeloma, 25-35. (2011)

S. V. Rajkumar, Treatment of multiple myeloma. Nature reviews Clinical oncology, 8(8), 479-491. (2011)

O. Landgren, & S. V. Rajkumar, New Developments in Diagnosis, Prognosis, and Assessment of Response in Multiple Myeloma. Clinical Cancer Research, 22(22), 5428–5433. doi: 10.1158/1078-0432.ccr-16-0866 (2016)