Müeloom

Müeloom, known in English as multiple myeloma, is a malignant neoplasm of plasma cells that primarily grows in the bone marrow. Neoplastic plasma cells produce abnormal monoclonal immunoglobulins (M proteins) and may form lytic bone lesions, leading to bone pain, fractures, anemia, weakness and fatigue. The disease often presents in older adults and accounts for a portion of hematologic cancers.

Symptoms commonly include bone pain, fatigue, recurrent infections, anemia, kidney dysfunction and hypercalcemia. These manifestations result from malignant plasma cell activity, bone destruction and the effects of circulating monoclonal proteins. Diagnosis relies on a combination of evidence: clonal plasma cells in bone marrow (typically ≥10%), presence of M-protein in serum or urine, and end-organ damage or myeloma-defining events; imaging often reveals lytic bone lesions. Staging uses the International Staging System (ISS) and the revised ISS (R-ISS), incorporating laboratory markers to assess prognosis.

Pathophysiology involves clonal expansion of plasma cells within the marrow and complex interactions with the bone marrow microenvironment that promote bone resorption and immune dysregulation. Genetic abnormalities influence prognosis and treatment response.

Treatment aims to control disease, relieve symptoms and extend survival. For eligible patients, induction therapy with a proteasome inhibitor (for example, bortezomib) and an immunomodulatory drug (such as lenalidomide) plus dexamethasone is commonly used, followed by autologous stem cell transplantation when feasible. Maintenance therapy, often with lenalidomide, helps prolong remission. Non-transplant regimens are employed for older or frail patients. New therapies, including monoclonal antibodies (daratumumab, isatuximab) and CAR-T cell therapies, are increasingly used in relapsed or refractory cases. Prognosis varies with stage, genetic abnormalities and response to therapy, but survival has improved with modern treatment strategies. Ongoing research focuses on minimal residual disease assessment, novel agents and combination regimens.