myeloma

Myeloma most commonly refers to multiple myeloma, a cancer of plasma cells that accumulate in the bone marrow. Malignant plasma cells produce a monoclonal antibody (M-protein) and can disrupt normal blood formation, weaken bones, cause kidney problems, and increase infection risk.

Symptoms often include bone pain, anemia-related fatigue, frequent infections, and kidney dysfunction. Diagnosis requires blood and urine tests for M-protein, a bone marrow biopsy showing clonal plasma cells, and imaging to detect bone lesions. Staging uses the International Staging System, with revisions that incorporate genetic abnormalities and LDH.

Treatment aims to control the disease and prolong survival. Regimens typically combine a proteasome inhibitor, an immunomodulatory drug, and a corticosteroid; many patients also receive daratumumab. Autologous stem cell transplantation is offered to eligible adults. In older or transplant-ineligible patients, similar drug combinations are used over longer periods. Relapsed disease may be treated with newer therapies such as monoclonal antibodies, CAR-T cell therapy, or bispecific antibodies.

Supportive care focuses on bone health with bisphosphonates, infection prevention and vaccination, anemia management, and treatment of kidney issues and high calcium levels. Prognosis varies with age, stage, and genetic abnormalities; outcomes have improved with newer therapies, but myeloma is generally considered incurable and requires ongoing management.

Other plasma cell disorders related to myeloma include solitary plasmacytoma and extramedullary plasmacytoma, which involve clonal plasma cells but limited or no systemic bone marrow involvement and have distinct management and prognosis.