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What is Multiple Myeloma ?

Multiple Myeloma is a type of blood cancer that originates from plasma cells in the bone marrow.  

In normal healthy adults, these normal plasma cells produce antibody that helps us to fight infection.  

In Myeloma, these plasma cells 

                   - have turned cancerous, and 

                  - they produce a large quantity of one toxic antibody called paraprotein or

                    M protein.

Signs and Symptoms of Multiple Myeloma

Multiple Myeloma may affects many parts of the body as shown below :

Body Part



Bone Marrow




Weak bones

bones that fracture easily

High blood Calcium level

Bone pain, weak bone

Vague abdominal pain or discomfort,



Kidney failure

Occasionally may require dialysis treatment


poor appetite


Peripheral neuropathy

Numbness and

weakness of the limbs

Immune system              

Low antibody level

Frequent infection

Tests to diagnose Multiple Myeoma

Blood tests :


Full blood count

Blood biochemistry : to determine - renal function

                                                      - calcium level etc

Antibody level

Protein study


Urine test :


This is sometimes done to determine 

if you are excreting an abnormal protein in your urine.

Classification of MM

By the type of abnormal antibody or paraprotein 

that your body is producing. 


Example : 


if you are producing an IgG paraprotein, 

the type of Multiple Myeloma is an IgG subtype.


The Durie-Salmon Staging





All of the following:

·   Haemoglobin level >10g/dL

·   Calcium level : normal or < 3 mmol/L

·   Bone X-ray : normal bone structure

   or Solitary bone plasmacytoma only

·   Low M Protein Production Rate

     (IgG<5g/dL; IgA <3g/dL;

   Bence-Jones Protein <4g/24H)


·   Fitting neither stage I nor stage III


One or more of the following:

·    Haemoglobin level < 8.5g/dL

·    Calcium level > 3 mmol/L

·    Advanced lytic bone lesions

·    High M Protein Production Rate

·   (IgG >7g/dL; IgA >5g/dL;

     Bence-Jones Protein > 12g/24H)


How does your Doctor decide what treatment you should receive ?


1.  Disease-related factors


v     The type of Myeloma

v     The extent and stage of the disease

v     Presence of any related complications 

       such as renal failure or   bony fracture

v     A new disease or a recurrence of Myeloma


2.  Patient-related factors

v  Health status, including presence of any co-existing medical conditions

v   Lifestyle and quality of life issues

v   Your fitness to undergo stem cell transplantation 

     should you need one in the future

 Your expectation, whether to try to achieve a sustained disease remission or to

    control the disease

Supportive care

These are therapies that your doctor may prescribe to reduce discomfort and manage complications associated with the disease.


Example :

v     Pain killer

v     Antibiotics

v     Growth factor

v     Red blood cell hormone / stimulants called erythropoietin

v     Blood transfusion

v     Medications to lower blood calcium level and help to build bone faster

       called biphosphonates

v     Radiation treatment

v     Medication to reduce the severity of nerve damage

Plasma Cell : a type of white blood cell


Fracture of arm bone, Lytic bone lesions


How is Multiple Myeloma Diagnosed ?


Multiple Myeloma is sometimes difficult to diagnose 

~ as there is no one single test or symptom that can point to the diagnosis.


Many patients go to their doctor because 

~ they feel tired, 

~ have vague low back ache, a bony fracture that has happened easily or 

~ when they have developed renal failure ‘all of a sudden’.



Tests to diagnose Multiple Myeloma

Radiological Imaging Methods :



CT scan or MRI 

( if there is a suspicion of nerve compression or spine fracture)

Whole body PET/CT scan – occasionally done



Bone Marrow Examination:  click to link


This is necessary to determine the presence and the severity of plasma cell infiltration in your bone marrow.

Staging of MM

There are two widely accepted staging systems :


~The Durie-Salmon Staging System – the older staging system


~The International Staging System (ISS) 

This is used more widely now, and it gives a better information on projected survival and a more useful guide in the treatment and decision-making process.

The International Staging System (ISS)




B2M < 3.5 mg/L and Albumin > 35g/L


B2M < 3.5 mg/L and Albumin < 35g/L

Or B2M 3.5 - 5.5 mg/L


B2M ≥ 5.5 mg/L



Multiple Myeloma Affecting the Kidneys & the Skull




Treatment for MM



Monitoring of Disease after Treatment

It is important that 


> you communicate with your doctor for any problems related to your treatment


> you undertand that treatment will take weeks to months to assess the response

    to treatment


​​> to be compliant to your treatment and follow-up


What's New in Multiple Myeloma