Multiple Myeloma Questions & Answers

Updated: Dec 06, 2018
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Questions & Answers

Overview

What is multiple myeloma (MM)?

What are the signs and symptoms of multiple myeloma (MM)?

How is multiple myeloma (MM) often discovered?

Which physical findings are characteristic of multiple myeloma (MM)?

What are the physical findings of multiple myeloma (MM) with amyloidosis?

What are the International Myeloma Workshop guidelines for the workup of suspected multiple myeloma (MM)?

Which routine lab tests are performed in the workup of multiple myeloma (MM)?

Which imaging studies are performed in the workup of multiple myeloma (MM)?

What are the treatment options for multiple myeloma (MM)?

Which chemotherapy regimens are used in the treatment of multiple myeloma (MM)?

What is the NCCN recommended primary induction therapy for patients with multiple myeloma (MM) who are candidates for transplantation?

What are the NCCN recommended chemotherapy regimens for the treatment of multiple myeloma (MM)?

What are the NCCN preferred regimens for treatment of relapsed multiple myeloma (MM)?

What is the pathophysiology of multiple myeloma (MM)?

What is the role of skeletal processes in the pathophysiology of multiple myeloma (MM)?

What is the role of hematologic processes in the pathophysiology of multiple myeloma (MM)?

What is the role of renal processes in the pathophysiology of multiple myeloma (MM)?

What is the role of neurologic processes in the pathophysiology of multiple myeloma (MM)?

What is the role of hyperviscosity syndrome in the pathophysiology of multiple myeloma (MM)?

What causes multiple myeloma (MM)?

What is the role of genetics in the etiology of multiple myeloma (MM)?

What are environmental or occupational risk factors for multiple myeloma (MM)?

How is monoclonal gammopathy of undetermined significance (MGUS) defined?

What are the types of monoclonal gammopathy of undetermined significance (MGUS)?

What are risk factors for progression of monoclonal gammopathy of undetermined significance (MGUS)?

What is smoldering multiple myeloma (MM)?

What is the role of radiation in the etiology of multiple myeloma (MM)?

What is the role of chronic inflammation in the etiology of multiple myeloma (MM)?

What is the role of infection in the etiology of multiple myeloma (MM)?

What is the prevalence of multiple myeloma (MM)?

What should the patient education for multiple myeloma (MM) address?

What is the prognosis of multiple myeloma (MM)?

What are poor prognostic factors for multiple myeloma (MM)?

What are the survival rates for multiple myeloma (MM)?

How do infections affect the prognosis of multiple myeloma (MM)?

Presentation

What are the signs and symptoms of multiple myeloma (MM)?

How prevalent is bone pain in multiple myeloma (MM)?

What is the prevalence of pathologic fractures in multiple myeloma (MM)?

What are the symptoms of spinal cord compression in multiple myeloma (MM)?

What causes bleeding in multiple myeloma (MM)?

What are the symptoms of hypercalcemia in multiple myeloma (MM)?

Which infections are common in patients with multiple myeloma (MM)?

What are the symptoms of hyperviscosity multiple myeloma (MM)?

What are neurologic symptoms in multiple myeloma (MM)?

What causes weakness in multiple myeloma (MM)?

Which physical findings are characteristic of multiple myeloma (MM)?

Which physical findings suggest amyloidosis in multiple myeloma (MM)?

What is the shoulder pad sign in multiple myeloma (MM)?

What does a finding of macroglossia suggest in the evaluation of multiple myeloma (MM)?

How are skin lesions characterized in multiple myeloma (MM)?

What does a finding of post-proctoscopic peripalpebral purpura suggest in the evaluation for multiple myeloma (MM)?

What is the prevalence of renal failure in multiple myeloma (MM)?

What are possible hematologic complications of multiple myeloma (MM)?

What are the skeletal complications of multiple myeloma (MM)?

What are potential complications in multiple myeloma (MM)?

DDX

How is multiple myeloma (MM) diagnosed?

What are the diagnostic criteria for active (symptomatic) multiple myeloma (MM)?

What are-defining events in multiple myeloma?

How is active multiple myeloma (MM) differentiated from smoldering multiple myeloma (MM)?

What are the differential diagnoses for Multiple Myeloma?

Workup

What are the guidelines for the standard workup for suspected multiple myeloma (MM)?

Which blood studies are performed in the workup of multiple myeloma (MM)?

What is the role of urine testing in the workup of multiple myeloma (MM)?

What is the role of electrophoresis and immunofixation in the workup of multiple myeloma (MM)?

What is the role of quantitative immunoglobulin (IgG, IgA, IgM) testing in the workup of multiple myeloma (MM)?

What is the role of beta-2 microglobulin and C-reactive protein (CRP) testing in the workup of multiple myeloma (MM)?

What is the role of serum viscosity testing in the workup of multiple myeloma (MM)?

What is the role of radiography in the workup of multiple myeloma (MM)?

What is the role of MRI in the workup of multiple myeloma (MM)?

What is the role of positron emission tomography (PET) scanning in the workup of multiple myeloma (MM)?

What is the role of bone scanning in the workup of multiple myeloma (MM)?

What is the role of bone marrow aspiration and biopsy in the workup of multiple myeloma (MM)?

Which histologic findings are characteristic of multiple myeloma (MM)?

What is the role of cytogenetic analysis of the bone marrow in the evaluation of multiple myeloma (MM)?

Which systems are used to stage multiple myeloma (MM)?

What is the Salmon-Durie classification of multiple myeloma (MM)?

What is the median survival for multiple myeloma (MM) according to the international staging system for multiple myeloma (MM)?

What is the international staging system for multiple myeloma (MM)?

Treatment

What is the approach to treatment of multiple myeloma (MM)?

When should treatment for multiple myeloma (MM) be initiated?

Which genetic mutations are indicators of high risk multiple myeloma (MM)?

What are treatment options for multiple myeloma (MM)?

What are the NCCN preferred regimens for primary induction therapy in patients with multiple myeloma (MM)?

Which regimens does NCCN consider useful in select circumstances of multiple myeloma (MM)?

What is the role of lenalidomide in the treatment of multiple myeloma (MM)?

What is included in adjunctive therapy for multiple myeloma (MM)?

How are skeletal related events (SREs) prevented in patients with multiple myeloma (MM) receiving first-line therapy?

When are chemotherapy and immunosuppression indicated in the treatment of multiple myeloma (MM)?

Which patient groups are candidates for autologous stem cell transplant to treat multiple myeloma (MM)?

What is the role of VAD (vincristine, doxorubicin [Adriamycin], and dexamethasone) in the treatment of multiple myeloma (MM)?

What is the role of thalidomide intoe treatment of multiple myeloma (MM)?

What is the role of combined thalidomide and lenalidomide (Revlimid) in the treatment of multiple myeloma (MM)?

What is the efficacy of lenalidomide for the treatment of multiple myeloma (MM)?

What are risks associated with lenalidomide for the treatment of multiple myeloma (MM)?

What is the role of bortezomib for the treatment of multiple myeloma (MM)?

What is the efficacy of combination therapy with bortezomib for the treatment of multiple myeloma (MM)?

What is the efficacy of bortezomib for the treatment of multiple myeloma (MM)?

Which high-risk patients with multiple myeloma (MM) are potential transplant candidates?

What is the standard treatment for newly diagnosed patients with multiple myeloma (MM) who are not transplant candidates?

What is the efficacy of melphalan and prednisone (MP) therapies for the treatment of multiple myeloma (MM)?

What is the role of daratumumab in the treatment of multiple myeloma (MM)?

What is the role of maintenance therapy in the treatment of multiple myeloma (MM)?

What is the efficacy of maintenance therapy in the treatment of multiple myeloma (MM)?

What are preferred regimens for treatment of multiple myeloma (MM) relapse?

What is the efficacy of bortezomib in the treatment of refractory multiple myeloma (MM)?

Which medications are FDA approved for treatment of refractory or relapsed multiple myeloma (MM)?

What is the role of Daratumumab (Darzalex), Ixazomib (Ninlaro), and Elotuzumab (Empliciti) in the treatment of multiple myeloma (MM)?

What is the efficacy of second-line therapies for multiple myeloma (MM)?

What is the role of autologous stem cell transplantation in the treatment of multiple myeloma (MM)?

What is the efficacy of tandem autologous stem cell transplantation in the treatment of multiple myeloma (MM)?

What is the role of allogeneic stem cell transplantation in the treatment of multiple myeloma (MM)?

What are some limitations of allogeneic stem cell transplantation less for the treatment of multiple myeloma (MM)?

What is the role of nonmyeloablative transplantation regimens in the treatment of multiple myeloma (MM)?

What is the role of bortezomib-dexamethasone induction therapy in the treatment of multiple myeloma (MM)?

What are the treatment options for multiple myeloma (MM) in patients with progressive or relapsing disease following autologous stem-cell transplantation?

What is the role of interferon alfa in the treatment of multiple myeloma (MM)?

What is the role of radiation therapy in the treatment of multiple myeloma (MM)?

What is the role of bisphosphonates in the treatment of multiple myeloma (MM)?

What medication is FDA approved for prevention of skeletal-related events (SREs) in multiple myeloma (MM)?

What is a possible severe adverse effect of bisphosphonate therapy for multiple myeloma (MM)?

What are possible complications of multiple myeloma (MM)?

How is hypercalcemia treated in patients with multiple myeloma (MM)?

What are the guidelines on the European Myeloma Network management of multiple myeloma (MM) complications?

What is the role of surgery in the treatment of multiple myeloma (MM)?

What dietary modifications are used in the treatment of multiple myeloma (MM)?

What physical activity modifications are needed in the treatment of multiple myeloma (MM)?

How is multiple myeloma (MM) prevented?

Which specialist consultations are needed for the treatment of multiple myeloma (MM)?

What is included in the long-term monitoring of multiple myeloma (MM)?

Guidelines

Which organizations have issued guidelines for the workup of multiple myeloma (MM)?

What are the International Myeloma Working Group (IMWG) guidelines for the workup of multiple myeloma (MM)?

What are the National Comprehensive Cancer Network (NCCN) guidelines for the workup of multiple myeloma (MM)?

What are the European Society for Medical Oncology (ESMO) guidelines for the diagnosis evaluation of multiple myeloma (MM)?

What are the National Comprehensive Cancer Network (NCCN) criteria for a diagnosis of smoldering multiple myeloma (MM)?

What are the National Comprehensive Cancer Network (NCCN) criteria for a diagnosis of active multiple myeloma (MM)?

What are considered myeloma defining events in the diagnosis of multiple myeloma (MM)?

What is the Revised International Staging System (R-ISS) and how is it used in the diagnosis of multiple myeloma (MM)?

What are the National Comprehensive Cancer Network (NCCN) general treatment recommendations for multiple myeloma (MM)?

What are the NCCN guidelines for primary induction therapy in patients with multiple myeloma (MM) who are candidates for transplantation?

Which regimens does the National Comprehensive Cancer Network (NCCN) consider useful in elderly or frail patients with multiple myeloma (MM)?

What are the NCCN guidelines for primary induction therapy in patients with multiple myeloma (MM) who are not candidates for transplantation?

What does the NCCN recommend for maintenance therapy in patients with multiple myeloma (MM)?

What does the NCCN recommend for salvage therapy in patients with multiple myeloma (MM)?

What are the International Myeloma Working Group (IMWG) practice treatment guidelines for bone disease associated with multiple myeloma (MM)?

What are the American Society of Clinical Oncology (ASCO) clinical practice guidelines governing bisphosphonate therapy for multiple myeloma (MM) patients?

Which novel drugs can be used as primary treatment for amyloidosis associated with multiple myeloma (MM)?

What are the American Society of Hematology (ASH) and ASCO recommendations for use of erythropoiesis-stimulating agents (ESAs) in multiple myeloma (MM)?

What are the European Myeloma Network treatment guidelines for multiple myeloma (MM) complications?

Medications

What type of medications are used in the treatment of multiple myeloma (MM)?

Which medications in the drug class Colony-stimulating Factors are used in the treatment of Multiple Myeloma?

Which medications in the drug class Immunosuppressant Agents are used in the treatment of Multiple Myeloma?

Which medications in the drug class Monoclonal Antibodies are used in the treatment of Multiple Myeloma?

Which medications in the drug class Bisphosphonates are used in the treatment of Multiple Myeloma?

Which medications in the drug class Interferons are used in the treatment of Multiple Myeloma?

Which medications in the drug class Corticosteroids are used in the treatment of Multiple Myeloma?

Which medications in the drug class Chemotherapeutic Agents are used in the treatment of Multiple Myeloma?