Continuing Medical Education

An approach to the diagnosis and management of multiple myeloma

F Fazel, F Bassa

Abstract


Multiple myeloma (MM) is a plasma cell dyscrasia that accounts for ~10% of haematological malignancies. It is a disease of the elderly, with a slight male predominance. Almost all cases of MM are preceded by an asymptomatic, premalignant phase known as monoclonal gammopathy of undetermined significance (MGUS). The clinical presentation of MM may be nonspecific, with the most common presenting symptoms being fatigue, bone pain and anaemia. The diagnostic criteria for MM were revised in 2014 to include 3 specific biomarkers of malignancy that are associated with an increased risk of target organ damage. This has resulted in a paradigm shift in the management of MM. The introduction of immunomodulatory agents and proteasome inhibitors has significantly improved the survival of patients with MM. Autologous stem cell transplantation remains the standard of care in younger, fit patients, where there is also a clear role for maintenance chemotherapy. Transplant-ineligible patients benefit from a prolonged induction therapy, and the role of maintenance therapy in this setting is still unclear. Despite major advances in therapy, MM remains an incurable malignant condition and novel agents such as monoclonal antibodies play an important role, especially in the elderly and patients who have relapsed.


Authors' affiliations

F Fazel, Division of Clinical Haematology, Department of Internal Medicine, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa

F Bassa, Division of Clinical Haematology, Department of Internal Medicine, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa

Full Text

PDF (145KB)

Keywords

Diagnosis; Management; Multiple myeloma

Cite this article

South African Medical Journal 2019;109(10):723-727. DOI:10.7196/SAMJ.2019.v109i10.14376

Article History

Date submitted: 2019-09-30
Date published: 2019-09-30

Article Views

Abstract views: 147
Full text views: 196

Comments on this article

*Read our policy for posting comments here