Multiple myeloma is a plasma cell cancer that often develops from precursor conditions like monoclonal gammopathy of undetermined significance or smoldering multiple myeloma (SMM). It makes up 1% of all cancers and 10% of blood cancers, with a higher incidence in older adults, men, and African Americans. Symptoms include anemia, bone lesions, kidney failure, and high calcium. Diagnosis requires ≥10% clonal plasma cells or a biopsy-confirmed plasmacytoma plus myeloma-defining events. Prognosis is guided by the Revised International Staging System, which includes serum markers and key cytogenetic changes such as t(4;14) or del(17p).

Treatment depends on transplant eligibility and risk. For eligible patients, a quadruplet regimen like daratumumab-bortezomib-lenalidomide-dexamethasone followed by autologous stem cell transplant and maintenance therapy is standard. Transplant-ineligible or frail patients may receive triplet regimens. Relapsed disease is treated based on prior therapies and resistance, using options like CAR-T therapy, bispecific antibodies, and monoclonal antibodies. Supportive care—including bone protection, infection prevention, and early intervention in high-risk SMM—is essential to a comprehensive, personalized treatment strategy.

Reference: Rajkumar SV. Multiple myeloma: 2024 update on diagnosis, risk-stratification, and management. Am J Hematol. 2024;99(9):1802-1824. doi: 10.1002/ajh.27422.