DIAGNOSIS
Patients with multiple myeloma sometimes present with any of the following:
- Low red cell mass or hemoglobin resulting in the pallor of the patient
- Elevated kidney function tests such as blood urea nitrogen and creatinine due to the accumulation of Tamm-Horsfall protein or the myeloma protein
- Low serum globulin, which is part of the total protein serum test
- Test for Bence Jones protein
- Serum protein electrophoresis – detects the presence of M protein or myeloma protein
- Complete blood count utilizing manual procedure in counting shows the presence of roleaux formation
- Elevated ESR (erythrocyte sedimentation rate) an acute phase reactant
- Presence of bone lesions in imaging studies.
Three of the following criteria should be met in diagnosing multiple myeloma, and these are as follows:
Symptomatic myeloma (all three criteria must be met):
- Presence of plasma cells on mounts of bone marrow biopsy
- Presence of M protein or myeloma protein in the serum or urine
Presence of organ damage as manifested by any of the following:
- Elevated calcium levels higher than 11mg/dl
- Renal impairment
- Low hemoglobin less than 10g/dl
- Presence of punched out bone lesions on radiographic images
TREATMENT
The treatment of choice for individuals below 65 years of age is the use of chemotherapy. Medications used include bortezomib, lenalidomide with dexamethasone and stem cell transplant.
Individuals over 65 years of age with co-morbidities were found in studies that they cannot tolerate stem cell transplantation. Chemotherapeutic drugs include melphalan and prednisone, and there is an improved outcome.
