An approach to the diagnosis and management of multiple myeloma
Date
2019-09-30
Journal Title
Journal ISSN
Volume Title
Publisher
South African Medical Association
Abstract
ENGLISH 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.
Description
CITATION: Fazel, F. & Bassa, F. An approach to the diagnosis and management of multiple myeloma. South African Medical Journal, 109(10):723-727. doi:10.7196/SAMJ.2019.v109i10.14376
The original publication is available at http://www.samj.org.za/index.php/samj/index
The original publication is available at http://www.samj.org.za/index.php/samj/index
Keywords
Multiple myeloma, Plasma cell diseases, Plasma cell dyscrasias -- Management, Haematological . . . -- Malignancy (Cancer)
Citation
Fazel, F. & Bassa, F. An approach to the diagnosis and management of multiple myeloma. South African Medical Journal, 109(10):723-727. doi:10.7196/SAMJ.2019.v109i10.14376