Medical Illustration: Multiple Myeloma

CURE, Hematology Special Issue, Volume 1, Issue 1

Multiple myeloma begins with a single precancerous plasma cell that multiplies uncontrollably and can eventually cause bone lesions and anemia.

1. Normal bone marrow produces new blood cells, which include red blood cells, white blood cells (neutrophils, plasma cells and monocytes) and platelets.

2. Monoclonal gammopathy of undetermined significance: Elevated levels of M protein due to an increased number of plasma cells. Bone lesions are absent. No treatment is necessary. Disease should be monitored every six to 12 months.

3. Smoldering myeloma: Elevated levels of M protein due to an increased number of plasma cells. Bone lesions are absent. Standard of care is to monitor disease without treatment. Enrollment in a clinical trial comparing treatment to observation might be an option.

4. Solitary or intramedullary plasmacytoma: Elevated levels of M protein, increased number of plasma cells and a single tumor in the bone or soft tissue. Treatment typically consists of radiation therapy.

5. Multiple myeloma: High levels of M protein and elevated levels of plasma cells accompanied by multiple painful bone lesions and anemia. Kidney damage might also be present. Treatment options include chemotherapy, targeted agents and immune modulators with or without bone marrow transplantation.