Myeloma

Several types of plasma cell neoplasms can be seen all of which are associated with a monoclonal (or myeloma) protein (M protein) (1). They include:

• monoclonal gammopathy of undetermined significance (MGUS) or asymptomatic myeloma
  • patients are asymptomatic
  • follow up is needed due to the risk of progressing to a symptomatic disease
• solitary myeloma or solitary plasmocytoma
  • uncommon, accounts for ≤5% of all plasma cell neoplasms
  • is a localised disease which consists of a solitary neoplastic mass of plasma cells found in bone or some soft tissue site
  • can be subdivided into
    • isolated plasmacytoma of the bone
    • extramedullary plasmacytoma (1,2)
• multiple myeloma
  • the most common form
  • is a disseminated neoplasm characterised by multiple neoplastic tumour masses of plasma cells, haphazardly scattered throughout the skeletal system and sometimes in soft tissues.

The British Society of Haematology (BSH) guidance suggests initial screening tests if suspecting multiple myeloma as (3):

• FBC
• Urea & creatinine
• Calcium
• Immunoglobulins & serum electrophoresis
• Serum-free light chains

Reference:

1. National Cancer Institute 2011. Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment
2. Reed V et al. Solitary plasmacytomas: Outcome and prognostic factors after definitive radiation therapy. Cancer. 2011;doi: 10.1002/cncr.26031
3. Sive, J., Cuthill, K., Hunter, H., Kazmi, M., Pratt, G., Smith, D. and (2021), Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Br. J. Haematol., 193: 245-268. https://doi.org/10.1111/bjh.17410