Diagnosis and treatment of multiple myeloma

Multiple myeloma is a malignancy of plasma cells characterized by osteolytic bone lesions, anemia, hypercalcemia, and renal failure [1, 2]. Patients with multiple myeloma must be differentiated from those with monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (Table 33.1). Multiple myeloma accounts for 1 % of all malignant disease and slightly more than 10 % of hematologic malignancies in the United States. The annual incidence, age-adjusted to the 2000 United States population, is 4.3 per 100,000 [14]. Approximately 20,850 new cases and 11,680 myeloma deaths are estimated to occur in the United States in 2009 [15]. Multiple myeloma is slightly more common in men than in women, and is twice as common in African-Americans compared with Caucasians [16]. The median age of patients at the time of diagnosis is about 65 years; [17] only 2 % of the patients are younger than 40.