Myeloma and MGUS

Plasma cell disorders result from a clonal proliferation of bone marrow plasma cells and range from the relatively benign monoclonal gammopathy of undetermined significance (MGUS) to malignant myeloma. A serum or urine monoclonal protein is usually detectable. MGUS is asymptomatic but can progress to myeloma or lymphoma. Myeloma is generally a disease of the elderly and presents with variable problems that include anaemia, bone pain and fractures, spinal cord compression, renal failure, hypercalcaemia, recurrent infections and hyperviscosity. Diagnosis is based on examination of the bone marrow, with prognosis influenced by specific genetic abnormalities. Treatment is required following the development of myeloma-related organ or tissue impairment. It is an incurable disease and treatment combines anti-myeloma chemotherapy and supportive therapy. Younger, medically fit patients are treated with intensive regimens that combine chemotherapy with autologous stem cell transplant, whereas older patients with reduced performance status are given chemotherapy alone. It has a remitting and relapsing course with eventual development of drug resistance. However, the availability of newer drugs, such as thalidomide, bortezomib and lenalidomide, along with improvements in supportive care, such as regular zoledronic acid, are leading to improved disease-free and overall survival.