Multiple myeloma and paraproteinaemia

The paraprotein is an immunoglobulin produced at abnormally high levels by a clone of plasma cells. These plasma cells may be relatively benign, with minimal proliferation and no associated tissue damage or cause organ impairment via cytokine effects or through the paraprotein itself. Myeloma is usually a disease of the elderly, typically presenting non-specifically with anaemia, back pain, renal impairment, hypercalcaemia or recurrent infections, or inducing medical emergencies such as acute renal failure, overwhelming sepsis, spinal cord compression and hyperviscosity. Prompt diagnosis requires a low threshold for screening investigations. Evidence of myeloma-related organ and tissue impairment should be actively sought. Treatment is tailored to the patient, in recognition of the increased co-morbidities present in this population. Supportive care is exceptionally important. This is accompanied by combination chemotherapy, aiming to reduce disease burden and reverse organ damage where possible. Other rarer conditions may be associated with a paraprotein, such as Waldenström’s macroglobulinaemia, solitary plasmacytomas, light chain (AL) amyloidosis and lymphoproliferative disorders. They require specialist investigation and management.