Myeloma and MGUS

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