Diagnosis and Management of Multiple Myeloma: A Review

Andrew J. Cowan, Damian J. Green, Mary Kwok, Sarah Lee, David G. Coffey, Leona A. Holmberg, Sherilyn Tuazon, Ajay K. Gopal, Edward N. Libby*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

330 Scopus citations


Importance: Multiple myeloma is a hematologic malignancy characterized by presence of abnormal clonal plasma cells in the bone marrow, with potential for uncontrolled growth causing destructive bone lesions, kidney injury, anemia, and hypercalcemia. Multiple myeloma is diagnosed in an estimated 34920 people in the US and in approximately 588161 people worldwide each year. Observations: Among patients with multiple myeloma, approximately 73% have anemia, 79% have osteolytic bone disease, and 19% have acute kidney injury at the time of presentation. Evaluation of patients with possible multiple myeloma includes measurement of hemoglobin, serum creatinine, serum calcium, and serum free light chain levels; serum protein electrophoresis with immunofixation; 24-hour urine protein electrophoresis; and full-body skeletal imaging with computed tomography, positron emission tomography, or magnetic resonance imaging. The Revised International Staging System combines data from the serum biomarkers β2microglobulin, albumin, and lactate dehydrogenase in conjunction with malignant plasma cell genomic features found on fluorescence in situ hybridization - t(4;14), del(17p), and t(14;16) - to assess estimated progression-free survival and overall survival. At diagnosis, 28% of patients are classified as having Revised International Staging stage I multiple myeloma, and these patients have a median 5-year survival of 82%. Among all patients with multiple myeloma, standard first-line (induction) therapy consists of a combination of an injectable proteasome inhibitor (ie, bortezomib), an oral immunomodulatory agent (ie, lenalidomide), and dexamethasone and is associated with median progression-free survival of 41 months, compared with historical reports of 8.5 months without therapy. This induction therapy combined with autologous hematopoietic stem cell transplantation followed by maintenance lenalidomide is standard of care for eligible patients. Conclusions and Relevance: Approximately 34920 people in the US and 155688 people worldwide are diagnosed with multiple myeloma each year. Induction therapy with an injectable proteasome inhibitor, an oral immunomodulatory agent and dexamethasone followed by treatment with autologous hematopoietic stem cell transplantation, and maintenance therapy with lenalidomide are among the treatments considered standard care for eligible patients..

Original languageEnglish
Pages (from-to)464-477
Number of pages14
JournalJAMA - Journal of the American Medical Association
Issue number5
StatePublished - 1 Feb 2022
Externally publishedYes


Dive into the research topics of 'Diagnosis and Management of Multiple Myeloma: A Review'. Together they form a unique fingerprint.

Cite this