Multiple myeloma is the most common primary bone malignancy
The median age at diagnosis of multiple myeloma is 70 years, and the prevalence increases with increasing age. With newer treatments, 5-year survival rates for multiple myeloma are nearly 33%, with median survival rate of 33 months.
The usual presenting symptoms of multiple myeloma are bone pain, malaise, anemia, renal insufficiency, and hypercalcemia, but it is not unusual for the disease to first be recognized incidentally from comprehensive laboratory panels.
Serum or urine protein electrophoresis or immunofixation and bone marrow aspirate analysis aid in diagnosis of multiple myeloma. Staging is accomplished with skeletal radiographs, which may reveal lytic lesions, vertebral compression fractures, and osteoporosis.
Other useful imaging procedures may include magnetic resonance imaging and positron emission tomography or computed tomography. However, nuclear bone scans and dual energy x-ray absorptiometry have no role in diagnosing and staging of myeloma.
Multiple myeloma is part of a spectrum of monoclonal gammopathies ranging from monoclonal gammopathy of uncertain significance, smoldering (asymptomatic) and symptomatic multiple myeloma, amyloidosis, B-cell non-Hodgkin lymphoma, Waldenström macroglobulinemia, and rare plasma cell leukemia and heavy chain diseases. Although patients with monoclonal gammopathy of uncertain significance or smoldering multiple myeloma should be closely monitored, treatment is not indicated unless the condition progresses.
Asymptomatic (smoldering) multiple myeloma should not be treated (Earlier treatment has no effect on mortality and may increase the risk of acute leukemia).
For symptomaticmultiple myeloma, chemotherapy is first-line therapy, followed by ASCT (autologous stem cell transplantation ) if possible. ASCT is the standard treatment for patients with symptomatic multiple myeloma who are younger than 65 years, as well as for older patients who are physically able to withstand this therapy. Median survival for patients treated with high-dose induction chemotherapy followed by ASCT is 68 months.
Chemotherapeutic options include melphalan, prednisolone, dexamethasone, vincristine, doxorubicin, bortezomib, and thalidomide and its analogue lenalidomide. The adverse effects of thalidomide include somnolence, deep venous thrombosis, and neuropathy which is not always reversible and which may require discontinuation of therapy.
Diagnosis and management of complications is an important facet of multiple myeloma treatment by family clinicians. For bone pain, opiates, bisphosphonates, radiotherapy, vertebroplasty, or kyphoplasty may be useful. However, nephrotoxic nonsteroidal anti-inflammatory drugs should be avoided (All patients with symptomatic multiple myeloma should be prescribed intravenous bisphosphonates) (oral bisphosphonates have not been proven effective)
Hypercalcemia may be managed with isotonic saline infusions, steroids, furosemide, or bisphosphonates. Patients with multiple myeloma are vulnerable to infections and often require treatment with broad-spectrum antibiotics for febrile illness, as well as vaccination to protect against influenza, pneumococcus, and Haemophilus influenzae B.
Anemia generally responds to myeloma treatment; however, symptomatic anemia is managed with transfusions and erythropoietin therapy

http://www.medscape.com/viewarticle/...8&uac=101330HZ

thanks a lot for the information, but i have a small quastion about the treatment, beacuse i was thinking that we need to try not to avoide the radiation for such patient but here you wrote that the radiotherapy it can be helpfull, so plaase can you be so nice and explain your point of view about it.
best regards

Many thanks for your question.
As you know Multiple myeloma is primary bone malignancy, which affects many locations in the same time, that's why chemotherapy is the first-line therapy. But there is form: Solitary bone plasmacytoma which presents with a single painful bone lesion due to a monoclonal plasma cell infiltrate, and further studies show no evidence of myeloma elsewhere. In this condition a radiotherapy with 50 Gy dose (range, 30–70 Gy), improve good results.
So to indicate Radiotherapy as an option we need precise staging of the tumor, not only with X-Ray, but with total spine MRI.

http://www.sciencedirect.com/science...71eac6f39642d9

thanks for your answer, just still have an additional quastion.
with precise stage you mean about TNM or specific part of it, and if u can give the specific number of it please.
and last quastion, with such radiation 30–70 Gy we are not putting the patint under risk to have an additional type of tumor?
sorry for my quastion, but it is really interesting topic to speak about
best regards

In fact I'm orthopaedic resident, I don't have much experience in oncology or radiotherapy, so it was just citation from article about the radiotherapy dosis, it's always controversial the dosis of radiotherapy and the cycle of chemotherapy even between the specialists themselves, especially in this special form of tumor, I mean Solitary bone plasmacytoma, so there are also not much articles in the litratures which reporting their results.
I hope any specialist can help us with his experience or with special article.
About the staging you can't use TNM system in all tumors, here I mean with staging: a total spine MRI to declare which vertebrae are most affected and at risk of fracture

thanks for answering about the part of stages and as you said hope any specialist can help us with his experience or with special article
have a nice day