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Introduction
Multiple myeloma is a cancer of the bone marrow plasma cells. It is primarily found in the elderly and current treatment may result in prolonged remissions but the disease remains generally incurable.
Before proceeding to treat multiple myeloma, it is important to exclude monoclonal gammopathy of unknown significance (which may affect as many as 5% of the population over 70 years of age) or any similar smouldering or indolent type of myeloma which may not require immediate treatment.
Diagnosis
Myeloma is confirmed by the presence of increased plasma cells in the bone marrow, bony lytic lesions or a monoclonal protein band on electrophoresis.
TreatmentTherapy in elderly patients is usually reserved for patients with symptomatic disease, or for those who may be asymptomatic, but have features suggesting that they may progress and develop complications over a short period of time.
Melphalan combined with prednisolone remains the standard therapy choice for most patients. Younger patients may be able to tolerate and benefit from stronger chemotherapy and other options like bone marrow transplantation. Radiotherapy is useful in relieving destructive bone disease. Other agents like bisphosphonates have been found to be helpful in controlling the bone pain and high calcium levels associated with the disease but should be employed with caution in kidney problems and adequate fluid intake should be ensured.
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