Multiple myeloma (MM) is a malignant tumor characterized by abnormal proliferation of monoclonal plasma cells and excessive production of monoclonal immunoglobulins.

bubble_chart Diagnosis

I. Medical History and Symptoms

(1) Medical History Inquiry: Note: ① Whether there is a history of exposure to radiation, benzene, or pesticides. ② Presence of bone pain, skeletal deformities, pathological fractures, or edema. ③ History of unexplained recurrent infections.

(2) Clinical Symptoms: In addition to general manifestations such as lack of strength and anemia, bone pain and back pain are the most common. If complicated by acute infections or renal insufficiency, corresponding symptoms may occur.

II. Physical Examination Findings

Pale skin and mucous membranes, localized bone tenderness. In cases with pathological fractures, skeletal deformities may be observed. A few patients may exhibit grade I hepatosplenomegaly, and extramedullary plasmacytoma is occasionally seen.

III. Auxiliary Examinations

1. Blood Test: Decreased hemoglobin, presenting as normocytic normochromic anemia; white blood cells and platelets are normal in early stages but decrease in advanced stages. Immature granulocytes and erythroblasts may be seen in the differential count, with red blood cells arranged in rouleaux formation.

2. Bone Marrow Examination: Hypercellularity, with plasma cells accounting for more than 15% and the presence of morphologically abnormal myeloma cells. Other cell lines are generally normal. Since lesions are often focal, multiple and multi-site punctures are recommended.

3. Serum Immunoglobulin Measurement: IgG >35g/L; IgA >20g/L; IgD >2.0g/L; IgE >2.0g/L; IgM >15g/L.

5. Bone X-ray, CT, or Isotope Scan: May reveal multiple punched-out lytic lesions or generalized osteoporosis.

6. Others: Increased erythrocyte sedimentation rate; elevated blood calcium; in cases of renal failure: increased blood urea nitrogen and creatinine.

IV. Differential Diagnosis

Differentiation is required from bone metastases, autoimmune diseases, chronic infections, infectious mononucleosis, and lymphoma, among other conditions.

bubble_chart Treatment Measures

1. General Treatment: ① Hemoglobin below 60g/L, red blood cell transfusion;

② Hypercalcemia: isotonic saline hydration, prednisone: 20mg, orally, 3-4 times/day;

③ Hyperuricemia: allopurinol: 0.2mg, orally, 3 times/day;

④ Hyperviscosity syndrome: plasmapheresis;

⑤ Renal failure: hemodialysis; ⑥ Infection: combined antibiotic therapy, prophylactic injections of penicillin and gamma globulin are effective for patients with recurrent infections.

2. Chemotherapy: - MP regimen: Melphalan 2mg, orally, 3 times/day; prednisone 20mg, orally, 3 times/day, course of 7 days, repeated every 6 weeks, treatment for 1-2 years. - M2 regimen: Carmustine 25mg/m2, cyclophosphamide 400 mg/m2, vincristine 1.4 mg/m2, all administered intravenously on day 1; melphalan as above, prednisone 40 mg/m2, orally, for 14 days. - Refractory MM chemotherapy regimens: - VAD regimen: Vincristine 0.5mg/day, doxorubicin 10mg/day, dexamethasone 40mg/day, all administered by intravenous infusion on days 1-4 and 17-20. - VBAP regimen: Vincristine 2mg/day, carmustine 60-80mg/day, doxorubicin 40-60mg/day, all administered intravenously on day 1, prednisone 60-100mg/day, orally on days 1-5.

4. α-Interferon: 3-5 million units/day, subcutaneous injection, 3 times/week, course >6 months.

5. Bone Marrow Transplantation: Autologous bone marrow, autologous peripheral blood stem cell, and allogeneic bone marrow transplantation can all be used for the treatment of multiple myeloma.