What are the clinical features of symptomatic plasma cell myeloma?

Updated: Oct 14, 2019
  • Author: Lesley Elizabeth Fox, MD; Chief Editor: Francis H Gannon, MD  more...
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Answer

Answer

Symptomatic plasma cell myeloma is a plasma cell neoplasm defined as the presence of end-organ damage (hypercalcemia, renal insufficiency, anemia, lytic lesions of bone) in a patient with a monoclonal protein (of any amount) and clonal plasma cells in the bone marrow (of any amount) or plasmacytoma. [1]

Patients with symptomatic plasma cell myeloma can present with features of bony involvement (bone pain, pathologic fractures), cytopenias (fatigue, immune dysfunction, infections), hyperviscosity syndrome, venous thromboembolism, and renal insufficiency. [1, 4, 5]

Hypercalcemia results from the increased osteoclastic activity, with resultant lytic bone lesions and pathologic fractures (see the image below). [1, 5, 10] Renal insufficiency is due to hypercalcemia and monoclonal light chain–induced injury to the kidney.

Computed tomography scan demonstrates a destructiv Computed tomography scan demonstrates a destructive lesion with an associated soft-tissue mass. This image depicts myeloma.

Anemia results from bone marrow replacement by plasma cell myeloma and/or the loss of erythropoietin as a result of renal injury. [1, 5] Hyperviscosity is a rare occurrence and is caused by increased circulating serum immunoglobulin. [11] Venous thromboembolism occurs in plasma cell myeloma, particularly in patients receiving multiagent chemotherapy or anti-angiogenesis drugs. [5]


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