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Hematology

Multiple Myeloma

Malignant plasma cell disorder producing monoclonal immunoglobulin (M-protein) with CRAB features: HyperCalcaemia, Renal impairment, Anaemia, Bone lesions.

Last reviewed 8 May 2026 - MedicoMedics editorial team

Bone marrow biopsy with plasma cells

Pathophysiology

Clonal plasma cells in marrow secrete monoclonal Ig; free light chains cause cast nephropathy; osteoclast activation causes lytic lesions.

Sources: IMWG Diagnostic Criteria (Lancet Oncol 2014;15:e538); NEJM Daratumumab (NEJM 2016;375:1319)

Presentation

Bone pain (vertebral), pathological fractures, fatigue from anaemia, renal failure, hypercalcaemia, infection risk from immunoparesis.

Diagnosis

IMWG: clonal plasma cells >=10% + CRAB or myeloma-defining events. SPEP/UPEP, serum free light chains, low-dose whole-body CT or PET-CT, marrow with FISH.

Management

Induction: bortezomib-lenalidomide-dexamethasone-daratumumab (VRd-D). Autologous stem-cell transplant for eligible. Maintenance lenalidomide. Relapsed: pomalidomide, carfilzomib, isatuximab, CAR-T (idecabtagene, ciltacabtagene) and bispecifics.

Sample USMLE-style MCQs

Try 5 questions on this topic. Practice hundreds more free with a trial.

Question 1

A 68-year-old has back pain, Ca 11.8, Hb 9, Cr 2.4, and IgG kappa M-spike. Bone marrow 30% plasma cells. Diagnosis?

Question 2

Which agent is a proteasome inhibitor?

Question 3

Which monoclonal antibody targets CD38?

Question 4

Cause of renal failure in MM?

Question 5

Which is a CAR-T therapy approved in relapsed MM?

References

Primary guidelines and peer-reviewed sources used for this entry. Reviewed 8 May 2026 by MedicoMedics editorial team.

  1. IMWG Diagnostic Criteria (Lancet Oncol 2014;15:e538)
  2. NEJM Daratumumab (NEJM 2016;375:1319)

Frequently asked

What is MGUS?

<10% clonal plasma cells, no CRAB - precursor with 1%/year progression.

Rouleaux formation?

Stacked RBCs on smear from high M-protein.

Bone imaging?

Low-dose whole-body CT or PET-CT (not skeletal survey).

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