Thank you to Dr. Morden for an outstanding case and presentation on multiple myeloma!

Teaching Points:

• Multiple myeloma is a neoplastic plasma cell disorder characterized by clonal proliferation of malignant plasma cells in the bone marrow, monoclonal protein in the blood or urine, and associated organ dysfunction.
• Myeloma may uncommonly present as bilateral pleural effusion, and may be due to non-malignant reasons such as heart failure or hypoproteinemia. The effusion will typically be exudative.
• Diagnostic studies include screening serum protein electrophoresis with confirmatory immunofixation, marrow biopsy, metastatic bone survey, CBC, and basic chemistries. Multiple myeloma is defined as >10% clonal bone marrow plasma cells with presence of organ impairment (anemia, hypercalcemia, renal insufficiency, or boney lesions)
• Staging of MM may be based on Durie-Salmon Criteria or ISS Criteria, with 5 year survival of Stage 1 or 2 being roughly 50% and Stage 3 being 30%.
• Click here for an excellent review article from NEJM on multiple myeloma.