• B-cell lymphoid malignancy.
  • Clonal proliferation of plasma cells (synthesize abnormal Ig) in bone marrow.
  • Commonest primary malignant tumour of bone (1% of bone Tu).
  • No specific risk factors.
SXR Pepper pot of Myeloma


  • May present as incidental finding (e.g. x-ray, ↑ESR, ↑Ca++) or very aggressive painful bony destruction
  • Often background history of renal symptoms or vague constitutional symptoms (anaemia)
  • Rarely recurrent infections : hypogammaglobulinaemia.

Major criteria

  • Monoclonal protein on electrophoresis or Bence Jones proteinuria >1 g/24 hr.
  • Bone marrow plasma cells at least > 10%.
  • Lytic bony lesions.

Minor criteria

  • Cytopenia (esp. ↓Hb or ↓Platelets).
  • Renal failure and hypercalcaemia.
  • Hyperviscosity (SOB, confusion, chest pain).


  • MRI useful for vertebral lesions.
  • Chromosomal abnormalities may help with prognosis.
  • ESR may be normal (non-Ig producing myeloma).


  1. Stage the condition (based on B marrow, proteinuria load on electrophoresis etc.).
  2. Confirm renal status, chromosomal abnormalities and Plasma Cell Labelling Index (PCLI).
  3. Aim to control disease and manage symptoms (beware electrolytes, ↑Ca++, renal fxn and cytopaenias).
  4. Aggressive appropriate analgesia as required.
  5. Options include chemoRx, radioRxs, immunomodulation and marrow transplant.

Content by Dr Íomhar O' Sullivan 22/09/2011. Last review Dr ÍOS 10/06/21.