Clinical Manifestations of Multiple Myeloma

Multiple myeloma can be defined as symptomatic monoclonal gammopathy. Elevated levels of immunoglobulin-G (IgG), immunoglobulin-A (IgA), immunoglobulin-M (IgM), immunoglobulin-D (IgD) or immunoglobulin-E (IgE) could be detected by immunoelectrophoresis. (IEP) of patient's serum. The frequency of occurrence for each immunoglobulin class is in the order mentioned above. The basis for all monoclonal gammopathies is an unrestricted proliferation of a single plasma cell clone probably due to failure of its immuno-regulatory switch or gene. The resulting homogeneous immunoglobulin accumulates in the plasma/serum and plasma cells crowd out the bone marrow. There would be suppressed/decreased production of the functional antibodies with the consequences of higher tendency towards infections.

Clinical Manifestations:

The patients with multiple myeloma present with bone pain, fatigue, pallor, anemia and weight loss. Upon examination, the bones may show osteoporosis pathologic fractures and there may also be sternal tenderness. Some patients may also show neurologic symptoms. Neurologic symptoms are caused by collapsed vertebrae compressing the spinal cord. When a patient presents with clinical symptoms of multiple myeloma, following tests should be requested immediately:

• X-Rays of the skull, ribs and vertebrae


• Blood count


• Bone marrow aspiration


• Serum protein electrophoresis (SPE)


• Urine examination for Bence Jones Protein

If the x-rays show osteolytic lesions, blood count is indicative of anemia, bone marrow aspiration examination shows sheets of plasma cells and SPE shows myeloma band (M-band) in gamma globulin region, the diagnosis would be multiple myeloma. Chemical examination of urine may or may not show presence of Bence Jones protein. There would be need to determine the type/class of M-band by immunoelectrophoresis (IEP) of patient's serum.