الفهرس 
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Abstract
Multiple myeloma is a prototype of a differentiated clonal B-cell tumor usually comprising slowly proliferating plasma cells. The disease is mainly contained within the bone marrow with tendency of the malignant plasma cells to invade peripheral blood only in the terminal stage. The disorder is frequently accompanied by monoclonal (M) protein production and either diffuse osteoporosis or lytic bone lesions.
MM is an incurable plasma cell disorder that comprises 1% of all cancer and 10% of hematologic neoplasms. Incidence increases greatly with age: the median age at diagnosis is 70 years.
Clinical manifestations of MM are related to malignant behavior of plasma cells and abnormalities produced by M protein. Plasma cell proliferation causes multiple osteolytic bone lesions, hypercalcemia and bone marrow suppression. Monoclonal M protein causes decreased level of normal immunoglobulins and hyperviscosity.
Diagnosis of MM needs presence of an M-protein in serum and/or urine but in true non-secretory MM, an M protein will not be detectable in the serum or urine. Presence of clonal bone marrow plasma cells (no minimum level, 5% have <5% plasma cells) or after histopathologic confirmation of a soft tissue or bony plasmacytoma. Presence of related organ or tissue impairment by Specification of CRAB.
The initial evaluation of a patient with MM should include testing for specific cytogenetic abnormalities that may help predict response to chemotherapy .MM patients are classified into high and standard risk groups according to mSMART. Although the favorable results obtained with long-term treatment with novel combinations in myeloma are challenging the role of ASCT to be done upfront or at time of relapse, ASCT is considered a cost effective therapy compared with cost of novel agents. As such, all patients should be evaluated at diagnosis for transplant eligibility so that the risks and benefits of ASCT can be reviewed with those eligible.