Acute complications in multiple myeloma

Svetlana Stankovikj, Kata Martinova


Multiple myeloma is a malignant disorder of plasma cells, characterized by uncontrolled and progressive proliferation of a single clone of plasma cells. The disease leads to progressive morbidity and eventual mortality by lowering resistance to infection and causing significant skeletal destruction with bone pain, pathological fractures and hypercalcemia. Improved understanding of the multiple myeloma biology along with the discovery of novel anti-myeloma agents has led to a better-quality treatment of these patients. However, it still remains an incurable disease for the vast majority of patients, with a median survival 2-3 years. Patients with multiple myeloma frequently develop complications that are reason for early mortality within 60 days of diagnosis. Acute complications such as hyperviscosity syndrome, hypercalcemia, spinal cord compression, early infection, bone disease and renal impairment may be life-threatening. The treatment of these medical emergencies has greatly decreased morbidity and early mortality in patients.


multiple myeloma, hyperviscosity syndrome, hypercalcemia, spinal cord compression

Full Text:



Palumbo A, Anderson K. Multiple myeloma. N Engl J Med.2011; 364(11): 1046-60.

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008. Int J Cancer 2010;127(12):2893- 917.

Mehta J, Singhah S. Hyperviscosity syndrome in plasma cell dyscrasias. Semin Thromb Hemost. 2003; 29(5): 467-71.

Kwaan HC. Hyperviscosity in plasma cell dyscrasias. Clin Hemorheol Microcirc. 2013; 55 (1):75-83.

Patient Care Spotlight. Current Management of Hypercalcemia Associated with Multiple Myeloma.Advances in Hematologic Malignancies. 2013;Issue 2.

Stewart AF. Clinical practice. Hypercalcemia associated with cancer. N Engl J Med. 2005;352(4):373–9.

Durie BGM, Salmon SE, Mundy GR. Relation of osteoclast activating factor production to the extent of bone disease in multiple myeloma. Br J Haematol.1981;47(1):21–30.

Thomas S.A, Chung S-H. Management of Hypercalcemia of Malignancy. JHOP,2016;6(1):18-21.

Tosi P.Diagnosis and treatment of bone disease in multiple myeloma: spotlight on spinal involvement. Scientifica. 2013;2013: 104546.

Damaj G, Mohty M, Vey N, Dincan E, Bouabdallah R, Faucher C, et al. Features of extramedullary and extraosseous multiple myeloma : a report of 19 patients from a single center. Eur J Haematol. 2004;73(6):402–6.

Benson WJ, Scarffe JH, Todd ID, Palmer M, Crowther D. Spinal-cord compression in myeloma. Br Med J. 1979;1(6177):1541–4.

Matsui H, Fujie H, Tsuji H. Extraosseous epidural tumor of immunoglobulin D myeloma. J Spinal Disord. 1992;5(3):366–9.

Avadhani A, Shetty AP, Rajasekaran S. Isolated extraosseous epidural myeloma presenting with thoracic compressive myelopathy. Spine J. 2010;10(4):e7–e10.

Lourbopoulos A, Ioannidis P, Balogiannis I, Stavrinou P, Koletsa T, Karacostas D. Cervical epidural plasmacytoma presenting as ascending paraparesis. Spine J. 2011;11(5):e1–4.

Jin R, Rock J, Jin JY, Janakiraman N, Kim JH, Movsas B, et al. Single fraction spine radiosurgery for myeloma epidural spinal cord compression. J Exp Ther Oncol. 2009;8(1):35–41.

Renier JC, Brégeon C, Boasson M, Audran M, Emile J, Guy G, et al. Spinal cord compression in multiple myeloma Study of 10 cases. Rev Rhum Mal Osteoartic.1984;51(4):193–6.

Smith A, Wisloff F, Samson D, UK Myeloma Forum, Nordic Myeloma Study Group, British Committee for Standards in Haematology.. Guidelines on diagnosis and management of multiple myeloma 2005. British Journal of Hematology 2006;132(4):410-51.

Augustson BM, Begum G, Dunn JA, Barth NJ, Davies F, Morgan G et al. Early mortality after diagnosis of multiple myeloma: analysis of patients entered onto the United kingdom Medical Research Council trials between 1980 and 2002--Medical Research Council Adult Leukaemia Working Party.J Clin Oncol.2005;23(36):9219-26.

Savage DG, Lindenbaum J, Garret TJ. Biphasic pattern of bacterial infection in multiple myeloma. Ann Intern Med.1982;96(1):47–50.

Oken MM, Pomeroy C, Weisdorf D, Bennett JM. Prophylactic antibiotics for the prevention of early infection in multiple myeloma. Am J Med. 1996;100(6):624–8.

Bucaneve G, Micozzi A, Menichetti F, Martino P, Dionisi MS, Martinelli G et al. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med. 2005;353(10):977–87.

Terpos E, Dimopolous M.A. Myeloma bone disease: pathophysiology and management. Ann Oncol. 2005; 16(8): 1223-31.

Giuliani N, Colla S, Rizzoli V. Update on the pathogenesis of osteolysis in multiple myeloma patients, Acta Biomed. 2004;75(3):143-52.

Barille-Nion S, Bataille R. New insights in myeloma-induced osteolysis. Leuk Lymphoma. 2003;44(9):1463-7.

Eleutherakis-Papaiakovou V, Bamia A, Gika D, Simeonidis A, Pouli A, Anagnostopoulos A, et al.Renal failure in myeloma multiplex: incidence, correlations and prognostic significance. Leukemia and Lymphoma. 2007; 48(2): 337-41.

Katagiri D, Noiri E, Hinoshita F. Multiple Myeloma and Kidney Disease. The Scientific World Journal.2013; 2013:487285.

Dimopoulos MA, KastritisE, RosinolL, BladéJ, and LudwigH. Pathogenesis and treatment of renal failure in multiple myeloma.Leukemia. 2008;22(8): 1485–93.



  • There are currently no refbacks.

Copyright (c) 2017 Svetlana Stankovikj, Svetlana Stankovikj, Kata Martinova, Vera Stankovikj

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.