Dawaa Reference

chronic

Multiple myeloma (plasma cell myeloma)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD25.03 - condition scope only, no dose · Multiple Myeloma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK534764/ · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Multiple myeloma (plasma cell myeloma) - disease-level clinical article (multiple-myeloma-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

  • CRAB features - raised calcium, kidney dysfunction, anaemia, or bone pain from lytic lesions - are the classic picture, often in an older adult [anaemia · bone pain]
  • In one series, anaemia was present in 73%, bone pain in 58%, raised creatinine in 48%, fatigue in 32%, high calcium in 28%, and weight loss in 24% [anaemia · bone pain · fatigue · weight loss]
  • High calcium from bone breakdown may show up as drinking and urinating more, aching bones or belly, feeling sick, being sick, or confusion [bone pain · confusion · nausea · vomiting]
  • Anaemia can bring on fatigue, palpitations, and worsening of pre-existing heart failure or angina [anaemia · fatigue · palpitations]
  • Bone pain from lytic lesions can lead to fractures, vertebral collapse with loss of height, cord compression, radicular pain, or kyphosis [bone pain · collapse]
  • Peripheral neuropathy or carpal tunnel syndrome is uncommon and should prompt a work-up for coexisting amyloidosis
  • Rare hyperviscosity symptoms - bleeding, confusion, neurological symptoms, or vision changes - are a medical emergency [bleeding · confusion]
  • Recurrent infections, especially pneumonia and kidney infection, are more common in these patients [recurrent infections]

Signs — what you find (1)

  • Pallor may be seen on exam, reflecting the anaemia from bone marrow replacement [anaemia · pallor]

Tests (11)

  • Recommended baseline work-up includes a CBC with differential and platelets, kidney and electrolyte panel with calcium, LDH, and beta-2 microglobulin
  • Serum protein and immunofixation electrophoresis, plus a 24-hour urine protein and urine electrophoresis, are part of the work-up
  • Bone marrow aspirate and biopsy with cytogenetics, plus plasma cell FISH testing, complete the work-up
  • The classic diagnosis needed clonal marrow plasma cells at least 10%, or a biopsy-proven plasmacytoma, plus at least one CRAB feature
  • A serum calcium over 11 mg/dL, or more than 1 mg/dL above the normal upper limit, meets the calcium criterion
  • Renal insufficiency means a creatinine over 2 mg/dL or a creatinine clearance under 40 mL per minute
  • Anaemia is defined as haemoglobin under 10 g/dL, or more than 2 g/dL below the normal lower limit
  • One or more punched-out, radiolucent osteolytic lesions on skeletal X-ray, CT, or PET-CT meets the bone criterion
  • Under the newer criteria, clonal bone marrow plasma cells at 60% is diagnostic on its own
  • An involved-to-uninvolved serum free light chain ratio of 100 or more is also diagnostic by itself
  • An abnormal MRI with more than one focal lesion, each over 5 mm, also meets the newer diagnostic criteria

If not this — what else fits (5)

  • MGUS has a serum monoclonal protein under 3 g/dL, clonal marrow plasma cells under 10%, and no end-organ damage
  • Smouldering myeloma has monoclonal protein at 3 g/dL or more and clonal plasma cells between 10% and 59%, still with no end-organ damage
  • Solitary plasmacytoma is one clonal-plasma-cell lesion with an otherwise normal marrow, clear imaging elsewhere, and no end-organ damage
  • Waldenstrom macroglobulinaemia has an IgM protein, unusual in myeloma, plus MYD88 L265P, with hyperviscosity, neuropathy, anaemia, and enlarged nodes or organs
  • AL amyloidosis brings heart failure, an enlarged liver, or nephrotic syndrome, with under 20% marrow plasma cells, no lytic lesions, and Congo-red staining

SourceStatPearls "Multiple Myeloma" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Needs urgent haematology referral for diagnosis (protein studies, bone marrow) and chemotherapy; GP can offer cautious analgesia (avoiding NSAIDs, which risk worsening the renal impairment common in myeloma) while arranging referral. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Needs urgent haematology referral for diagnosis (protein studies, bone marrow) and chemotherapy; GP can offer cautious analgesia (avoiding NSAIDs, which risk worsening the renal impairment common in myeloma) while arranging referral.

Cautions
  • RED FLAG - Acute metastatic spinal cord compression (severe new back pain, lower limb motor weakness, sensory level, urinary retention): assess urgently and refer.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Spinal cord compression resulting from vertebral fracture or plasmacytoma is an emergency requiring immediate intervention.
  • RED FLAG - Bone pain or pathological fracture, renal impairment, unexplained anaemia, hypercalcaemia symptoms (confusion, constipation, thirst), or recurrent infections.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.