Key points

• Symptoms and complications of myeloma occur as a result of the consequences of myeloma cell infiltration into the bone marrow; the effects of paraprotein in the blood and/or the urine; the secretion of cytokines, and inadequate production of normal antibodies
• Symptoms and complications of myeloma most commonly include bone pain and skeletal damage, anaemia, fatigue, hypercalcaemia, recurrent or persistent infection, renal impairment and/or failure, hyperviscosity and neurological symptoms
• A diagnosis of myeloma is made by the detection of: paraprotein in the serum or urine; more than 10% plasma cells in the bone marrow; myeloma-related organ or tissue impairment
• Other plasma cell disorders may present with symptoms and or laboratory features similar to myeloma. These include AL amyloidosis, solitary plasmacytoma of the bone, extramedullary plasmacytoma and Waldenström’s macroglobulinaemia
• Monoclonal gammopathy of undetermined significance (MGUS) is a benign condition and is defined by the presence of low levels of a monoclonal protein
• Smouldering myeloma is distinguished from active myeloma by specific criteria related to the amount of serum paraprotein, clonal plasma cells in the bone marrow and absence of myeloma-defining events. Patients are generally asymptomatic and do not require treatment except for patients who fall into the high-risk smouldering myeloma category
• Nurses can play an important role in supporting patients around diagnosis
• Knowledge of the myeloma diagnosis pathway will help to ensure nurses can answer patients’ questions accurately and respond appropriately with a range of supportive care resources