Article Sections

Introduction

Multiple myeloma (MM) is a hematologic neoplasm of plasma cells – differentiated B cells capable of secreting antibodies.  The disease is characterized by the production of excess monoclonal immunoglobulins known as M proteins.

Pathogenesis

The pathogenesis of MM likely begins with genetic mutations in plasma cells (eg, affecting cell cycle regulators such as cyclin D1) that lead to unregulated proliferation and:

  • Disrupted hematopoiesis:  Unregulated proliferation of monoclonal plasma cells, or myeloma cells, in the bone marrow interferes with normal hematopoiesis.  B-cell development is particularly affected, reducing plasma cell diversity and the generation of immunoglobulins against specific pathogens.  In addition, impaired erythropoiesis results in a normocytic, normochromic anemia.
  • Bone resorption:  Myeloma cells stimulate osteoclasts by producing receptor activator of nuclear factor kappa B ligand (RANKL) (

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