Multiple myeloma continues to represent an enormous challenge for the haematology oncologist. Until very recently, complete remission rates were less than 5% while the three year survival rate has been around 25%. This disease is a nightmare for the haematology oncologist. The setbacks are due to poor chemo-sensitivity and non-existent cure rates, terribly painful bone disease and hardly any  progress in treatment for the last 25 years

It was originally considered to be a tumour arising from the bone marrow itself. However, recent studies have shown that the increased plasma cells in the marrow are the terminally-differentiated progeny of a malignant pre-plasma cell population that circulates in the blood stream. These cells seed the marrow with antibody-producing plasma cells all derived from the one cell, that made an identical protein to produce the paraprotein band.  However, 20% of the cases made light chains only which spills over into the urine and are not detectable either by serum electrophoresis  or by dipstick urine protein tests. A serum and urine electrophoresis must be done to exclude myeloma. The onset is insidious. This growing tumour produces paraprotein, invades the bone marrow, and causes bony resorption. The insidious nature yet powerful progression collectively explains why  the patient presents late. The pathogenesis of organ dysfunction and symptoms is highly complex.

Therefore, a unique and protean spectrum of presentations and complications can occur in patients with myeloma. These include renal failure and hyperviscosity syndrome from the paraproteinaemia, bone disease and pathological fractures from excessive action of osteoclast activating factor, signs and symptoms of bone marrow failure from high tumour burden or treatment, and recurrent infections from immune paresis, resulting from hypogammaglobulinaemia.