Myeloma is a malignancy of the plasma cells that normally produce immunoglobulin. It affects multiple organs and systems, including the bones, kidneys, blood and immune systems.

Myeloma is the seventeenth most common cancer in the UK. In 2010, 4672 people in the UK were diagnosed with myeloma. It occurs more frequently in men and in people of African–Caribbean family origin. Diagnosis is often delayed because the symptoms are not specific to myeloma, and this leads to significant early morbidity and mortality.

Myeloma management is complex and challenging. Effective treatments have been developed over the past 15 years, and although myeloma is still incurable these treatments have led to improvements in overall survival and quality of life. However, myeloma treatment increasingly involves expensive drugs and frequent hospital visits. Complications of myeloma and myeloma treatment cause an increasing long‑term strain on supportive and palliative care services, and on carers.

This guideline covers areas in which there is uncertainty or variation in practice. It contains recommendations on:

  • communication and support

  • laboratory investigations and imaging to diagnose myeloma and determine further treatment

  • managing bone disease and acute renal disease

  • autologous and allogeneic stem cell transplantation

  • preventing and managing myeloma‑ and treatment‑induced complications

  • monitoring for people with smouldering myeloma and myeloma.

Because of the changes to the International Myeloma Working Group definition of smouldering myeloma, it was not possible to make any recommendations for clinical practice on managing this condition. The new definition has changed how smouldering myeloma and myeloma are differentiated, and there is currently no evidence available that is using the new definitions.

This guideline covers adults (aged 16 years and over):

  • who are referred to secondary care with suspected myeloma

  • with newly diagnosed or relapsed myeloma (including high‑risk myeloma and primary plasma cell leukaemia).

This guideline does not cover people who have:

  • a solitary plasmacytoma without myeloma

  • amyloid light‑chain amyloidosis in the absence of myeloma

  • paraproteins secondary to other conditions.