© Springer International Publishing AG 2017 73
T. Pandey (ed.), Imaging in Stem Cell Transplant and Cell-based Therapy,
Stem Cell Biology and Regenerative Medicine, DOI 10.1007/978-3-319-51833-6_5
Chapter 5
Stem Cell Transplantation for Multiple
Myeloma
Sharmilan Thanendrarajan and Tarun K. Garg
5.1 Multiple Myeloma
Multiple myeloma (MM) is a malignant blood disorder which is characterized by
accumulation of abnormal, clonal plasma cells (myeloma cells) in the bone marrow
with production of complete and/or partial (light chain) monoclonal immunoglobu
lin protein which can be detected in serum and/or urine [ 1 ]. The expansion of plasma
cells in the bone marrow leads to impairment of hematopoiesis with leucopenia,
anemia and thrombocytopenia, resulting in clinical symptoms consisting of recur
rent infections, persisting fatigue and bleedings [ 2 ]. Further major characteristics of
this fatal disease are bone lesions with pathological fractures and/or cord comp
ression, renal insufficiency (related to cast nephropathy) and hypercalcemia [ 2 ].
Hypercalcemia (C), renal insufficiency (R), anemia (A) and bone lesions (B) are
summarized as CRABcriteria and stand for myeloma defining events [ 3 ]. Figure 5.1.
provides an overview and summary of the diagnostic criteria for MM according to
the International Myeloma Working Group (IMWG). MM is the second most com
mon hematological malignancy and contributes to 1% of all malignant tumors [ 2 ,
4 ]. The median age at diagnosis is 70 years, and more than 60% of the newly diag
nosed patients are elder than 65 years [ 2 ].
MM arises from asymptomatic premalignant expansion of monoclonal plasma
cells in the bone marrow that are derived from post–germinalcenter B cells. Several
additional microenvironmental and genetic changes lead to the transformation of
these abnormal plasma cells into a malignant neoplasm. The first stage in this pro
cess is defined as monoclonal gammopathy of undetermined significance (MGUS)
that progresses to smoldering myeloma and finally to symptomatic MM which
required systemic treatment [ 5 ]. The risk of progression from MGUS to MM
S. Thanendrarajan, M.D. Dr. Med. (GER) (*) • T.K. Garg, Ph.D.
Myeloma Institute, University of Arkansas for Medical Sciences (UAMS),
4301 West Markham St, Little Rock, AR 72211, USA
email: [email protected]