II. Epidemiology

  1. Elderly (median age 70 years old)
    1. Those <65 years old with Multiple Myeloma represent only 15% of cases
  2. Incidence: 28,850 new cases per year in United States (2015)
  3. Deaths: 11,000 per year
  4. Twice as common in black persons
  5. More common in men
  6. Family History confers 2-4 fold increased risk (Autosomal Dominant trait)
  7. Associated conditions
    1. Obesity
    2. Rheumatoid Arthritis
    3. Monoclonal Gammopathy of Undetermined Significance (MGUS)
  8. Associated with certain occupational exposures
    1. Farming Pesticides
    2. Petroleum workers
    3. Woodworkers
    4. Leather workers
    5. Ionizing radiation

III. Pathophysiology

  1. Malignant proliferation of Plasma Cells
    1. Overproduce monoclonal protein
    2. Abnormal Immunoglobulin (IgG, IgM, IgA are most common)
    3. May also involve light chains (either kappa or lambda)
  2. Plasmacytoma may also form solitary plasma cell tumor
  3. On spectrum of plasma cell malignancy
    1. Spontaneous (de novo) onset in 80% of cases
    2. Monoclonal Gammopathy of Undetermined Significance (MGUS) in 20% of cases
      1. Progression to Multiple Myeloma at rate of 1% per year
    3. Smoldering Multiple Myeloma (SMM)
      1. Progression to Multiple Myeloma at rate of 10% per year for first five years (then decreases)
    4. Clinical Multiple Myeloma
    5. Plasma Cell Leukemia
  4. Risk Factors for progression from MGUS or SMM to Multiple Myeloma
    1. Non-IgG subtype
    2. High levels of monoclonal protein
    3. Abnormal free light chain ratio
    4. Gene alterations

IV. Symptoms

  1. Asymptomatic in 34% of cases (present with abnormal labs: Anemia, Proteinuria, Hypercalcemia)
  2. Back pain or bone pain (58%)
  3. Fatigue (32%)
  4. Pathologic Fracture (up to 34-40% of cases)
  5. Anorexia and weight loss (24%)
  6. Paresthesias (5%)
    1. Wrist Pain (Carpal Tunnel related Neuropathy)
  7. Other presenting symptoms
    1. Nausea or Vomiting
    2. Spinal cord compression (5%)
    3. Hyperviscosity related symptoms (e.g. Venous Thromboembolism, TIA, Retinal Hemorrhage)

V. Signs: Bone Findings

  1. Osteolytic lesions
  2. Pathologic Fractures
  3. Palpable swellings on accessible bones
  4. Location
    1. Sternum
    2. Skull
    3. Ribs
    4. Vertebrae (May result in spinal cord compression)

VI. Differential Diagnosis: General

  1. Primary or metastatic cancer
  2. Benign bone lesions
  3. Vertebral Compression Fracture (Osteoporosis)

VII. Differential Diagnosis: Plasma Cell Peripheral Disorder

  1. Common
    1. Monoclonal Gammopathy of Undetermined Significance (MGUS)
  2. Uncommon
    1. Waldenstrom Macroglobulinemia
    2. Amyloidosis
    3. B-Cell non-Hodgkin Lymphoma
  3. Rare
    1. Plasmacytoma
    2. Plasma Cell Leukemia

VIII. Labs: Initial

  1. Comprehensive Metabolic Panel (including Serum Calcium, Serum Albumin and protein, Renal Function tests, electrolytes)
    1. Hypercalcemia
      1. Serum Calcium >10.1 mg/dl (present in 28%, Serum Calcium >11 mg/dl in 13% of patients)
    2. Renal Insufficiency
      1. Serum Creatinine >1.3 mg/dl (present in 48%, Creatinine >2 mg/dl in 23% of patients)
  2. Complete Blood Count with platelets
    1. Normochromic Normocytic Anemia
      1. Hemoglobin <12 grams/dl (present in 65-73% of patients)
      2. Anemia is nearly always present at one point for every patient
  3. Other initial tests to consider
    1. Thyroid Stimulating Hormone (TSH)
    2. Acute phase reactants (ESR, C-RP)
    3. Serum Vitamin B12
    4. Urinalysis
      1. Proteinuria (bence jones proteins)
    5. Peripheral Smear
      1. Myeloma Cells
      2. Rouleaux of Red Blood Cells

IX. Labs: Confirmatory

  1. Serum Protein Electrophoresis and Urine Protein electrophoresis for Monoclonal Peak
    1. M Protein in either serum or urine: 97% of patients
    2. Serum M Protein by electophoresis (82%) or immunofixation (93%)
    3. Urine M Protein by electrophoresis: 75%
  2. Immunofixation electrophoresis of serum and urine
  3. Serum quantitative Immunoglobulins
  4. 24 Hour Urine Protein
  5. Beta-2 microglobulin
  6. Lactate Dehydrogenase (LDH)
  7. Serum free light chain

X. Labs: Diagnosis - typically done in oncology

  1. Bone Marrow Biopsy and aspirate (with cytogenetics, FISH, immunohistochemistry)
    1. Typically performed by oncology
    2. HemeoncMultipleMyelomaMarrow.jpg

XI. Imaging

  1. Skeletal Survey (including Skull XRay)
    1. Recommended imaging for primary providers
    2. Classic "punched out" lytic lesions (66% of patients)
    3. Pathologic Fractures (26% of patients)
  2. PET/CT or whole body MRI
    1. Typically obtained in oncology
  3. Bone Densitometry or DEXA (consider)
    1. Osteoporosis (23% of patients)

XII. Diagnosis: Multiple Myeloma

  1. Clonal Bone Marrow plasma cells >10% or biopsy proven bony or extramedullary Plasmacytoma AND
  2. Myeloma defining event (one or more, absence suggests smoldering Multiple Myeloma)
    1. Hypercalcemia
      1. Serum Calcium >11 mg/dl (or >1 mg/dl above upper range of normal)
    2. Renal Insufficiency
      1. Serum Creatinine >2 mg/dl (or GFR <40 ml/min)
    3. Anemia
      1. Hemoglobin <10 g/dl (or more than 2 g/dl below the lower limit of normal)
    4. Osteolytic Bone lesions
      1. Osteolytic lesions (one or more) on XRay, CT or PET/CT

XIII. Staging

  1. Systems
    1. International Staging (ISS)
      1. Standard staging system used most commonly (as of 2017)
    2. Revised International Staging (R-ISS)
      1. Better predictor of progression and survival than ISS (which it will likely replace)
    3. Durie-Salmon Staging
  2. Stage I
    1. International Staging (ISS)
      1. Serum B2 Microglobulin <3.5 mg/L and Serum Albumin >= 3.5 g/dl
    2. Revised International Staging (R-ISS)
      1. ISS Stage I AND
      2. Normal Lactate Dehydrogenase (LDH)
      3. No high risk Chromosomes (e.g. del(17p), t(4;14), t(14:16))
    3. Durie-Salmon Staging
      1. Hemoglobin >10 g/dl
      2. Serum Calcium <12 mg/dl
      3. No bone disease or Plasmacytoma
      4. Serum paraprotein <5g/dl (IgG) or <3 g/dl (IgA)
      5. Urinary light chain excretion <4 g per 24 hours
  3. Stage 2
    1. International Staging
      1. Serum B2 Microglobulin 3.5 to 5.5 mg/L
    2. Revised International Staging (R-ISS)
      1. Not R-ISS stage I or III
    3. Durie-Salmon Staging
      1. Not DSS stage I or III
  4. Stage 3
    1. International Staging
      1. Serum B2 Microglobulin >=5.5 mg/L
    2. Revised International Staging (R-ISS)
      1. ISS Stage III AND
      2. Increased Lactate Dehydrogenase (LDH) OR
      3. High risk Chromosomes (e.g. del(17p), t(4;14), t(14:16))
    3. Durie-Salmon Staging
      1. Hemoglobin <8.5 g/dl
      2. Serum Calcium >12 mg/dl
      3. Skeletal Survey with >2 lytic lesions
      4. Serum paraprotein >7 g/dl (IgG) or >5 g/dl (IgA)
      5. Urinary light chain excretion >12 g per 24 hours

XIV. Management: Combination Therapy

  1. Indication
    1. Symptomatic Multiple Myeloma
  2. Protocol 1: Otherwise physically healthy patients (previously limited to age <65 years)
    1. High dose myeloablative Chemotherapy (2-3 drug, historically included Vincristine, Doxorubicin), AND
    2. Autologous Stem Cell Transplant (ASCT)
  3. Protocol 2: Serious comorbidity (unable to tolerate marrow ablation and ASCT)
    1. Historically treated with Melphalan, Prednisolone, and in some cases Thalidomide
    2. See oncology references for current management protocols
  4. Other medications
    1. Newer Chemotherapy agents: Proteasome Inhibitors (monoclonal antibodies)
      1. Bortezomib (Velcade)
      2. Carfilzomib (Kyprolis)
    2. Corticosteroids (Dexamethasone)
      1. Administered concurrently with Chemotherapy to reduce light chain renal load (Kidney injury risk)
  5. Efficacy
    1. ASCT increases median survival 12 months, and results in longterm survival 10% in some cases
    2. Palliative (Not curative)
    3. Relapse is common

XV. Management: Adjunctive

  1. Bisphosphonates (IV Zoledronic acid or Pamidronate)
    1. All treated patients (regardless of bony lesions) to prevent Vertebral Fractures and other bony complications
    2. Vitamin D supplementation should also be given, and consider Calcium Supplementation with caution
    3. Terpos (2013) J Clin Oncol 31(18): 2347-57 [PubMed]
  2. Venous Thromboembolism prophylaxis
    1. Reduces VTE Risk from 12-26% to 5-8% in Multiple Myeloma
    2. Indications
      1. Active treatment of Multiple Myeloma (esp. immunomodulatory agents)
      2. Continue for first 4-6 months after diagnosis (or until disease controlled)
    3. Options
      1. Low Molecular Weight Heparin (e.g. Lovenox)
      2. Warfarin (Coumadin) and target INR 2-3
      3. As an alternative, Aspirin alone may be considered for patients at very low risk
    4. References
      1. Falanga (2012) Curr Opin Oncol 24:702-10 [PubMed]
  3. Prophylactic antibiotics
    1. First 3 months of treatment (some cases)
      1. Trimethoprim-sulfamethoxazole (Septra, Bactrim) OR
      2. Fluoroquinolone
    2. Recurrent pneumococcal infections
      1. Penicillin
    3. Proteasome inhibitor therapy
      1. Antivirals (prevent Varicella Zoster Virus reactivation)
  4. Immunizations (at least 2 weeks before or 1 month after ASCT)
    1. Pneumococcal Vaccine
    2. Haemophilus influenzae B Vaccine
    3. Influenza Vaccine
  5. Anemia management
    1. Erythropoiesis-stimulating agents (risk of thrombosis)
    2. Red Blood Cell transfusion for Hemoglobin <7 g/dl
  6. Pain management
    1. Analgesics
    2. Neuropathy medications
    3. Physical Activity

XVI. Management: Monitoring

  1. Complication monitoring (see below)
    1. Weight loss
    2. Fatigue
    3. Bone pain
    4. Peripheral Neuropathy
    5. Venous Thromboembolism
    6. Infection
    7. Chemotherapy adverse effects and toxicity (e.g. Pancytopenia)
  2. MGUS and SMM monitoring
    1. Scheduled monitoring of paraproteins and serum light chains

XVII. Complications

  1. Immune Suppression
    1. Infection presenting complaint in 25% of patients
    2. Start empiric antibiotics for febrile illness
    3. See prevention below for Immunizations
  2. Hypercalcemia
    1. Initial Management: Normal Saline Infusion with Corticosteroids
    2. Additional management in Refractory Cases: Furosemide, Bisphosphonates
  3. Renal Failure
    1. Acute Kidney Injury is multifactorial (free light chains at proximal tubules, Hypercalcemia, dehydration, nephrotoxicity)
    2. Treat Acute Kidney Injury with crystalloid (e.g. NS, at least 3 L/day)
    3. Dexamethasone is often given prophylactically with Chemotherapy to reduce light chain renal load
    4. Dialysis as indicated
  4. Neuropathy (Nerve infiltration by amyloid)
  5. Anemia
    1. Results from Bone Marrow invasion
    2. Consider differential diagnosis for Anemia
    3. Often improves with Multiple Myeloma treatment
    4. Consider Erythropoietin or transfusion
  6. Invasive bone lesions (80-90%)
    1. Pathologic Fractures
    2. Bone pain
    3. Osteoporosis
    4. Hypercalcemia
  7. Vertebral Fractures
    1. See Vertebral Fracture
    2. Intravenous Bisphosphonates (Pamidronate, Zoledronic acid)
      1. Continue indefinately
      2. Reduces fracture Incidence and pain
    3. Surgical Intervention: Percutaneous Vertebroplasty or Kyphoplasty
      1. Indicated in refractory cases
    4. Radiation Therapy
      1. Indicated for spinal cord compression
  8. Hyperviscosity Syndrome
    1. Findings: Fatigue, Headache, Visual disturbance, Retinopathy
    2. Treat with plasma exchange, antimyeloma Chemotherapy

XVIII. Monitoring

  1. Symptomatic improvement
  2. Decrease in M Component

XIX. Prognosis

  1. Invariably fatal but relates to staging
    1. Stage I: 62 Month median survival
    2. Stage 3: 29 Month median survival
  2. Treated patients live asymptomatically for years
    1. Five year survival was 45% in 2007 (compared with 30% in 1990)
    2. Median overall survival approaches 8 years with modern management (including monoclonal antibodies)
  3. Mortality from cause unrelated to Myeloma: 25%

XX. Resources

  1. Multiple Myeloma Research Web Server
    1. http://myeloma.med.cornell.edu
  2. Cleveland Clinic Multiple Myeloma and Amyloidosis
    1. http://www.clevelandclinic.org/myeloma

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Ontology: Multiple Myeloma (C0026764)

Definition (MEDLINEPLUS)

Multiple myeloma is a cancer that begins in plasma cells, a type of white blood cell. These cells are part of your immune system, which helps protect the body from germs and other harmful substances. In time, myeloma cells collect in the bone marrow and in the solid parts of bones.

No one knows the exact causes of multiple myeloma, but it is more common in older people and African Americans. It can run in families. Common symptoms may include

  • Bone pain, often in the back or ribs
  • Broken bones
  • Weakness or fatigue
  • Weight loss
  • Repeated infections
  • Frequent infections and fevers
  • Feeling very thirsty
  • Frequent urination

Doctors diagnose multiple myeloma using lab tests, imaging tests, and a bone marrow biopsy. Your treatment depends on how advanced the disease is and whether you have symptoms. If you have no symptoms, you may not need treatment right away. If you have symptoms, you may have chemotherapy, stem cell transplantation, radiation, or targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells.

NIH: National Cancer Institute

Definition (NCI_NCI-GLOSS) A type of cancer that begins in plasma cells (white blood cells that produce antibodies).
Definition (NCI) A bone marrow-based plasma cell neoplasm characterized by a serum monoclonal protein and skeletal destruction with osteolytic lesions, pathological fractures, bone pain, hypercalcemia, and anemia. Clinical variants include non-secretory myeloma, smoldering myeloma, indolent myeloma, and plasma cell leukemia. (WHO, 2001)
Definition (NCI_CDISC) A malignant neoplasm of the bone marrow composed of plasma cells.
Definition (CSP) malignant neoplasm of plasma cells usually arising in the bone marrow and manifested by skeletal destruction, bone pain, and the presence of anomalous immunoglobulins.
Definition (MSH) A malignancy of mature PLASMA CELLS engaging in monoclonal immunoglobulin production. It is characterized by hyperglobulinemia, excess Bence-Jones proteins (free monoclonal IMMUNOGLOBULIN LIGHT CHAINS) in the urine, skeletal destruction, bone pain, and fractures. Other features include ANEMIA; HYPERCALCEMIA; and RENAL INSUFFICIENCY.
Concepts Neoplastic Process (T191)
MSH D009101
ICD9 203.0
ICD10 C90.0 , M9732/3, C90.00
SnomedCT 55921005, 94705007, 154585004, 109989006
English Multiple Myeloma, Multiple Myelomas, Myeloma, Plasma Cell, Myelomas, Multiple, MYELOMATOSIS MULTIPLE, Myeloma, Plasma-Cell, Myelomas, Plasma-Cell, PLASMA CELL MYELOMA, Plasma-Cell Myeloma, Plasma-Cell Myelomas, Multiple myeloma / Plasma cell neoplasm, MYELOMA, MULTIPLE, [M]Plasma cell myeloma, multiple myeloma (diagnosis), multiple myeloma, Multiple myeloma, no ICD-O subtype, Peripheral plasma cell myeloma, Plasma Cell Myeloma, Cell Myeloma, Plasma, Cell Myelomas, Plasma, Plasma Cell Myelomas, Myelomas, Plasma Cell, Multiple myeloma NOS, Multiple Myeloma [Disease/Finding], Myeloma-Multiple, Kahler Disease, Myelomatoses, Disease, Kahler, Myelomatosis, Myeloma-Multiples, Myeloma Multiple, myelomas, kahler disease, Myeloma;multiple, multiple myeloma (MM), multiple myelomatosis, kahler's disease, multiple myelomas, Myeloma, Multiple, Plasma-cell myeloma, Plasma-cell Myeloma, Multiple myeloma myelomatosis, Myelomatosis multiple, Myeloma (disorder), Multiple myeloma, no International Classification of Diseases for Oncology subtype (morphologic abnormality), Multiple myeloma, no ICD-O subtype (morphologic abnormality), Multiple myeloma, no International Classification of Diseases for Oncology subtype, Plasma cell myelomas, MYELOMA, myeloma, MULTIPLE MYELOMA, MYELOMA, PLASMA CELL, MALIGNANT, Myeloma, NOS, myelomatosis, Kahler disease, Plasma cell myeloma, Plasmacytic myeloma, Myeloma, Multiple myeloma, Kahler's disease, Multiple myeloma (disorder), plasma cell neoplasm, neoplasm, plasma cell, myeloma, plasma cell, plasma cell myeloma, myeloma, multiple, multiple myeloma and other plasma cell neoplasms, plasma cell neoplasms, Kahler, myelomata; multiple, Multiple myeloma (clinical), Multiple myeloma, morphology (morphologic abnormality)
French MYELOME MULTIPLE, Myélome périphérique à cellules plasmatiques, MYELOMATOSE MULTIPLE, Myélomatose multiple, Myélomatose avec myélomes multiples, Myélome des cellules plasmatiques, Myélomatose, Myélome, Myélomes plasmocytaires, Myélome multiple, Maladie de Kahler
Portuguese MIELOMA MULTIPLO, Mieloma plasmocítico periférico, MIELOMATOSE MULTIPLA, Mieloma de Plasmócitos, Mielomatose múltipla, Mieloma múltiplo, Mieloma, Mielomatose, Mieloma de plasmócitos, Mielomatose de mieloma múltiplo, Mieloma Plasmocitário, Mielomas de plasmócitos, Mieloma Múltiplo
Spanish MIELOMA MULTIPLE, Mieloma de células plasmáticas periféricas, mieloma múltiple, morfología (anomalía morfológica), mieloma múltiple (clínico) (trastorno), MIELOMATOSIS MULTIPLE, mieloma múltiple, subtipo sin ICD-O (anomalía morfológica), mieloma múltiple, subtipo sin ICD-O, (M)mieloma de células plasmáticas, mieloma múltiple, no clasificado como subtipo en CIE-O, Mieloma, Mielomatosis, Mieloma de células plasmáticas, Mielomatosis múltiple, Mieloma múltiple, mieloma múltiple, enfermedad (concepto no activo), enfermedad de Khaler, mieloma múltiple, no clasificado como subtipo en la Clasificación Internacional de Enfermedades para Oncología (anomalía morfológica), mieloma múltiple, no clasificado como subtipo en CIE-O (anomalía morfológica), mieloma múltiple, no clasificado como subtipo en la Clasificación Internacional de Enfermedades para Oncología, Mielomas de células plasmáticas, mieloma de células plasmáticas, mieloma múltiple, mielomatosis, mieloma, mieloma múltiple (clínico), enfermedad de Kahler, mieloma múltiple (trastorno), Mieloma de Células Plasmáticas, Mieloma Múltiple
German MULTIPLES MYELOM, peripheres Plasmazellenmyelom, MYELOMATOSE MULTIPLE, Plasmozytom [Multiples Myelom], Plasmazellenmyelom, multiples Myelom, multiples Myelom, Myelomatose, Myelom, Myelomatose multiple, Myelomatose, Plasmazellenmyelome, Multiples Myelom, Myelom, Plasmazell-
Dutch perifeer plasmacelmyeloom, plasmacel myeloom, myelomatosis, multipel myeloom, myeloom, multipel myeloom myelomatosis, myelomatosis multipel, plasmacelmyelomen, myelomata; multipel, Multipel myeloom, Myeloom, multipel, Plasmacelmyeloom
Italian Plasmocitoma maligno periferico, MM, Mieloma plasmacellulare, Malattia di Kahler-Bozzolo, Mieloma, Mielomatosi multipla, Mielomatosi, Mielomatosi da mieloma multiplo, Mielomi delle plasmacellule, Mieloma multiplo
Japanese 末梢形質細胞性骨髄腫, マッショウケイシツサイボウセイコツズイシュ, 骨髄腫-多発性, Kahler病, 骨髄腫症, ミエローマ, ケイシツサイボウセイコツズイシュ, タハツセイコツズイシュ, ミエローマ, コツズイシュショウ, 多発性骨髄腫症, タハツセイコツズイシュショウ, カーレル病, プラスマ細胞性骨髄腫, 多発性骨髄腫, 多発骨髄腫, 形質細胞性骨髄腫, 形質細胞骨髄腫, 骨髄腫-形質細胞, カーラー病
Swedish Multipelt myelom
Finnish Multippeli myelooma
Russian MIELOMNAIA BOLEZN', MIELOMA MNOZHESTVENNAIA, MIELOMATOZ, BOLEZN' RUSTITSKOGO-KALERA, MIELOMA, RETIKULOPLAZMOTSITOZ, MNOZHESTVENNAIA MIELOMA, БОЛЕЗНЬ РУСТИЦКОГО-КАЛЕРА, МИЕЛОМА, МИЕЛОМА МНОЖЕСТВЕННАЯ, МИЕЛОМАТОЗ, МИЕЛОМНАЯ БОЛЕЗНЬ, МНОЖЕСТВЕННАЯ МИЕЛОМА, РЕТИКУЛОПЛАЗМОЦИТОЗ
Czech Myelom z periferních plazmatických buněk, mnohočetný myelom, myelom mnohočetný, nemoc Kahlerova, Kahlerova nemoc, Myelom, Myelomatóza mnohočetná, Myelomatóza, Myelomatóza s mnohočetným myelomem, Mnohočetný myelom, Plazmocytický myelom, mnohotný myelom, myelomatóza, plazmocytární myelom, Myelomy z plazmatických buněk
Korean 다발성 골수종
Croatian MULTIPLI MIJELOM
Polish Siatkowiak plazmocytowy, Choroba Kahlera, Plasmocytoma, Szpiczak mnogi, Szpiczak plazmocytowy
Hungarian Peripheriás plazmasejtes myeloma, Myelomatosis multiplex, Plazmasejtes myeloma, Myeloma multiplex, Multiplex myeloma myelomatosis, Myelomatosis, Myeloma, Plazmasejtes myelomák
Norwegian Medullært plasmocytom, Kahlers sykdom, Multiple myelomer, Plasmacellemyelom, Myelomatose

Ontology: Plasmacytoma (C0032131)

Definition (NCI_NCI-GLOSS) A type of cancer that begins in plasma cells (white blood cells that produce antibodies). A plasmacytoma may turn into multiple myeloma.
Definition (NCI) A single focus of clonal (malignant) plasma cells either in the bone or in another anatomic site without peripheral blood involvement. --2003
Definition (NCI) A malignant (clonal) proliferation of plasma cells that are cytologically and immunophenotypically identical to those of plasma cell myeloma, but manifest a localized osseous or extraosseous growth pattern. (WHO, 2001)
Definition (MSH) Any discrete, presumably solitary, mass of neoplastic PLASMA CELLS either in BONE MARROW or various extramedullary sites.
Concepts Neoplastic Process (T191)
MSH D010954
ICD10 M9731/3 , C90.3, C90.30
SnomedCT 274907000, 269652000, 189507001, 190017008, 302852008, 190019006, 308122007, 190016004, 188719003, 188720009, 154644004, 309571000009106, 10639003, 109987008, 415112005
English Monostotic myeloma, Plasma Cell Tumors, Plasmacytoma, Plasmacytomas, Plasmocytoma, Plasmocytomas, Plasma Cell Tumor, Plasma cell tumor NOS, Plasma cell tumour NOS, Tumor, Plasma Cell, Tumors, Plasma Cell, [M]Plasma cell tumor NOS, [M]Plasma cell tumour NOS, [M]Plasma cell tumors, [M]Plasma cell tumours, Plasma cell tumors, Plasma cell tumours, [M]Plasmacytoma NOS, Plasmacytoma NOS, malignant plasmacytoma (diagnosis), malignant plasmacytoma, plasmacytoma, Solitary plasmacytoma NOS, Plasmacytoma [Disease/Finding], plasmacytomas, plasmocytomas, plasma cell tumors, bone plasmacytoma, plasma cell tumor, plasma cell neoplasms, plasmacytomas solitary, plasmocytoma, Plasma cell tumor (morphologic abnormality), Myeloma, solitary, [M]Plasmacytoma NOS (disorder), [M]Plasma cell tumor NOS (morphologic abnormality), Plasmacytoma NOS (disorder), [M]Plasma cell tumors (morphologic abnormality), Myeloma - solitary, Plasma cell tumour (clinical), Plasma cell tumor (clinical), Solitary myeloma (clinical), Plasmacytoma of animal, Plasmacytoma of animal (disorder), Plasma cell tumor, Solitary myeloma, Solitary plasmacytoma, Plasma cell tumour, Plasmacytoma of bone, solitary plasmacytoma, monostotic; myeloma, plasma cell, monostotic; myeloma, myeloma; monostotic, plasma cell, myeloma; monostotic, myeloma; solitary, plasma cell; tumor, solitary; myeloma, tumor; plasma cell, Plasmacytoma, NOS, Solitary Plasmacytoma, Plasmacytoma (disorder), Plasmacytoma - disorder, Solitary plasmacytoma of bone (morphologic abnormality), Plasmacytoma (morphologic abnormality)
Italian Plasmocitoma, Tumore plasmacellulare, Tumore delle plasmacellule, Plasmacitoma
Dutch plasmaceltumor, monostotisch; myeloom, plasmacel, monostotisch; myeloom, myeloom; monostotisch, plasmacel, myeloom; monostotisch, myeloom; solitair, plasmacel; tumor, solitair; myeloom, tumor; plasmacel, plasmacytoom, Plasmaceltumor, Plasmacytoom
French Tumeur à cellules plasmatiques, Plasmocytome solitaire, Plasmocytome
German Plasmazellentumor, Plasmazelltumor, Plasmozytom
Portuguese Tumor de plasmócitos, Tumor de Células Plasmáticas, Neoplasia de Plasmócitos, Plasmacitoma, Plasmocitoma, Tumor de Plasmócitos
Spanish Tumor de células plasmáticas, plasmocitoma (anomalía morfológica), Plasmacytoma NOS, tumor de células plasmáticas (anomalía morfológica), mieloma solitario (clínico), plasmocitoma, SAI, [M]plasmocitomas, SAI (anomalía morfológica), tumor de células plasmáticas (clínico), [M]plasmocitomas, SAI, plasmocitoma, SAI (trastorno), [M]plasmocitomas (anomalía morfológica), mieloma monostótico, tumor de células plasmáticas, SAI, [M]plasmocitomas, Plasmocitoma, mieloma solitario, plasmocitoma solitario, tumor de células plasmáticas, plasmocitoma (trastorno), plasmocitoma, plasmocitoma solitario óseo (anomalía morfológica), plasmocitoma solitario óseo, Plasmacitoma, Tumor de Células Plasmáticas
Swedish Plasmacytom
Japanese ケイシツサイボウシュ, 骨髄腫, 形質細胞腫, ケイシツサイボウシュヨウ, 形質細胞腫瘍, プラスマ細胞腫, プラスモサイトーマ, ミエローマ
Czech plazmocytom, Plazmocytom, Nádor z plazmatických buněk, plasmocytom, plazmocelulární myelom
Finnish Plasmosytooma
Russian PLAZMOTSITOMA, ПЛАЗМОЦИТОМА
Croatian PLAZMOCITOM
Polish Guz plazmatycznokomórkowy, Plazmocytoma
Hungarian Plazmasejtes tumor, Plasmocytoma
Norwegian Plasmocytom, Plasmacytom