Myeloma, a malignancy of the plasma cells in the bone marrow, is the most common primary neoplasm in the skeletal system. It is called multiple myeloma when myeloma cells occur in more than one bone marrow site in the body. The etiology of myeloma is a clonal proliferation of a B cell, with a resultant increase in a single immunoglobulin and its fragments in the blood or urine. Patients with undiagnosed myeloma often present with bone pain, most commonly in a weight-bearing location. Patients may also have systemic symptoms, such as fatigue, renal insufficiency, and recurrent infections. Radiographically, multiple myeloma is characterized by well-circumscribed, "punched out" lytic lesions within the skull, spine, pelvis, and long bones. The International Myeloma Working Group has simplified the diagnostic criteria for myeloma to include (1) M protein in serum or urine, (2) clonal plasma cells in bone marrow or solitary plasmacytoma, and (3) related organ or tissue impairment (end organ damage, including bone lesions). Multiple myeloma is an incurable disease. Evolving treatments in the past 25 years, including intralesional curettage, radiation therapy, chemotherapy, and bone marrow transplantation, have increased the median survival rates. The most recent Surveillance Epidemiology and End Results (SEER) data state that the median survival rate is just more than 3 years. There are some studies that report survival rates of 5 years, but these are small series.

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