Multiple Myeloma Differential Diagnosis Table

Multiple Myeloma Differential Diagnosis Table:

Multiple myeloma is a cancer of plasma cells.
The uncontrolled proliferation of plasma cells in the bone marrow can displace the normal blood cells, causing anemia, so the patient will have paleness, weakness, and tiredness, thrombocytopenia that can cause internal or external bleeding, and appearance of bruises, and leukopenia, which can cause problems when fighting infections.
Plasma cells are an important component of the immune system. The immune system is made up of several types of cells that work in order to fight infections. This system is composed of lymphocytes (lymphatic cells), which are one of the main types of white blood cells of the immune system and are divided into T cells and B cells. Lymphocytes are found in various parts of the body such as bone marrow, lymph nodes, and bloodstream.
When B cells respond to an infection, they mature and turn into plasma cells. These plasma cells produce antibodies called immunoglobulins; they also help fight microorganisms and germs that try to enter our body and are mainly found in the bone marrow.
When plasma cells become cancerous and grow uncontrollably, this is called multiple myeloma.

How to Distinguish Multiple Myeloma from Other Diseases

Distinguish Leukemia from Multiple Myeloma – Diagnosis

A group of malignant blood diseases is defined as leukemia.

• In leukemia, the affected blood cells are usually leukocytes or white blood cells, unlike multiple myeloma where affected cells are plasma cells.
• Black people are more likely to develop multiple myeloma, unlike leukemia where Caucasian people have a higher risk of suffering from it.
• Patients with leukemia, unlike multiple myeloma, present the following symptoms: sweating for no apparent reason, difficulty breathing, and abdominal pain.

Distinguish Lymphoma from Multiple Myeloma – Diagnosis

Lymphoma is a type of cancer that affects the lymphatic system of the organism.

• The symptoms of lymphoma different from multiple myeloma are swelling of the lymphatic vessels in the neck, armpits, or groin, weight loss with no apparent cause, itching, difficulty breathing, and night-time sweats.
• Some types of lymphoma are more common in young people and more frequent in women, unlike multiple myeloma, which is more common in men and aging people.

Distinguish Metastatic Cancer from Multiple Myeloma – Diagnosis

Metastatic cancer is one that is spread from the place where it invaded to a distant part of the body.

• Multiple myeloma begins in the bone marrow while metastatic cancer can begin anywhere and then spread into the bone marrow.

Distinguish Rheumatoid Arthritis from Multiple Myeloma – Diagnosis

Rheumatoid Arthritis is an inflammatory autoimmune disorder that affects joints.

• Rheumatoid Arthritis is more common in middle-aged patients while multiple myeloma is presented in aging patients.
• Rheumatoid Arthritis is more common in women unlike multiple myeloma where it is more common in men.
• Rheumatoid Arthritis generally affects the joints unlike multiple myeloma where hips and ribs bones are affected.
• Rheumatoid Arthritis presents a crucial symptom that multiple myeloma does not present, which is joint pain in the mornings.

Distinguish MGUS from Multiple Myeloma – Diagnosis

Monoclonal gammopathy of uncertain significance (MGUS) is a benign condition where there is an excess of protein known as monoclonal protein or M protein.

• Monoclonal gammopathy of uncertain significance (MGUS), unlike multiple myeloma, is asymptomatic.
• Monoclonal gammopathy of uncertain significance (MGUS), unlike multiple myeloma, does not require treatment.

Distinguish Plasmacytoma from Multiple Myeloma – Diagnosis

Plasmacytoma is a bone or soft tissue plasma cell tumor that can be present anywhere in the body.

• Plasmacytoma can occur alone in a single part of the body as solitary plasmacytoma, unlike multiple myeloma that, although it develops in the bone marrow, can spread throughout the body.

Distinguish Waldenström Macroglobulinemia from Multiple Myeloma – Diagnosis

Waldenström Macroglobulinemia is a type of cancer characterized by the uncontrolled and abnormal proliferation of B lymphocytes.

• In Waldenström Macroglobulinemia, the affected cells are the B lymphocytes, unlike multiple myeloma where the affected cells are the plasma cells.
• Waldenström Macroglobulinemia, unlike multiple myeloma, is presented with hepatomegaly, lymphadenopathy, and splenomegaly.

Distinguish Light-Chain (AL) Amyloidosis from Multiple Myeloma – Diagnosis

Light-Chain Amyloidosis is a chronic disease that is characterized by the deposit of fibrillar proteins in the organs and tissues of the body.

• Light-Chain Amyloidosis, unlike multiple myeloma, affects organs such as the heart, liver, spleen, nerves, intestines, skin, tongue, and blood vessels.
• Light-Chain Amyloidosis, unlike multiple myeloma, will present dermatological symptoms such as a shiny serous skin with loss of sensitivity, nodules, and non-pruritic plaques.
• In the physical exam for Light-Chain Amyloidosis, the shoulder pad sign will be found bilaterally in the anterior deltoid, while in multiple myeloma it is unusual.

Distinguish Smoldering Multiple Myeloma (SMM) from Multiple Myeloma – Diagnosis

Smoldering Multiple Myeloma is a benign condition of plasma cells without the presence of indicators of active myeloma.

• Unlike multiple myeloma, Smoldering Multiple Myeloma is asymptomatic.
• Unlike multiple myeloma, Smoldering Multiple Myeloma does not require treatment.
• Unlike multiple myeloma, Smoldering Multiple Myeloma has a lower amount of M protein accumulated in the bone marrow.

Common Red Flags with Multiple Myeloma

The prognosis of multiple myeloma has gradually improved; it will depend on the age, organ or tissue affection, kidney damage, and the stage at which the patient is diagnosed.
The treatment consists of chemotherapy, radiotherapy, immunomodulatory drugs, protease inhibitors, corticosteroids, and bisphosphonates. There is the use of an autologous stem cell transplant which is recommended for patients under 65 years of age after using induction therapy with immunomodulators and protease inhibitors. Melphalan is used for patients under this transplant since this therapy has myelosuppressing effects.