Navigating the Landscape of Multiple Myeloma: Classification, Staging, and Modern Therapeutics

Abstract

Background: Multiple myeloma (MM) is a clonal plasma-cell neoplasm that can cause end-organ injury through bone disease, anemia, renal impairment, and hypercalcemia. Diagnosis and management have changed with the use of sensitive imaging, cytogenetic and molecular testing, and treatments directed at plasma-cell biology. Scope: This narrative review summarizes the biological basis and clinical presentation of MM, the diagnostic criteria used to distinguish active disease from precursor conditions, and the role of staging and cytogenetic risk assessment. It then reviews treatment principles for newly diagnosed and relapsed/refractory disease, including transplantation, maintenance therapy, supportive care, and newer immune-based treatments. Review Approach: The manuscript draws on a selective PubMed literature search covering 2008–2024 and on relevant clinical guidelines. It is a narrative review rather than a systematic review: the source manuscript does not report a reproducible full search strategy, predefined eligibility criteria, duplicate screening, or formal risk-of-bias assessment. Conclusion: MM management now combines clinical assessment with cytogenetic risk, response monitoring, and treatment tailored to disease setting and patient fitness. Immunotherapies have expanded options for relapsed disease, while measurable residual disease assessment is increasingly used to describe depth of response. The evidence and availability of individual therapies continue to change, so treatment choices should be checked against current guidelines.

Keywords: Multiple myeloma; Plasma cell neoplasms; Cytogenetic abnormalities; International Staging System; Risk stratification; Immunotherapy; Chimeric antigen receptor T-cell therapy; Bispecific antibodies; Minimal residual disease; Autologous stem cell transplantation.