Abstract
Introduction: Multiple myeloma (MM) is a hemato-lymphoid malignancy of B-cell type. It occurs due to the accumulation of malignant monoclonal plasma cells. The exact incidence of MM in India is not well-known. The current study presented the clinical characteristics, radiological findings and laboratory findings of MM patients who were initially treated at the tertiary care centre, Dehradun, Uttarakhand (India).
 Material and methods: Retrospective analysis of the medical records of 123 consecutive patients with MM who were initially presented to Hemato-Oncology department during the period from January 2014 to December 2018. Peripheral blood finding, bone marrow diagnosis, flow-cytometry analysis, serum protein and immunofixation electrophoresis finding, biochemical parameter, histo-pathological and cytological diagnosis, if any, urine examination finding and radiological examination of cases shall be compiled and tabulated. Diagnosis of symptomatic multiple myeloma was done based on The International Myeloma Working Group criteria for the diagnosis of MM.
 Result: The study included 123 cases of multiple myeloma with male: female ratio of 2:1, mean age of 59.88 ±11.08 years and range of 32-87 years. The back pain (n=106, 86.2%) was the common presenting complaint followed by inability to walk (n=90,73.2%). CT scan and/or MRI scan finding of MM patients, the lytic lesion was found in 107 patients (87%) and was found significant with its correlation with ISS/DS plus staging system (pvalue 0.013). The most location was dorso-lumbar spine (n=72, 67.28%) followed by skull (n=37, 34.58%) and ribs (n=19, 17.75%). Hemoglobin (Hb) analysis showed 92.7 % (n=114) cases were anemic with mostly had normocytic (n=95,77.2%). 62.6%(n=77) of cases showed rouleaux formation while 23.57% (n=29) cases were circulating plasmacytoid lymphocytes or plasma cells. The raised ESR values was found in 89.33% (n=67) of cases. Diagnosis of cases shows 99.2% (n=122) of cases diagnosed as secretory MM while 1 (0.8%) case diagnosed as non-secretory MM.
 Conclusion: MM is a disease with a inconsistent clinical presentation with multiple system involvement. Younger age of disease onset is some noteworthy features of myeloma in Uttarakhand state of India. Bony pain associated with generalized weakness is the commonest presentation, normocytic normochromic anemia with rouleaux formation, raised ESR, raised total protein with hypoalbuminemia, hypercalcemia, presence of M band and presence of >10% plasma cell in bone marrow is clue to diagnosis in MM cases .
 Keywords: Multiple Myeloma, Uttrakhand, Hemato-lymphoid malignancy
Highlights
Multiple myeloma (MM) is a hemato-lymphoid malignancy of B-cell type
The current study presented the clinical characteristics, radiological findings and laboratory findings of MM patients who were initially treated at the tertiary care centre, Dehradun, Uttarakhand (India)
MM is a disease with a inconsistent clinical presentation with multiple system involvement
Summary
Multiple myeloma (MM) is a hemato-lymphoid malignancy of B-cell type. It occurs due to the accumulation of malignant monoclonal plasma cells. Bony pain associated with generalized weakness is the commonest presentation, normocytic normochromic anemia with rouleaux formation, raised ESR, raised total protein with hypoalbuminemia, hypercalcemia, presence of M band and presence of >10% plasma cell in bone marrow is clue to diagnosis in MM cases. It is associated with presence of large quantities of abnormal immunoglobulin proteins secreted by malignant monoclonal plasma cells called monoclonal (M) protein alongwith bone destruction in the form of lytic lesions, anemia, increase serum calcium levels and renal dysfunction [1] For the diagnosis of MM, all the three criterias must be meet, which are presence of monoclonal bone marrow plasma cells which are >10% or biopsy proven plasmacytoma, presence of serum and/or urinary M protein (except in patients with true non-secretory MM) and confirmation of end organ damage that can be recognized as the underlying plasma-cell proliferative disorder, increased serum calcium level (>11.5 mg/dL), renal insufficiency in the form of increased serum creatinine (> 1.73 mmol/L or >2 mg/dL) or estimated creatinine clearance less than 40 mL/min, normochromic normocytic anemia with Hb value
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