Median survival is about 2.5 to 3 yr, but this varies according to the extent of disease at diagnosis, adequacy of supportive measures, and response to drugs. At diagnosis, high levels of M protein in serum or urine, elevated serum 2 -microglobulin levels, diffuse bone lesions, hypercalcemia, anemia, and renal failure are unfavorable prognostic signs. Maintenance of ambulation is vital for protection from hypercalcemia and bone quality. However, radiotherapy may impair the patient's ability to receive cytotoxic doses of systemic chemotherapy. This treatment may also improve survival.
Adequate hydration is essential.
Antibiotics are indicated for documented bacterial infection, but prophylactic use is not recommended. Most patients experience infections only during chemotherapy-induced neutropenia. Prophylactic IV immunoglobulin has been shown in some studies to reduce the risk of infections. However, it should be reserved for select patients with recurrent infections. Transfusion of packed RBCs is indicated for symptomatic anemia.