Multiple Myeloma and Related Paraproteinemias

Abstract

Multiple myeloma (MM) is a complex clonal malignancy of plasma cells in which the malignant cell has synergistic and complex interactions with the stroma. The first description of the disease was in the 1840s. The patient, Thomas Alexander McBean, was a carpenter born in 1800. He went to his family physician Dr. Thomas Watson in 1844 with sternal pain, which was treated with a plaster cast. The pain recurred 1 yr later and was treated with cupping and then steel and quinine. With relapse in August 1845, the patient was referred to William MacIntyre, a Harley Street physician, who personally examined both the urine and the patient. He noted that with boiling, the urine became opaque, and that on cooling, a precipitate formed that clarified on reheating. Henry Bence Jones, physician at St. George’s Hospital, confirmed the finding and, by chemical analysis, determined the substance to be a protein different from albumin. Mr. Bean died on New Year’s Day 1846. John Dalrymple performed the autopsy and, noting bony abnormalities, coined the term “mollities and fragilitas ossium.” Subsequently, Bence Jones presented a paper “On a new substance occurring in the urine of a patient with ‘mollities ossium’,” and 2 years later, MacIntyre described the patient in a paper “Case of mollities and fragilitas ossium accompanied with urine strongly charged with animal matter.”