Hematology/Oncology Manages Multiple Myeloma
Multiple myeloma is managed by hematologists and hematology-oncologists, as evidenced by guidelines developed by hematology societies and the classification of myeloma as a hematologic malignancy requiring specialized expertise in plasma cell disorders. 1
Primary Specialty Responsible for Care
Hematology is the primary specialty that manages multiple myeloma, as demonstrated by the Italian Society of Hematology (SIE), Italian Society of Experimental Hematology (SIES), and Italian Group for Bone Marrow Transplantation (GITMO) developing comprehensive evidence-based guidelines for MM management 1
Multiple myeloma accounts for approximately 10% of all hematologic malignancies, firmly establishing it within the domain of hematology practice 1, 2
The Mayo Clinic consensus guidelines were developed by more than 20 myeloma physicians, reflecting the specialized nature of this disease requiring dedicated hematology expertise 1
Rationale for Hematology Management
Complex treatment algorithms require hematology expertise, including decisions about autologous stem cell transplantation, novel agent combinations (proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies), and risk-stratified therapy based on cytogenetic features 1
Management involves specialized procedures such as stem cell collection, high-dose chemotherapy, and bone marrow transplantation that are within the scope of hematology practice 1
The disease requires ongoing monitoring of hematologic parameters, bone marrow plasma cell burden, and monoclonal protein levels that necessitate hematology training 3
Multidisciplinary Support (Not Primary Management)
While hematology/oncology provides primary management, supportive care may involve:
Nephrology consultation for renal failure management, particularly for plasma exchange in rapidly progressive renal failure secondary to cast nephropathy 1
Radiation oncology for solitary plasmacytomas and palliative treatment of bone lesions 1
Orthopedic surgery for pathologic fractures or spinal cord compression requiring surgical intervention 1
However, these specialists provide consultative support rather than primary disease management, with the hematologist/oncologist maintaining overall treatment coordination 1