Multiple myeloma (MM) accounts for the second highest incidence of hematologic malignancies and is a B-cell malignancy in which plasma cells in the bone marrow clonally proliferate, producing large amounts of monoclonal globulin, or κ/λ light chain protein (M) protein, accompanied by massive destruction of bone matrix and trabeculae, resulting in osteolytic bone destruction-i.e., myeloma bone disease. Its cause is not well understood and may be related to radiation, environmental pollution, genetics and other factors. Most patients will first present with skeletal pain, pathological fractures, and paraplegia. In the later stages, more severe anemia, renal insufficiency and hypercalcemia may occur, which are the main causes of death. In terms of morbidity trend, the onset of the population is mainly the elderly, less than 40 years old is rare, and its incidence is higher in men than in women. A. Multiple skeletal pains need to be alerted to multiple myeloma? Most people think that the pain in the bones of the back is a common thing, and patients often consult orthopedic and rheumatology departments for osteophytes and rheumatism. However, pain in multiple bones throughout the body may also be a sign of malignant disease. Pain in multiple bones throughout the body is one of the main symptoms of multiple myeloma, mainly in the back, lumbosacral region and thoracic ribs, and less commonly in the extremities. At first, the patient’s pain is mild and may occur intermittently, progressing to become constant and severe. If the pain is severe or suddenly worsens, then a fracture may have occurred. Therefore, when elderly people are found to have multiple skeletal pains that persist and worsen, or even often fractures without falls or collisions, they should especially be alert and go to the hospital for relevant examinations in time to exclude the possibility of multiple myeloma. What should be done if an inverted albumin/globulin ratio is found in the physical examination? Many patients with multiple myeloma may have an inverted albumin/globulin ratio during physical examination. In many cases, this is related to reduced albumin production or excessive consumption caused by liver disease or other wasting diseases (e.g. nephrotic syndrome, hyperthyroidism), which requires active cooperation with doctors in treating the primary disease in order to correct it. In contrast, an inverted albumin/globulin ratio may also be caused by an increase in globulin, except in chronic inflammatory and immune diseases. For middle-aged and elderly people, especially those around 60 years old, they should be alert to the possibility of multiple myeloma and should not be careless. They should go to the hospital for further examination, including bone marrow routine, serum β2 microglobulin, blood sedimentation, X-ray, etc., in order to make a clear diagnosis. Third, can multiple myeloma osteoporosis be treated by calcium supplementation? Patients with multiple myeloma often show signs of osteoporosis through X-rays, which is related to increased bone destruction and structural disorder of bone trabeculae caused by the disease. Because of this, many patients are often misdiagnosed with “osteoporosis” and treated for a long time before being diagnosed with the disease. When multiple myeloma occurs, due to the massive destruction of bone, calcium enters the bloodstream, resulting in hypercalcemia, which is characterized by fatigue, nausea, vomiting, loss of appetite, and constipation. At this point, if you take calcium supplements to correct the “osteoporosis” illusion, you may further aggravate the hypercalcemia. So is there no medicine? In this regard, bisphosphonates can be used to reduce new osteolytic damage, prevent spinal destruction and pathological fractures, relieve bone pain, and improve the quality of life. Fourth, why does anemia occur in multiple myeloma? What can be done? More than 90% of patients with multiple myeloma have varying degrees of anemia, with severe hematocrit <50 g/L. The main cause of anemia is malignant proliferation and infiltration of tumor cells in the bone marrow, which crowd out hematopoietic tissues and affect hematopoietic function. In addition, factors such as renal insufficiency, recurrent infections, and malnutrition can also cause or aggravate anemia. In terms of treatment, we mainly rely on high doses of adrenocorticotropic hormone and erythropoietin to stimulate the potential hematopoietic function, but this is still only a method to treat the "symptoms" but not the "root" of the problem. It is especially important for patients with multiple myeloma to take care of their daily hygiene, minimize the occurrence of infections, and increase nutrient supplementation, which is helpful in reducing anemia and improving symptoms. V. Can multiple myeloma patients take painkillers for a long time because of the obvious pain? How to choose? Since patients with multiple myeloma suffer from severe bone pain, and some even feel chest pain when breathing, pain medication is necessary for some patients. The choice of painkillers is important. There are simple analgesics, sedatives and fentanyl, but it should be noted that non-steroidal anti-inflammatory drugs (aspirin, paracetamol, etc.) should be prohibited. This is because such drugs can inhibit prostaglandin metabolism, resulting in reduced glomerular filtration rate, which impairs renal function and even affects the patient's prognosis and quality of survival. Other painkillers that can lead to addiction, such as dulcolax, should be used with caution and should not be used for a long time. What drugs are preferred for the treatment of multiple myeloma? Patients with multiple myeloma need treatment when they are diagnosed with symptoms. Simple local radiotherapy is feasible for isolated or extramedullary plasmacytoma. For those who are asymptomatic in the early stage (stage IA), treatment can be withheld, but follow-up examinations are recommended every 1-2 months until the disease progresses and symptoms appear, such as progressive increase of M protein in blood and urine, increase of tumor cells in bone marrow, and osteoclastic lesions on X-rays. For patients on first treatment, MPT regimens (oral marfarin, prednisone and response stop-thalidomide) are generally considered for those over 70 years of age, and V-VAD regimens (proteasome inhibitors-vancomycin, vincristine, doxorubicin, dexamethasone) are considered for those younger than 70 years of age. Other drugs, such as interferon, are generally considered to have more advantages than disadvantages, and patients may choose to use it for maintenance therapy to prolong the duration of the stable phase, but it should be recognized that it does not improve overall survival. How to choose antibiotics in case of multiple myeloma infection? In multiple myeloma, most patients have reduced normal immunoglobulin production and lack of immune activity of abnormal monoclonal immunoglobulin, resulting in decreased immunity of the body and frequent lung and urinary tract infections. In addition, during chemotherapy, the effect of immunosuppressive agents, especially the application of high-dose glucocorticoids, increases the chance of infection. At this time, the use of antibiotics must be timely and correct. When patients choose their own antibiotics at home, they should pay particular attention to avoid drugs with toxicity to the kidney, especially aminoglycosides, such as kanamycin, gentamicin, streptomycin, etc., and recommend the use of broad-spectrum penicillin antibiotics. Why do we advocate drinking more water for patients with multiple myeloma? It is not difficult to find that some patients with multiple myeloma often have symptoms such as vomiting and polyuria, which are related to hypercalcemia. This is related to hypercalcemia. If this happens for a long time, it may lead to dehydration and kidney failure. To avoid deterioration of the disease, patients should be instructed to drink more water to increase blood flow to the kidneys and improve renal function on the one hand, and to reduce the occurrence of hyperviscosity syndrome on the other. In severe cases, patients should be promptly seen and given intravenous fluids to keep the daily urine volume above 2000 ml. After the dehydration is corrected, diuretics can be taken. Can multiple myeloma be cured? At present, multiple myeloma is still an incurable disease, but standardized treatment can significantly prolong the survival of patients. Some brand-new drugs such as proteasome inhibitors-Vanco and ralidomide (LEN) for clinical treatment are constantly appearing, changing the myeloma treatment pattern, and a small number of patients even achieve long-term disease-free survival. Hematopoietic stem cell transplantation is one of the more researched treatments for multiple myeloma, of which autologous transplantation is less toxic and less expensive, and is available to most patients, but the age of selection is generally less than 65 years old, because age and severity of disease are key factors affecting the success of transplantation. Many patients may worry about disease recurrence after transplantation. The current view is that patients with autologous transplantation can undergo secondary transplantation to further reduce the recurrence rate and achieve a more desirable treatment effect, which can be considered for patients whose conditions allow.