An imaging review of extramedullary myeloma

Learning objectives Numerous studies have demonstrated increasing overall survival in patients with multiple myeloma over the last 40 years. Novel agents including thalidomide and bortezomib used in induction therapy, together with autologous stem cell transplant in consolidation, have improved patient outcomes. Whilst extramedullary myeloma can be a presenting form of the disease, it is becoming increasingly recognised that extramedullary disease is common in patients who have relapsed disease, often after multiple lines of therapy. Whether this is due to either a possible “sanctuary site” effect from treatment in extramedullary tissues, prolonged overall survival leading to an evolution in the natural history of the disease, or the improved sensitivity of imaging techniques is not clear.