Multiple Myeloma

What is multiple myeloma?

Multiple myeloma is a cancer of plasma cells. Plasma cells are a type of white blood cell that lives mainly in the bone marrow, the soft tissue inside bones where blood cells are made. Healthy plasma cells produce antibodies, which are proteins that help the body fight infection. In multiple myeloma, a group of abnormal plasma cells multiplies out of control inside the bone marrow. These cancerous cells crowd out healthy blood-forming cells and often produce large amounts of a single abnormal antibody, sometimes called an M protein or monoclonal protein, that does not protect against infection and can harm organs such as the kidneys.

When people ask what is multiple myeloma in simple terms, a helpful way to think about it is this: it is a blood cancer that starts in the bone marrow, affects many bones at once (which is where the word “multiple” comes from), and can cause problems with the bones, the blood, the kidneys, and the immune system.

Multiple myeloma is more common in older adults, and most people are diagnosed after the age of 60. It is somewhat more common in men than in women, and it occurs more often in people of African descent. It is not contagious, and it is not caused by anything a person did or failed to do. Some people are found to have an early, symptom-free stage called smoldering myeloma, or a related benign condition called MGUS (monoclonal gammopathy of undetermined significance), before active disease develops. Not everyone with these early conditions goes on to develop active multiple myeloma.

Symptoms of multiple myeloma

Multiple myeloma symptoms vary widely from person to person. Some people have no symptoms at all when the disease is found, often during blood tests done for another reason. Others develop symptoms gradually over months. Because the early signs are vague and overlap with many common conditions, the diagnosis is often delayed.

Common multiple myeloma symptoms include:

• Bone pain — most often in the back, ribs, or hips; the pain is frequently persistent and may worsen with movement.
• Bone fractures — bones weakened by myeloma can break after minor injury or even normal activity; collapses of the small bones of the spine (vertebral compression fractures) are common.
• Fatigue and weakness — often caused by anemia, which means a low level of red blood cells.
• Frequent or repeated infections — because the abnormal antibodies do not fight germs, and healthy immune cells are crowded out.
• Kidney problems — the abnormal protein can damage the kidneys; signs may include swelling in the legs, foamy urine, or abnormal kidney blood tests.
• Symptoms of high blood calcium (hypercalcemia) — such as excessive thirst, frequent urination, constipation, nausea, confusion, or drowsiness, caused by calcium released from damaged bone.
• Unexplained weight loss and loss of appetite.
• Numbness, tingling, or weakness — which can occur if a weakened spinal bone or a growth of myeloma cells presses on the spinal cord or nerves. This is a medical emergency.

Doctors sometimes summarize the four classic organ effects of active myeloma with the acronym CRAB: elevated Calcium, Renal (kidney) impairment, Anemia, and Bone disease. Symptoms differ by stage and type. In smoldering (early, inactive) myeloma there are typically no symptoms, and doctors may simply monitor the condition. In active disease, symptoms usually reflect which organs are affected: some people mainly have bone pain, others mainly have anemia-related fatigue or kidney problems. A rarer related form, solitary plasmacytoma, involves a single tumor of plasma cells in one bone or in soft tissue rather than widespread disease.

Causes and risk factors

The exact multiple myeloma causes are not fully understood. The disease begins when a single plasma cell in the bone marrow acquires genetic changes (mutations) that make it divide abnormally and survive longer than it should. Over time, these abnormal cells accumulate. Researchers have identified some of the genetic changes involved, but in most cases no single trigger can be identified in an individual patient.

Several factors are known to increase the risk of developing multiple myeloma:

• Age — the risk rises significantly after age 60; the disease is rare in people under 40.
• Sex — men are affected somewhat more often than women.
• Ethnic background — people of African descent have a higher risk than people of other backgrounds.
• MGUS — monoclonal gammopathy of undetermined significance, a common and usually harmless condition in which a small amount of abnormal antibody is found in the blood. A small proportion of people with MGUS develop multiple myeloma each year, which is why doctors often monitor it with periodic blood tests.
• Family history — having a close relative with multiple myeloma modestly increases risk, although most cases are not inherited.
• Obesity — excess body weight has been linked to a higher risk in many studies.
• Certain exposures — long-term exposure to radiation or to some industrial chemicals may play a role in some cases, though the evidence is less certain.

Having one or more risk factors does not mean a person will develop the disease, and many people diagnosed with multiple myeloma have no known risk factors other than age. There is currently no proven way to prevent multiple myeloma.

Diagnosis

Multiple myeloma diagnosis is based on a combination of blood tests, urine tests, bone marrow examination, and imaging. No single test is enough on its own; doctors put the results together to decide whether myeloma is present and whether it is causing organ damage that requires treatment.

Tests your doctor may use include:

• Blood tests — a complete blood count to check for anemia; tests of kidney function and calcium levels; and specialized protein tests. Serum protein electrophoresis (a test that separates blood proteins) can detect the abnormal M protein, and a serum free light chain test measures fragments of antibodies that myeloma cells often release.
• Urine tests — a 24-hour urine collection may be examined for abnormal protein fragments, sometimes called Bence Jones proteins, which can damage the kidneys.
• Bone marrow biopsy — a small sample of bone marrow, usually taken from the back of the hip bone with a needle under local anesthesia, is examined under a microscope to count the plasma cells and to study their genetic features. Finding an increased proportion of abnormal plasma cells in the marrow is central to confirming the diagnosis. Genetic testing of the myeloma cells (cytogenetics) also helps doctors estimate how the disease may behave.
• Imaging — modern practice favors sensitive imaging such as low-dose whole-body CT (computed tomography), MRI (magnetic resonance imaging), or PET-CT (a scan that highlights metabolically active disease) to look for areas of bone damage or plasma cell tumors. Plain X-rays may also be used.

Using internationally accepted criteria, doctors generally confirm active multiple myeloma when there is a significant proportion of clonal plasma cells in the bone marrow (or a biopsy-proven plasmacytoma) together with evidence of organ damage — the CRAB features described above — or certain laboratory and imaging markers that indicate a very high risk of imminent organ damage. Once the diagnosis is confirmed, additional tests are used to assign a stage, which helps guide treatment planning and gives a general sense of how the disease may behave. Staging in myeloma is based mainly on blood markers and genetic features rather than on tumor size, as it would be in many solid cancers.

Treatment options

Multiple myeloma treatment has improved considerably over recent decades, and many people now live for years with the disease well controlled. Although multiple myeloma is generally considered treatable rather than curable, treatment can often push the disease into remission — a period in which it is inactive and causes no symptoms — sometimes for long stretches of time. Care is usually coordinated by a hematologist or oncologist; in hospital groups such as Acibadem, this condition is typically managed within the medical oncology department, working together with hematology, radiology, nephrology, and orthopedic specialists as needed.

The main approaches include:

• Watchful waiting (active monitoring) — for smoldering myeloma and MGUS, which cause no symptoms and no organ damage, doctors often recommend regular blood tests and check-ups rather than immediate treatment. Starting treatment before active disease develops has not been shown to help most people in this situation, although research in this area is ongoing.
• Drug therapy — the backbone of treatment for active myeloma. Modern regimens usually combine several types of medication, which may include proteasome inhibitors (drugs that interfere with how myeloma cells dispose of proteins), immunomodulatory drugs (which alter the immune environment around the cancer), monoclonal antibodies (laboratory-made antibodies that target markers on myeloma cells), and steroids. Traditional chemotherapy is also used in some settings. The exact combination depends on the person’s age, overall health, kidney function, and the genetic features of the disease.
• Stem cell transplantation — for people who are fit enough, doctors may recommend an autologous stem cell transplant. In this procedure, the patient’s own blood-forming stem cells are collected and stored, high-dose chemotherapy is given to destroy myeloma cells, and the stored cells are then returned to restore the bone marrow. This can deepen and prolong remission in many cases, although it is not suitable for everyone.
• Radiation therapy — focused radiation can relieve pain from a damaged area of bone or treat a solitary plasmacytoma. It is generally a local treatment rather than a treatment for the disease throughout the body.
• Newer immune therapies — treatments such as CAR T-cell therapy (in which a patient’s own immune cells are modified to attack myeloma) and bispecific antibodies (drugs that link immune cells to myeloma cells) are available in some centers for disease that has returned after earlier treatments. Availability and suitability vary, and your doctor can explain whether these options apply to your situation.
• Supportive care — an essential part of treatment. This may include bone-strengthening drugs (bisphosphonates or similar medicines) to reduce fractures, medicines or dialysis for kidney problems, transfusions or growth factors for anemia, vaccinations and prompt antibiotics for infections, and effective pain management.
• Surgery — surgery does not treat myeloma itself, but orthopedic procedures may be used to stabilize a weakened or fractured bone, and procedures such as vertebroplasty or kyphoplasty (injecting bone cement into a collapsed spinal bone) can relieve pain in selected cases. Urgent surgery or radiation may be needed if the spinal cord is compressed.

Treatment is highly individualized, and plans often change over time as the disease responds or returns. Because myeloma tends to relapse, many people receive several different lines of treatment over the years, and ongoing maintenance therapy after initial treatment is common. A general overview of how this condition is managed is available on the multiple myeloma treatment page.

Living with multiple myeloma and outlook

The outlook for people with multiple myeloma varies widely and depends on factors such as the stage at diagnosis, the genetic features of the myeloma cells, kidney function, age, overall health, and how the disease responds to treatment. It is honest to say that multiple myeloma is usually not curable with current standard treatments, but it is also honest to say that survival has improved substantially, and many people live for years — sometimes many years — with the disease controlled and a good quality of life. Because outcomes differ so much between individuals, general statistics may not reflect any one person’s situation; your own care team is the best source of information about your prognosis.

Day-to-day life with myeloma often involves regular blood tests, periodic imaging, and ongoing medication. Practical steps that many patients find helpful include:

• Staying as physically active as your doctor advises, to protect bones, muscles, and mood, while avoiding activities with a high risk of falls or fractures.
• Drinking enough fluids, which helps protect the kidneys, unless your doctor advises otherwise.
• Reducing infection risk — keeping up with recommended vaccinations, practicing good hand hygiene, and seeking care promptly for fever.
• Reporting new or worsening pain early, since it may indicate a bone problem that can be treated before a fracture occurs.
• Seeking support for the emotional side of a long-term cancer diagnosis, whether from family, patient support groups, counselors, or your care team.

Many people continue working, traveling, and enjoying family life during and between treatments, especially when the disease is in remission. Living with a relapsing condition can be emotionally demanding, and it is normal to need support at different points along the way.

Frequently asked questions

What is multiple myeloma in simple terms?

Multiple myeloma is a cancer of plasma cells, which are infection-fighting cells that live in the bone marrow. In this disease, abnormal plasma cells multiply inside the marrow, weaken the bones, crowd out normal blood cells, and produce an abnormal protein that can damage the kidneys. It is called “multiple” because it usually affects many areas of bone at the same time.

Can multiple myeloma be cured?

With current standard treatments, multiple myeloma is generally considered treatable but not curable for most people. Treatment can often put the disease into remission, sometimes for long periods, but it tends to return eventually and then requires further treatment. Research is moving quickly, and newer immune-based therapies are producing deep remissions in some patients, so the long-term picture continues to improve. Your doctor can discuss what is realistic in your particular case.

How serious is multiple myeloma?

Multiple myeloma is a serious cancer because it can damage bones, kidneys, the blood, and the immune system. However, seriousness varies greatly between individuals. Some people have slow-moving disease that is controlled for many years, while others have more aggressive forms. The stage at diagnosis, the genetic profile of the cancer cells, and the response to treatment all influence how serious the disease is for a given person.

What are the first warning signs of multiple myeloma?

The earliest multiple myeloma symptoms are often vague: persistent back or bone pain, unusual tiredness caused by anemia, and repeated infections are among the most common first signs. Some people first come to attention because of a fracture from a minor injury, kidney problems found on blood tests, or high calcium levels. In many cases the disease is discovered incidentally on routine blood work before any symptoms appear.

What causes multiple myeloma?

The precise cause is unknown. The disease arises from genetic changes in a single plasma cell, but why those changes occur in a particular person usually cannot be determined. Known risk factors include older age, male sex, African ancestry, a prior diagnosis of MGUS, family history, and obesity. Multiple myeloma is not contagious and is not caused by lifestyle choices in any proven, direct way.

How is multiple myeloma diagnosed?

Doctors confirm multiple myeloma diagnosis using blood tests that detect the abnormal M protein and check for anemia, calcium, and kidney problems; urine tests for abnormal protein fragments; a bone marrow biopsy to count and analyze the plasma cells; and imaging such as low-dose CT, MRI, or PET-CT to look for bone damage. The diagnosis of active disease generally requires both evidence of abnormal plasma cells and signs of organ involvement or high-risk laboratory markers.

What is recovery like after multiple myeloma treatment?

Recovery depends on the treatment received. Drug therapy is often given in cycles over months, with side effects such as fatigue, increased infection risk, or nerve tingling that are usually manageable and often improve after treatment ends. Recovery after a stem cell transplant typically takes several weeks to a few months, during which energy levels and immunity gradually return. Because myeloma is a long-term condition, most people continue regular monitoring, and many take ongoing maintenance medication even when the disease is in remission.

When to see a doctor

If you have persistent, unexplained bone or back pain, ongoing fatigue, repeated infections, or unexplained weight loss, it is reasonable to see a doctor for evaluation. These symptoms have many possible causes, most of which are not cancer, but they deserve investigation when they do not resolve.

Seek urgent medical attention if you experience any of the following red-flag warning signs, especially if you have already been diagnosed with multiple myeloma or MGUS:

• New numbness, tingling, or weakness in the legs, or loss of bladder or bowel control — possible signs of spinal cord compression, which is an emergency.
• Sudden severe back pain, particularly after minor strain, which may indicate a spinal fracture.
• Fever or chills, especially during treatment, since infections can worsen quickly when the immune system is weakened.
• Confusion, extreme drowsiness, severe thirst, or frequent urination — possible signs of dangerously high blood calcium.
• Markedly reduced urination or new swelling of the legs — possible signs of kidney failure.
• Shortness of breath, chest pain, or significant unexplained bleeding or bruising.

Prompt assessment of these symptoms can prevent serious complications. If you are being monitored for smoldering myeloma or MGUS, keep your scheduled follow-up appointments even when you feel well, and report any new symptoms between visits.