Multiple Myeloma

What is multiple myeloma?

Multiple myeloma is a cancer of plasma cells, a type of white blood cell found in the bone marrow that normally helps make antibodies. In myeloma, abnormal plasma cells build up in the bone marrow and may produce an abnormal protein called monoclonal protein, or M-protein. Myeloma can affect the bones, blood counts, kidneys, calcium levels, and immune system.

What are MGUS, smoldering myeloma, and active multiple myeloma?

Plasma cell disorders can exist along a spectrum. MGUS is a precursor condition with a small amount of abnormal plasma-cell protein but no myeloma-related organ damage. Smoldering multiple myeloma (SMM) has more abnormal plasma cells or M-protein than MGUS but does not have the features that define active myeloma. Active multiple myeloma meets criteria showing that treatment is needed.

Many people with smoldering myeloma are monitored closely without immediate treatment. However, some people with high-risk smoldering myeloma may now be offered treatment based on their individual risk and situation.

Why are so many blood and urine tests needed?

Myeloma is followed with several different tests because no single number tells the whole story. Your care team may monitor blood counts, kidney function, calcium, M-protein, serum free light chains, immunoglobulins, and other results to understand your disease and how it changes over time.

How is active multiple myeloma treated?

Active multiple myeloma is usually treated with a combination of medicines that attack myeloma cells in different ways. Initial treatment is sometimes called frontline or induction therapy. The exact treatment plan depends on factors such as your overall health, features of the myeloma, kidney function, previous health conditions, and whether an autologous stem-cell transplant may be appropriate.

Your oncology team will explain which treatment approach is recommended for you and why.

What is an autologous stem-cell transplant, and will I need one?

Some people with multiple myeloma may be candidates for an autologous stem-cell transplant (ASCT). In this process, your own blood-forming stem cells are collected and stored. After high-dose treatment is given, your stem cells are returned to help your bone marrow recover.

Not every person with myeloma receives a transplant. Whether ASCT is recommended depends on your overall health, treatment response, preferences, and other factors.

Why might treatment continue after my initial therapy?

Many people with multiple myeloma receive ongoing treatment after their initial therapy or stem-cell transplant. This is often called maintenance therapy. The goal is to help keep the myeloma under control for as long as possible while balancing treatment effectiveness, side effects, and quality of life.

The type and duration of maintenance therapy are individualized. Your oncology team will consider your response to treatment, features of your myeloma, previous therapy, side effects, and personal preferences when planning ongoing treatment.

How does my care team know if treatment is working?

Your care team follows trends over time rather than relying on a single result. Depending on your type of myeloma, monitoring may include M-protein, serum free light chains, blood counts, kidney function, calcium, imaging, and sometimes bone marrow testing. These results help your team assess how deeply the myeloma has responded and whether the disease remains controlled.

Could a clinical trial be an option for me?

Clinical trials are research studies that evaluate new treatments or new ways of using existing treatments. Myeloma clinical trials may be available at different points in the disease course, including smoldering myeloma, newly diagnosed disease, or relapsed myeloma. Participation is voluntary, and each study has specific eligibility requirements.

Your oncology team can help you understand whether a clinical trial may be appropriate for your situation.

What if my multiple myeloma comes back?

Multiple myeloma can return after a period of good disease control. This is called relapsed myeloma. If the disease does not respond adequately to a treatment, it may be described as refractory. If either occurs, there are often additional treatment options available.

The next treatment depends on your previous therapies, how long the myeloma remained controlled, your health, characteristics of the myeloma, and your preferences.

What are CAR T-cell therapy and bispecific antibodies?

For some people with relapsed or refractory multiple myeloma, the oncology team may discuss newer immune-based treatments.

CAR T-cell therapy uses your own T cells, which are collected and modified in a laboratory so they can recognize and attack myeloma cells.

Bispecific antibodies are medicines designed to connect an immune cell with a myeloma cell, helping the immune system recognize and attack the cancer.

These treatments are not needed or appropriate for every patient, and when they are used depends on your individual disease and treatment history.