What Is Multiple Myeloma? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Multiple myeloma is a cancer that affects plasma cells, a type of white blood cell found primarily in bone marrow (the soft, inner tissue of bones).
Plasma cells are an important part of the immune system; they produce proteins called antibodies that help the body fight infection by attacking and killing germs. In multiple myeloma, cancerous plasma cells grow out of control, collecting in the bone marrow and spreading (metastasizing) to different areas of the body.
Multiple myeloma has no cure, but treatments are available to help put the cancer into remission.
Symptoms of multiple myeloma vary from person to person. Some people may not have any symptoms at all, especially when the cancer is at an early stage. When symptoms occur, they can be vague or similar to those of other health conditions or aging.
Symptoms may include:
Bone pain, most often in the spine, pelvis, or ribs
Thrombocytopenia, or low levels of platelets in the blood, which can cause increased bruising and bleeding
Scientists don’t know exactly what causes multiple myeloma or how to prevent it. Known risk factors include:
Age Multiple myeloma is most often diagnosed in adults over age 65.
Gender Men are at a slightly higher risk than women.
Race Black Americans are almost twice as likely to get multiple myeloma as white Americans.
Family History Having a close relative with multiple myeloma increases a person’s odds of developing it. However, most people with multiple myeloma have no family history of the disease.
Obesity People who are overweight or have obesity are at a higher risk.
Precursors to Multiple Myeloma
Two precancerous conditions can progress to active multiple myeloma.
Monoclonal Gammopathy of Undetermined Significance (MGUS): This is a precancerous condition in which abnormal proteins, called M proteins, are found in the blood, with no other symptoms or signs of myeloma present. MGUS is typically monitored, but not treated unless it progresses to myeloma.
Smoldering Multiple Myeloma (SMM): This precancerous stage shows a higher level of M proteins than MGUS, but still without the symptoms of active myeloma. The risk of SMM progressing to active myeloma is higher than with MGUS, so closer monitoring is needed. In some high-risk cases, treatment is considered to delay progression.
To make a multiple myeloma diagnosis, healthcare providers will take into account a person’s symptoms, the results of a physical exam, and test results. Doctors use these tests to diagnose myeloma:
Complete blood count
Urine analysis
Bone marrow biopsy
Fluorescence in situ hybridization (FISH), a procedure that allows researchers to locate the positions of specific DNA sequences on chromosomes
A diagnosis of multiple myeloma is made when a biopsy has found a plasmacytoma (myeloma tumor) or at least 10 percent of the bone marrow is made up of cancerous plasma cells, and at least one of the following myeloma-associated findings is present:
Hypercalcemia (high calcium levels in the blood)
Kidney damage
Anemia (low red blood cell counts)
Bone lesions
Bone marrow where at least 60 percent of the cells are cancerous plasma cells (No other criteria are needed to make a diagnosis in this case.)
A large ratio between kappa and lambda free light chains (small protein components of antibodies), in which one is over 100 times higher than the other
More than one focal lesion (an abnormal area that signals the development of a small hole in the bone) on an MRI
Staging indicates how much cancer is in the body, where it is, and whether it has spread. Doctors stage multiple myeloma to help determine the best treatment plan and estimate prognosis.
In patients who are symptomatic, doctors use the Revised International Staging System, which considers four factors to determine the stage of a person’s cancer:
The amount of albumin, a protein made by the liver, in the blood
The amount of beta-2-microglobulin, a type of protein that is a tumor marker, in the blood
The amount of lactate dehydrogenase (LDH), an enzyme, high levels of which can indicate more severe disease.
Chromosomal abnormalities
Based on the findings, the disease can be categorized into three stages:
Multiple myeloma is considered an incurable disease. However, treatment can put the cancer into remission for long periods. It’s typical for patients to experience periods of symptomatic myeloma, which requires treatment, followed by periods of remission, during which treatment may not be necessary.
Current treatments aim to relieve symptoms, prolong periods of remission, and extend survival. Oncologists have many ways to treat multiple myeloma and will typically use more than one treatment at a time.
Induction Therapy
The first-line therapy for multiple myeloma is typically induction therapy followed by a stem cell transplant. (A stem cell is a special kind of cell that can make copies of itself and turn into many different types of cells your body needs to function properly.)
If your doctors determine that you are not a candidate for a transplant — a decision based on various factors, including the stage and specific nature of your disease — you may continue induction therapy for a longer period, followed by maintenance therapy.
Induction therapy consists of a three-drug or four-drug combination regimen given over three to four cycles, each of which typically lasts 3 or 4 weeks. The goal is to kill as many cancer cells as possible prior to transplant.
Three-drug regimens (triplet therapy) generally include:
Proteosome Inhibitors Proteasome inhibitors stop enzyme complexes (proteasomes) in your cells from breaking down certain proteins that are important for controlling cell division. These drugs affect tumor cells more than normal cells.
Immunomodulatory Drugs These work by activating certain cells in the immune system, preventing myeloma cell growth, and by directly killing myeloma cells.
Steroids In high doses, steroids can kill multiple myeloma cells. They can also decrease inflammation, relieve pain and reduce side effects from other treatments.
Four-drug regimens (quadruplet therapy) are similar to three-drug regimens but include monoclonal antibodies. These drugs are manmade versions of antibodies made in the immune system They can be designed to attack a specific target. In the case of multiple myeloma, the target is the CD38 protein on the surface of myeloma cells.
Stem Cell Transplantation
Once induction therapy is complete, you may undergo a stem cell transplant. Here are the steps involved in the procedure:
Stem cells are collected from your blood and stored for later use. Most transplants for multiple myeloma are autologous stem cell transplants (ASCT), in which a person’s own stem cells are removed and later transplanted back into the bloodstream. Stem cells from a donor (allogeneic transplants) are used primarily in research.
You will undergo high-dose chemotherapy (with a drug called melphalan) to kill any remaining cancer cells.
Your saved stem cells are infused back into your bloodstream.
You will go on maintenance therapy, typically with an oral immodulatory drug called lenalidomide.
Other Treatments
Other treatments that may be used to treat multiple myeloma include:
CAR T-Cell Therapy CAR T-cell therapy involves genetically engineering a patient’s own T-cells (a type of white blood cell) to allow them to recognize and attack cancer cells.
Chemotherapy Chemotherapy is used during the stem cell transplant process. It is rarely used on its own to treat multiple myeloma.
Radiation Therapy Radiation uses high-energy rays to kill cancer cells. It’s often used to target areas of bone damaged by multiple myeloma, or in the case of a solitary bone plasmacytoma, in which the disease has only presented as a single bone lesion and has not spread to the bloodstream.
Surgery This is sometimes used to stabilize bones that have deteriorated due to the effects of multiple myeloma or to relieve spinal cord compression.
Novel Therapies Some of the newest drugs used to treat multiple myeloma do not fit the classification of any existing drugs. These new drugs work in different ways than drugs in the other classes — that is, they have novel mechanisms of action.
For every treatment approach, outcomes for people with multiple myeloma depend on several factors, including overall health and ability to tolerate treatment. Quality of care also makes a difference. It’s important to seek out a doctor with experience treating multiple myeloma or one who will work in concert with a specialist, such as a hematologist oncologist.
The median five-year survival rate for multiple myeloma is around 62 percent, but this number won’t be true for every patient.
Prognosis depends on many factors, including the stage of the cancer when it was first detected and the tumor’s genetic characteristics. The patient’s age, kidney function, and overall health also play a role.
The type of multiple myeloma also makes a difference. People with smoldering multiple myeloma may remain symptom-free for many years before the disease begins to take a toll. Conversely, patients who have a form of myeloma with a high-risk genetic feature may have a poor prognosis.
Multiple myeloma can cause a number of complications, some of which may be very serious:
Low Blood Counts As myeloma cells multiply in bone marrow, they leave less space for red blood cells, white blood cells, and platelets. Low red blood cell levels, a condition known as anemia, can result in fatigue and weakness. A drop in your white blood cell count can decrease the body’s ability to fight disease. Lack of platelets can lead to significant bruising and bleeding, even from minor scrapes or cuts.
Bone and Calcium Issues Myeloma cells can accelerate the breakdown of old bone and slow the buildup of new bone. This can lead to osteoporosis, raising the risk of fractures. Bones may become so fragile that even normal activities, like coughing and walking, may be enough to lead to a broken bone.
Suppressed Immune System Myeloma cells interfere with both the quality and quantity of infection-fighting white blood cells, raising the risk of infection.
Kidney Damage An antibody produced by myeloma cells can harm the kidneys and lead to kidney failure.
Neuropathy Proteins secreted by myeloma cells may damage motor and sensorimotor nerve cells by stripping their myelin sheaths and by causing degeneration of axons, the long threadlike parts of nerve cells along which impulses are conducted from the cell body to other cells. Neuropathy may also be a consequence of spinal damage caused by the disease.
Eye Problems M proteins can thicken the blood and slow down blood flow in the small blood vessels of the retina, leading to various eye problems.
More than 36,000 Americans are estimated to receive a multiple myeloma diagnosis in 2025. This makes multiple myeloma relatively rare, accounting for 1.8 percent of all new cancer cases.
Age-adjusted death rates fell on average by 2.6 percent each year from 2014 to 2023.
The number of people diagnosed with multiple myeloma has climbed an average of 0.9 percent each year over the course of a decade, according to the most recent data. But death rates from multiple myeloma have decreased 0.5 percent per year, reflecting improvements in treatment.
Black Americans are twice as likely to be diagnosed with multiple myeloma or MGUS compared with white Americans; 20 percent of all cases of multiple myeloma occur in Black Americans. Black Americans are also more likely to develop this at a younger age compared to white Americans.
In addition, survivorship rates are lower among Black Americans. This is likely due to disparities in access to treatments such as stem cell transplantation, a treatment that is becoming more common in the United States as a whole but not at the same rates among Black Americans.
Black Americans are also underrepresented in clinical trials for new and potentially promising treatments for multiple myeloma. This could be due to clinical trial availability by location, the cost, or inherent racism built into the system, such as a patient not being told about a clinical trial that they qualify for because a physician assumes they won’t be interested.
Hispanic Americans experience similar disparities in care and outcomes as Black Americans. They are less likely than non-Hispanic Whites to receive an autologous stem cell transplant, and wait a longer time from diagnosis to initiation of newer drugs and treatments that have emerged in recent years and helped improve results for myeloma patients.
If you’ve been diagnosed with multiple myeloma, you may want to seek support to help you understand and cope with your condition. The following organizations are among those that provide information as well as medical, emotional, and financial support for people with multiple myeloma:
The IMF provides resources, including over 160 patient support groups, that can help patients access information on treatments, including clinical trials, as well as other support.
Multiple myeloma is a cancer of the plasma cells, a type of white cell found in the bone marrow.
Symptoms are not always present, but when they are they include bone pain and fractures, weakness, and fatigue.
Risk factors for multiple myeloma include being over 65, being male, and having obesity. Black Americans are almost twice as likely to be diagnosed with multiple myeloma and face obstacles to getting care compared to White Americans.
Treatment for multiple myeloma includes stem cell transplantation, chemotherapy, and a variety of medications.
