Multiple Myeloma – Diagnosis and Treatment

Diagnosis

Doctors rely on several tests to figure out if someone has multiple myeloma. Usually, they start with blood or urine tests, searching for abnormal proteins or changes in blood cell counts.

A lot of people get checked because they’re dealing with tiredness, bone pain, or maybe their blood tests looked off during a routine check-up for something else.

Blood and Urine Tests

• Blood Tests:
  • These tests can pick up high levels of proteins called M proteins, which myeloma cells release into the blood.
  • Doctors also check beta-2-microglobulin, albumin, calcium, and creatinine to check how well your kidneys and other organs are working.
  • A complete blood count (CBC) checks red and white blood cells and platelets, which can show if someone has anemia or other issues.
• Urine Tests:
  • Sometimes, lab tests check for Bence Jones proteins in your urine.
  • These are small pieces of a larger abnormal protein made by certain blood cells.
  • Finding them can help doctors diagnose or monitor conditions like multiple myeloma.

Testing the Bone Marrow

Doctors often do a bone marrow biopsy and aspiration to check how your bone marrow is working. They use a needle to take small samples of both the liquid and solid parts of your bone marrow—usually from the hip bone.

In the lab, specialists look for unusual or abnormal plasma cells, which may be signs of certain blood diseases.

They might also use a special test called FISH (fluorescence in situ hybridization) to look for genetic changes in the DNA of those cells.

Imaging Tests to Check Bones

Imaging helps doctors see bone damage. They might order:

• X-rays
• CT scans
• MRI scans
• PET scans

These scans can reveal bone lesions, tumors, or weak spots where cancer cells have caused trouble. Doctors especially look for lytic lesions, which are spots where bone has been destroyed.

Common Symptoms Noted

Doctors pay close attention if someone complains about bone pain, fatigue, lots of infections, or unexplained weight loss.

They use blood and urine test results, along with symptoms, to decide what tests to run next. Sometimes, a physical exam uncovers bone tenderness or other helpful clues.

Level and Phases of the Disease

After all the testing, doctors figure out how advanced the multiple myeloma is by assigning a stage from 1 to 3.

Stage	Description	Features Like
1	Slow growth, early findings	Mild impact
2	Medium phase	Some organ issues
3	Fast growth, advanced disease	Organ damage

• Stage 1:
  • The disease is usually moving slowly. There aren’t many cancer cells, and organ function is mostly okay.
• Stage 2:
  • The number of cancer cells goes up, and some organ changes might show up. This is kind of a middle ground.
• Stage 3:
  • The cancer spreads quickly. There are a lot of myeloma cells and more damage to organs like kidneys and bones.

The stage and risk group help shape the treatment plan and give a sense of what to expect.

Treatment

Sometimes, multiple myeloma doesn’t cause symptoms right away. In those cases, doctors might hold off on treatment and just monitor things with regular blood and urine tests.

They want to see if the disease is getting worse or if symptoms start to show up. When treatment does begin, the main goals are to manage pain, lower complications, and slow down cancer growth.

Early Stages: When Immediate Treatment Is Not Required

In some cases, the disease moves slowly and doesn’t cause symptoms. Doctors call this inactive or smoldering multiple myeloma.

People in this group usually don’t need treatment right away. Instead, they go for routine checkups to keep an eye on things.

The care team watches for changes. If symptoms appear or test results get worse, they’ll talk about starting therapy. Early treatment isn’t given unless there’s a clear reason, like organ problems or more active cancer.

Different Treatments Used for Myeloma

Doctors have several ways to treat multiple myeloma, and they often use more than one approach at a time.

Targeted Therapies

• These drugs go after specific chemicals or markers on cancer cells.
• Examples include monoclonal antibodies and medicines that block certain cell pathways.

Immunotherapy

• Immunotherapy boosts the immune system so it can fight cancer cells better.
• Treatments might use drugs that alert immune cells or lab-made antibodies.

Chimeric Antigen Receptor T-Cell (CAR-T) Therapy

• Doctors modify a patient’s T cells in a lab to help them recognize and attack myeloma cells. Then, they put the changed cells back into the patient’s body.
• They usually try CAR-T cell therapy if other treatments haven’t worked.

Chemotherapy

• Chemotherapy uses strong drugs to kill fast-growing cancer cells.
• It can hit healthy cells too, so side effects like infections are possible.

Corticosteroids

• These medications help lower swelling and fight the cancer.
• Doctors often use these with other treatments.

Stem Cell Transplantation

• Also called bone marrow transplant.

• Doctors collect blood-forming cells from the patient or a donor, give high-dose chemotherapy to wipe out sick marrow, and then put healthy cells back.

• There are two main types:

Type of Transplant	Description
Autologous (own cells)	Patient’s own stem cells are used
Allogeneic (donor cells)	Cells are obtained from a donor

Radiation Therapy

• Doctors use high-energy beams, like X-rays or protons, to target and kill cancer cells.
• Sometimes, radiation helps with painful tumor masses (plasmacytomas) or bone damage.

Table: Common Medicines for Multiple Myeloma

Medicine Type	Main Purpose
Proteasome inhibitor	Blocks cancer cell waste removal
Immunomodulator	Boosts immune response and slows growth
Immunomodulator	Changes the immune environment
Monoclonal antibody	Finds and kills myeloma cells

Doctors mix and match these treatments depending on the patient’s needs.

How Treatment Is Planned and Given

Doctors look at a few things before deciding on treatment: age, overall health, stage, how aggressive the disease is, and whether the patient can handle a stem cell transplant.

If Stem Cell Transplant Is Possible

Most patients start with a combo of medicines—targeted drugs, immunotherapy, corticosteroids, maybe chemotherapy. After that first phase, doctors collect stem cells.

The transplant might happen right away or later if the disease comes back. Sometimes, two transplants are on the table. Doctors might add more therapies after the transplant to help keep myeloma from returning.

If Stem Cell Transplant Is Not Possible

Some people can’t have a transplant because of age or other health issues. In those cases, doctors still use combinations of medicines to control myeloma.

If the Disease Comes Back or Does Not Respond

If myeloma returns or doesn’t respond, doctors might repeat the original treatment or try new options.

Managing Problems Caused by Myeloma

Multiple myeloma can lead to a bunch of complications. Here are some common issues and how doctors deal with them:

Bone Problems and Pain

• Medicines can help strengthen bones and lower the risk of fractures or osteoporosis.
• Doctors sometimes use radiation or surgery to ease pain or shore up weak bones.
• Pain meds keep discomfort under control.

Kidney Issues

• Some patients develop kidney problems or even kidney failure.
• Dialysis might be needed if the kidneys can’t keep up.
• Staying hydrated and avoiding certain drugs helps protect kidney function.

Infections

• Myeloma and its treatments can make it harder for the body to fight infections.
• Vaccines help prevent diseases like the flu and pneumonia.
• Doctors give antibiotics at the first sign of bacterial infection.

Anemia

• Low red blood cells (anemia) is common with multiple myeloma.
• Medicines like erythropoiesis-stimulating agents can help boost red blood cells, fight fatigue, and improve quality of life.

Nervous System Problems

• Some treatments, particularly certain chemotherapy drugs and immunomodulatory agents, can lead to tingling, pain, or numbness in the hands and feet, known as peripheral neuropathy.
• Changing the dose or switching meds might help with side effects.

Other Possible Issues

• High calcium in the blood (from bone breakdown) may need medicines or fluids.
• Problems with blood thickness (hyperviscosity syndrome) might call for special treatments.

Doctors use regular blood tests, imaging scans (like MRI or X-ray), and kidney function tests to watch for new or worsening problems.

Alternative medicine

Alternative medicine can’t cure multiple myeloma, but it might help with stress and side effects. Some people try art therapy, meditation, music therapy, exercise, or relaxation exercises. Others turn to spirituality for support.

Coping and Support

Living with multiple myeloma isn’t easy, but there are ways to make things a bit better. Learning about the disease is important—knowing your treatment options and possible side effects helps you take charge of your care.

A solid support system matters a lot. Friends, family, and support groups can help with everyday challenges and emotional stress.

Many people find it comforting to connect with others going through the same thing, whether face-to-face or online. Support groups let people share advice and learn practical ways to handle problems.

Ways to Strengthen Support and Well-Being:

Action	How it Helps
Join a support group	Shares experiences and advice
Ask for help	Reduces stress and feelings of isolation
Talk with professionals	Builds knowledge and confidence

Setting realistic goals can help you feel more in control. Goals should fit what you can handle at the time.

Even small wins can give you purpose and lift your mood. For example, you might adjust your work hours or set personal milestones that feel doable and meaningful.

Self-care is a big deal, too. Eating well, taking time to relax, and getting enough sleep can lower stress and fight fatigue.

Planning for days when you need extra rest helps protect your quality of life during treatment. Taking time for yourself isn’t selfish—it’s just part of managing your health, both physical and emotional.

Getting Ready for Your Visit

Getting ready for your appointment ahead of time makes things go a lot smoother. Bringing a friend or family member is a smart move—they can help remember details or jot down notes during the visit.

Make a list before you go. Include:

• A Summary of Your Symptoms: When did each one start? Have they changed?
• Your Current and Past Medical Conditions: Especially any plasma or blood disorders.
• All Medications, Vitamins, and Supplements: List names and doses.
• Questions for the Provider: Planning ahead helps you cover everything.

Here are some questions you might want to ask:

Topic	Example Questions
Diagnosis	What could be causing my symptoms?
Testing & Next Steps	What tests are needed? What comes after?
If seeing a specialist	Do I have multiple myeloma? What stage is it?
Risk & Treatment	Does my disease have high-risk features? What are my treatment options? Are there alternatives?
Managing Other Conditions	How does this affect my other health problems?
Treatments	What are possible side effects?
Outcomes & Further Planning	What if the first treatment doesn’t work?

No question is too small. If something worries you—about the condition or the treatment plan—bring it up.

What Your Doctor Will Want to Know

When you visit, your provider will probably start by asking about your health and any symptoms you’ve noticed.

They might ask things like:

• Bone Pain: Do you feel pain in your bones? Where exactly do you notice it?
• General Symptoms: Have you been feeling more tired, weak, or maybe lost some weight?
• Infections: Are you dealing with more infections than usual, like pneumonia, skin issues, bladder problems, or even shingles?
• Family History: Has anyone in your family had plasma cell disorders?
• Blood Clots or Circulation Problems: Have you or someone in your family had blood clots or trouble with circulation?
• Digestive Changes: Have you noticed any changes in your bowel habits?

If you come prepared with answers, you’ll make the appointment a lot smoother. Honestly, jotting down your symptoms or keeping a quick log can make a big difference.

This way, your provider can figure out which tests you might need and what to do next. Bring a list, maybe even a friend, and think about what you want to ask or say—sometimes those little steps help everyone get more out of the visit.