Multiple Myeloma

Types of multiple myeloma are based on how active the disease is and where plasma‑cell tumors are located. Early stages and types of multiple myeloma include:

• Monoclonal gammopathy of undetermined significance (MGUS) – An unusual protein made by plasma cells is found in the blood. People with high amounts of this protein need to be monitored, since it can lead to multiple myeloma.
• Smoldering (early) multiple myeloma – Abnormal plasma cells are found in the bone marrow, but they aren’t yet causing symptoms or damaging the body. People with this condition also need monitoring in case it becomes active multiple myeloma.
• Active multiple myeloma – Abnormal plasma cells in the bone marrow build up and crowd out healthy cells, causing noticeable symptoms and sometimes organ damage.
• Solitary plasmacytoma – A single plasma-cell tumor forms in the body, usually in the bone marrow.
• Extramedullary plasmacytoma – Plasma‑cell tumors form outside the bone, often in soft tissues like the nose, throat or sinuses. 

Certain factors increase your risk of developing multiple myeloma, including:

• Age 50+, with age 65+ being the most common at diagnosis
• Male
• Black or African American
• Family history of plasma-cell disorders
• Obesity
• Exposure to pesticides or Agent Orange

Multiple myeloma symptoms vary, and some people don’t notice symptoms in the early stages. Multiple myeloma symptoms may include:

• Bone pain, especially in the spine, ribs or hips
• Fatigue from anemia
• Frequent infections
• Numbness or weakness from nerve compression
• Weight loss, nausea or constipation
• Thirst and confusion from high calcium

Multiple myeloma can lead to other health issues. Abnormal plasma cells produce excess antibodies, which can damage organs and bones. Health issues that can occur with multiple myeloma include:

• Anemia
• Hypercalcemia
• Kidney damage
• Bone disease
• Nerve damage and blood thickening
• Increased clotting risk

Early diagnosis of multiple myeloma leads to better outcomes. Talk with your primary care doctor or oncologist if you have any of the following symptoms:

• Persistent bone pain
• Repeated infections
• Unexplained fatigue
• Numbness in the arms and legs
• Unexplained weight loss
• Excessive thirst, nausea or confusion

Testing for multiple myeloma may include:

• Blood and urine tests to measure protein levels, blood counts and kidney function
• Bone-marrow biopsy to confirm the presence of abnormal plasma cells
• Imaging tests, such as X-rays, MRIs and PET/CT scans, to identify tumors
• Genetic testing to detect cancer risk factors

Protein levels and genetics are used to place multiple myeloma into one of the following stages:

• Stage I (low risk)
• Stage II (intermediate risk)
• Stage III (high risk)

Treatment for multiple myeloma depends on your stage, genetics and overall health. Treatment options may include:

• Induction therapy to destroy the myeloma cells or keep them from spreading using a combination of medications, which may include targeted therapy or immunotherapy
• Stem-cell transplant to collect healthy stem cells (often your own); after high-dose chemotherapy, the healthy cells are returned to the body to rebuild bone marrow
• Maintenance therapy to maintain remission after initial treatment or stem-cell transplant using low-dose medications
• Relapsed or refractory therapy to treat multiple myeloma that returns or resists treatment with medications or cell-based therapies
• Radiation therapy to relieve bone pain, nerve compression or fractures while protecting nearby healthy tissues

Your Mercy cancer care team will create a treatment plan that’s tailored to your health needs and personal goals. 

Other types of care can help manage the symptoms and side effects of multiple myeloma treatment. Supportive care may include:

• Bone protection – Multiple myeloma can weaken bones, so medications are given to strengthen bones and help prevent fractures.
• Anemia management – Treating multiple myeloma can cause anemia (low red blood cells). Blood transfusions and medications help boost red blood cells and ease fatigue.
• Infection prevention – Antibiotics, antiviral medications and vaccines are given to protect your immune system.
• Pain relief – Medications and physical therapy can help keep pain under control.
• Kidney support – Multiple myeloma can affect your kidney function, so staying hydrated is essential. If your kidneys aren’t working well, dialysis or plasmapheresis (removing plasma from the blood) may be needed.
• Nutrition and emotional support – Guidance from dietitians, counselors and support groups helps you stay strong in body and mind. 

At Mercy, your care team includes medical and radiation oncologists, oncology nurses and other professionals who provide patient-centered care for multiple myeloma.
 

If your treatment requires stem-cell transplants or certain immunotherapies, Mercy collaborates with specialized health centers. We coordinate your referrals and provide follow-up care after treatment.

With the right care and support, many people with multiple myeloma live for years. Healthy lifestyle habits to support recovery include:

• Eating a balanced diet, getting regular exercise and avoiding tobacco
• Having regular follow-up visits with your care team
• Boosting your emotional and mental health through counseling or support groups
• Accessing survivorship programs and financial-assistance resources