Dr. Joseph Mikhael

Multiple myeloma is a chronic blood cancer affecting plasma cells, but with today’s treatments many patients can manage symptoms and live fulfilling lives.

What Does Multiple Myeloma Mean? 

Multiple myeloma is a cancer that begins in a type of white blood cell called plasma cells. These cells are found in the bone marrow and are responsible for producing antibodies, which are also known as immunoglobulins, that help fight infections. When a person has multiple myeloma, these plasma cells become cancerous and multiply uncontrollably.

These cancerous plasma cells produce abnormal immunoglobin, known as the monoclonal or M protein. The myeloma cells can also crowd out healthy blood cells in the bone marrow and release substances that cause bone damage.

Multiple myeloma is not a solid tumor like breast or lung cancer. Instead, it’s a type of blood cancer that can affect how multiple parts of the body work, including the bones, kidneys, and immune system. The disease is considered chronic, which means that while it can’t typically be cured, it can be managed for many years with effective treatment.

Diagnosis often begins with a routine blood test showing high levels of protein or calcium, low levels of hemoglobin (anemia) or with a patient experiencing symptoms like bone pain or fatigue. The diagnostic process involves several tests to confirm the presence of myeloma and determine its extent.

 These tests check for the presence of the M protein and other substances or issues that indicate myeloma, such as high calcium levels or kidney problems.

 This is a key diagnostic test. A small sample of bone marrow is taken, usually from the hip, to be examined for cancerous plasma cells.

 X-rays, MRI, PET scans, or CT scans are used to look for bone damage, or lesions, caused by the myeloma cells.

 This genetic test is performed on the bone marrow sample to identify specific chromosomal abnormalities in the myeloma cells, which helps determine prognosis and guide treatment decisions.

“The diagnosis of myeloma is very often delayed,” Dr. Joseph Mikhael, a professor in the Clinical Genomics and Therapeutics Division at the Translational Genomics Research Institute, an affiliate of City of Hope Cancer Center, and Chief Medical Officer of the International Myeloma Foundation, said 

. “On average, people see their primary care provider three times with signs and symptoms consistent with multiple myeloma before the diagnosis is made.”This is even longer in certain populations such as African Americans and Latino Americans."

The treatment for patients with multiple myeloma is highly personalized and depends on several factors, including the patient’s age, overall health, and the specific characteristics of their myeloma cells. The goal of treatment is to reduce the number of cancerous cells, control symptoms, and prolong remission.

 This is the initial treatment phase. It’s often a combination of different drugs aimed at killing the myeloma cells and getting the disease under control. Common drug types include:

 These drugs block the proteasome, a cellular complex that breaks down proteins, causing myeloma cells to die. Examples include Velcade (bortezomib) and Kyprolis (carfilzomib).

 These drugs work by enhancing the body’s immune response against myeloma cells. Examples include Thalomid (thalidomide), Revlimid (lenalidomide), and Pomalyst (pomalidomide).

 These drugs adhere to the surface of the myeloma cell on a very specific target, then trigger the immune system to destroy the cell. mABs include Darzalex (daratumumab) and Sarclisa (isatuximab).

 Medications such as dexamethasone are often used in combination with other drugs to enhance their effectiveness.

The combination of all four classes, often called quadruplets have become the standard of care in the majority of patients – both in those undergoing stem cell transplantation and those who are not.This has considerably improved the outcomes for patients.Initial treatment of myeloma is critical to the long-term management of the disease.

 An autologous stem cell transplant is often considered for eligible patients. It involves collecting a patient’s own healthy stem cells, giving high-dose chemotherapy to destroy the remaining cancerous cells, and then reinfusing the stored stem cells to help the bone marrow recover and produce new, healthy blood cells.

 After induction therapy or a stem cell transplant, a patient may be placed on a lower dose of medication (often an IMiD and possibly a second agent) to maintain remission and prevent the disease from returning.

 Some mAbs act like a poison dart, triggering the myeloma cell’s death.

 Other mAbs act like a beacon, tagging the myeloma cell so the body’s own immune system can more easily find and destroy it.

 Some mAbs can block signals the cancer cells use to grow and survive.

Examples include Darzalex (daratumumab) and Sarclisa (isatuximab), which both target the CD38 protein on myeloma cells, and Empliciti (elotuzumab), which targets the SLAMF7 protein.

Monoclonal antibodies are now a standard part of treatment for many newly diagnosed patients. Specifically, the anti-CD38 monoclonal antibody Darzalex has revolutionized the initial treatment of patients with multiple myeloma. Clinical trials have shown that adding Darzalex to standard-of-care regimens significantly improves outcomes. Specifically, its injection form, known as Darzalex Faspro (daratumumab and hyaluronidase-fihj), makes treatment time faster and has become more common than the original intravenous formulation.

 Daratumumab is often used in combination with other drugs, such as Velcade, Thalomid, and dexamethasone, as an induction therapy before an autologous stem cell transplant.

 A combination of Darzalex, Revlimid, and dexamethasone is a standard regimen for newly diagnosed patients who are not candidates for a stem cell transplant. Similarly, Sarclisa is indicated for use in combination with Velcade, Revlimid, and dexamethasone in adult patients with newly diagnosed multiple myeloma who are ineligible for transplant.

“These are exciting times in cancer therapy in general and in particular in multiple myeloma, where, historically, we had to use the sorts of treatments that were tough on the patient, not just tough on their myeloma,” 

. “But now we have come to an era where we can be much more targeted.”

Other novel classes of agents, such as CAR T-cell therapy and bispecific antibodies, which are showing promising results for patients who have relapsed or are refractory to other treatments, are being explored in the frontline setting.

Multiple Myeloma Treatment-Related Side Effects

Treatments for multiple myeloma can cause various side effects. It’s important to discuss these with your oncologist, as many can be managed with supportive care.

 Feeling tired is a very common side effect of both the disease and its treatments.

 This is nerve damage that can cause tingling, numbness, or pain, most often in the hands and feet. It’s a common side effect of some proteasome inhibitors.

 Myeloma and its treatments can suppress the bone marrow, leading to a low number of red blood cells (anemia), white blood cells (neutropenia), and platelets (thrombocytopenia). This can increase the risk of infections and bleeding.

 Nausea, vomiting, diarrhea, or constipation can occur with many of the medications.

 The disease itself due to a weakened immune system increases the risk of infection – but treatment can also contribute to this further.

Embracing the Journey: Your Path Forward With Multiple Myeloma

A diagnosis of multiple myeloma can be overwhelming, but it’s important to remember that it’s a very treatable cancer. Your treatment plan will be carefully tailored to your specific needs, and with ongoing research, new and more effective therapies are becoming available. This overview is just the beginning of your journey.

“The year 2025, especially, has been a good one, and we have so many good immunotherapies now that we didn’t have in the past, that I give new patients optimism. I use myself as an example,” 

Dr. Jim Omel, a retired family practitioner from central Nebraska diagnosed with multiple myeloma in 1997, told CURE

 “I’m an outlier when it comes to living that long, but new patients now can expect long, healthy lives. I use the analogy of diabetes. We cannot cure diabetes, but you can live with it, and we have good treatment for it. So I say that myeloma now is, for the majority — not all — but for the majority of patients, a chronic disease. You can live with it and enjoy your life.”

The most important step you can take is to partner with your healthcare team. Ask questions, share your concerns, and be open about any side effects you experience. This will help your oncologist and you make the best decisions for your care, ensuring you have the highest quality of life throughout your treatment.

Interested in learning more about your multiple myeloma diagnosis? Hear firsthand a

multiple myeloma survivor share his story

surrounding his 1997 cancer diagnosis and how his cancer journey has evolved.

This guide is designed to be a starting point. Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice. Please contact your healthcare team with any questions or concerns.

This article was endorsed by the International Myeloma Foundation.

For more news on cancer updates, research and education,

don’t forget to subscribe to CURE®’s newsletters here.

Articles

Multiple myeloma is a blood cancer originating in plasma cells, leading to excessive production of abnormal antibodies and potential bone damage. Diagnosis involves blood tests, bone marrow biopsy, imaging, and genetic analysis. Treatment is personalized, often starting with induction therapy using proteasome inhibitors, immunomodulatory drugs, and steroids, followed by stem cell transplant and maintenance therapy. Monoclonal antibodies, such as Darzalex, have significantly improved outcomes. Emerging therapies like CAR T-cell therapy and bispecific antibodies show promise. Managing side effects and maintaining quality of life are crucial for patients.

Dr. Joseph Mikhael discusses the overlooked symptoms of multiple myeloma in honor of Myeloma Awareness Month.

Myeloma Awareness Month and Acknowledging Early Symptoms of The Disease

March is Myeloma Awareness Month, a time to recognize the subtle but serious symptoms of multiple myeloma, including persistent fatigue, unexplained bone pain and anemia. Since diagnosis is often delayed — especially in higher-risk populations — raising awareness can help identify the disease earlier for timely treatment.

Dr. Joseph Mikhael sat down for an interview with CURE to discuss the often-overlooked symptoms of multiple myeloma in honor of Myeloma Awareness Month.

Mikhael is a professor in the Applied Cancer Research and Drug Discovery Division at the Translational Genomics Research Institute, an affiliate of City of Hope Cancer Center, and chief medical officer of the International Myeloma Foundation. You can read more of our conversation with him on 

the topic of Multiple Myeloma Awareness Month here

Myeloma is a challenging diagnosis to make because there is not one particular sign or symptom [that] points us to a diagnosis of myeloma. Typically, the signs and symptoms that patients have are that they experience fatigue, and not just the regular fatigue you and I might face on a regular basis, but when it really is beyond what is normal, an ongoing weakness that is not typical. [Another] is bone pain, or pain in the distribution of our bones. This is often in our backs, where we have obviously a lot of bones, because myeloma attacks the bone. Often our patients — over half of our patients — present with bone pain.

And the third most common reason is what we call anemia, or a low hemoglobin. If that blood test has been done, a lot of times, family doctors and primary care will measure hemoglobin level in terms of what we call a CBC, or complete blood count. About three-quarters of the time, our patients have a low hemoglobin.

Now, of course, there's lots of causes for fatigue, there's lots of causes for bone pain, there are lots of causes for anemia; myeloma is not the one that comes to the top of mind with these very common things. However, when those are going on, and there really isn't a clear explanation, we want people to start to think about the potential of multiple myeloma. This is particularly important in patients who are at higher risk. Myeloma is more common as we get older, in particular, as patients get into their 60s and 70s. Those of us of African descent are at twice the risk, and individuals of Latino American background also are diagnosed at a younger age.

We want people to simply to be aware of [these risks]; we don't want people to think about myeloma every time they are tired, but when it reaches a point when they are working with their primary care provider and something doesn't make sense in [these areas], we want to think about multiple myeloma.

What is so important is that the diagnosis of myeloma is very often delayed. On average, people see their primary care provider three times with signs and symptoms consistent with multiple myeloma before the diagnosis is made. That is even longer in African American and Latino American patients, and that is one of the reasons that during this month, we have people think of these signs and symptoms, [making sure] that they are aware of them.

Transcript was edited for clarity and conciseness.

For more news on cancer updates, research and education, don’t forget to 

subscribe to CURE®’s newsletters here.

Dr. Joseph Mikhael

What Does Multiple Myeloma Mean?

Myeloma Awareness Month and Acknowledging Early Symptoms of The Disease

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