What Does A Multiple Myeloma Diagnosis Mean?

What Does Multiple Myeloma Mean?

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

These cancerous plasma cells produce abnormal immunoglobulin, 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 although it can’t typically be cured, it can be managed for many years with effective treatment.

How Is Multiple Myeloma Diagnosed?

Diagnosis often begins with a routine blood test that shows 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.

• Blood and urine tests: 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.
• Bone marrow biopsy: This is a key diagnostic test. A small sample of bone marrow is taken, typically from the hip, to be examined for cancerous plasma cells.
• Imaging tests: X-rays, MRI, PET scans or CT scans are used to look for bone damage or lesions caused by the myeloma cells.
• Fluorescence in situ hybridization analysis: 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 in an interview with CURE. “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 American and Latino American [patients]."

How Is Multiple Myeloma Treated?

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.

• Induction therapy: 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 the following:
  • Proteasome inhibitors: These drugs block the proteasome, a cellular complex that breaks down proteins, causing myeloma cells to die. Examples include Velcade (bortezomib) and Kyprolis (carfilzomib).
  • Immunomodulatory drugs (IMiDs): These drugs work by enhancing the body’s immune response against myeloma cells. Examples include Thalomid (thalidomide), Revlimid (lenalidomide) and Pomalyst (pomalidomide).
  • Monoclonal antibodies (mAbs): These drugs adhere to the surface of the myeloma cell on a very specific target and then trigger the immune system to destroy the cell. mABs include Darzalex (daratumumab) and Sarclisa (isatuximab).
  • Steroids: 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, has 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.
• Stem cell transplant: 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.
• Maintenance therapy: 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.
• Directly killing the cell: Some mAbs act like a poison dart, triggering the myeloma cell’s death.
• Flagging for destruction: Other mAbs act like a beacon, tagging the myeloma cell so the body’s own immune system can more easily find and destroy it.
• Blocking signals: Some mAbs can block signals the cancer cells use to grow and survive.

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

Monoclonal antibodies are now a standard part of treatment for many newly diagnosed patients. Specifically, Darzalex, the anti-CD38 mAb, 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.

• For transplant-eligible patients: Darzalex is often used in combination with other drugs, such as Velcade, Thalomid and dexamethasone, as an induction therapy before an autologous stem cell transplant.
• For transplant-ineligible patients: 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, [both] in general and [particularly] 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,” Mikhael said. “But now we have come to an era where we can be much more targeted.”

Other novel classes of agents, such as chimeric antigen receptor 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.

• Fatigue: Feeling tired is a very common side effect of both the disease and its treatments.
• Peripheral neuropathy: 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.
• Low blood counts: 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.
• Gastrointestinal issues: Nausea, vomiting, diarrhea or constipation can occur with many of the medications.
• Infection: Due to a weakened immune system, the disease itself increases the risk of infection; however, 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. We have so many good immunotherapies now that we didn’t have in the past that give new patients optimism. I use myself as an example,” Dr. Jim Omel, a retired family practitioner from central Nebraska who received a multiple myeloma diagnosis 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 health care 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 about 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 health care team with any questions or concerns.

This article was endorsed by the International Myeloma Foundation.

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