Myeloma is caused by the uncontrolled growth of abnormal plasma cells in the bone marrow.
What is myeloma?
Multiple myeloma is a type of blood cancer of plasma cells, a kind of white blood cell found in the bone marrow. Healthy plasma cells make antibodies that protect the body from infection. In myeloma, these plasma cells become abnormal, multiply uncontrollably, and produce a single type of dysfunctional antibody called a monoclonal protein (also known as M-protein). These abnormal proteins can build up in the body and cause complications such as kidney damage. At the same time, the myeloma cells weaken bones, creating painful lesions and increasing the risk of fractures.
Although myeloma is a relatively rare cancer, it is being diagnosed more often as people live longer and awareness improves. The American Cancer Society estimates the average lifetime risk of getting myeloma is less than 1%. Myeloma is more common in older people, with the average age of diagnosis being 69. At the AHN Blood Cancer Center of Excellence, our team is at the forefront of treating myeloma and related blood cancers. We combine the most advanced therapies such as immunotherapy, targeted treatments, stem cell transplantation, and cellular therapy with a personalized care approach designed to meet each patient’s unique needs. We also offer access to clinical trials across different stages of the disease, giving patients the opportunity to benefit from promising new treatments before they are widely available.
AHN Hematology and Cellular Therapy Center of Excellence
Our Hematology and Cellular Therapy Center of Excellence is home to physicians who specialize in both malignant and benign blood disorders. Many of our physicians focus exclusively on a single disease area. For example, we have experts dedicated solely to myeloma, so patients benefit from highly specialized, disease-specific care. We provide comprehensive inpatient and outpatient services, with care available across AHN Cancer Institute sites throughout the region. Your care team goes beyond physicians and includes:
- Physician assistants
- Nurse practitioners
- Nurses
- Medical assistants
- Pharmacists
- Administrators
Why choose AHN for your myeloma treatment
At AHN, we combine compassionate care with the most advanced treatments available for myeloma. You will be seen by physicians who specialize in myeloma and who design a care plan tailored to your individual disease and goals. Our Hematology and Cellular Therapy Center of Excellence offers access to cutting-edge therapies, including:
- CAR T-cell therapy
- Bispecific antibodies
- Stem cell transplantation
- Immunotherapy and targeted agents
- Enrollment in clinical trials across different stages of disease
Our multidisciplinary team meets regularly to review your case, share expertise, and adjust your plan as needed. This ensures that your treatment remains personalized and up to date with the latest advances.
At AHN, you are never just a patient. You are cared for as a whole person by a team that knows myeloma in depth and is committed to guiding you through every step of your journey.
Myeloma symptoms and signs
Multiple myeloma can be difficult to detect early because its symptoms are often vague and can resemble those of other conditions. If you notice any of the following, especially if they persist, contact your health care provider:
- Bone pain: The most common symptom, often in the back, ribs, or hips.
- Fatigue: A frequent complaint, usually caused by anemia.
- Frequent infections: Myeloma weakens the immune system, increasing susceptibility to infections.
- Kidney problems: Abnormal proteins can damage the kidneys, sometimes causing increased thirst or changes in urination.
- Nausea, constipation, or loss of appetite: Often related to high calcium levels in the blood (hypercalcemia).
- Mental fogginess or confusion: Another possible effect of hypercalcemia.
- Unexplained weight loss: Loss of appetite or unintentional weight loss may be a later sign of disease progression.
It is also important to know that some patients have no noticeable symptoms at the time of diagnosis. In these cases, myeloma may be discovered through routine blood tests or imaging done for another reason.
It's also important to remember that these symptoms can be caused by many other conditions, and experiencing one or more of them doesn't necessarily mean you have multiple myeloma. However, if you're experiencing persistent or concerning symptoms, it's always best to see your doctor.
Causes and risk factors
Multiple myeloma begins when a plasma cell in the bone marrow undergoes genetic mutations, causing it to grow uncontrollably and crowd out healthy blood cells. These cancerous cells produce abnormal proteins that can damage organs like the kidneys and weaken bones. The precise triggers for these mutations remain uncertain.
The exact cause of multiple myeloma is not known. However, certain factors are associated with a higher risk:
- Age: The risk of myeloma increases with age. Most people diagnosed are over 65.
- Sex: Those assigned male at birth are slightly more likely to develop myeloma.
- Race: African Americans have about twice the risk compared with Caucasians.
- Family history: Having a close relative (parent, sibling, or child) with myeloma increases the risk.
- Monoclonal gammopathy of undetermined significance (MGUS): MGUS is a benign condition marked by low levels of abnormal antibodies. Those with MGUS have an annual progression risk of approximately 0.5 – 2%, and almost all myeloma cases are preceded by MGUS.
- Occupational/environmental exposures: Long-term exposure to certain substances, including benzene, pesticides, herbicides (such as Agent Orange), and radiation, has been linked with an increased risk of myeloma.
Myeloma screening and diagnosis
There is currently no routine screening recommended for multiple myeloma in people without symptoms. Myeloma is relatively uncommon, and population screening has not shown a clear benefit. Myeloma is sometimes noticed when routine blood work shows more unusual abnormalities leading to further testing. People with conditions such as MGUS or smoldering myeloma are monitored with labs and, when appropriate, imaging based on their risk factors.
Blood and urine tests
If your symptoms or routine labs suggest myeloma, your clinician may order some of the following to detect abnormal proteins, assess organ effects, and help stage disease. These are often the tests that are used to help diagnose myeloma:
- Blood protein test (SPEP and SIFE): This test looks for a special kind of protein in the blood that shouldn't be there. Finding it can mean someone might have a disease called myeloma.
- Urine protein test (UPEP with IFE): This test checks urine collected over a whole day for tiny pieces of protein called light chains. If they're there, it's another clue about myeloma.
- Light chain test (sFLC): This test measures two types of light chains in the blood, called kappa and lambda. It's important for your health care provider to know if the light chains are causing the biggest problems.
- IgG, IgA, IgM test: This test measures different types of proteins called immunoglobulins in the blood. It helps doctors understand the special protein that might be causing problems.
- Complete blood count (CBC): This is a regular blood test that checks if you have enough red and white blood cells. If you don't, it could mean the disease is affecting your bones. It also looks at kidney function and calcium. This test checks if your kidneys are working well and if you have the right amount of calcium in your blood. Problems here can mean the disease is hurting your organs.
- Beta-2, Albumin, and LDH: These are markers that help doctors figure out how serious the disease is and what might happen in the future, once they know someone has myeloma.
Bone marrow biopsy
A bone marrow aspiration and biopsy test is essential for confirming the diagnosis of myeloma. A sample of bone marrow is removed, usually from the back of the hip, and examined to determine how many plasma cells are present and whether they are clonal (genetically identical). The sample is also tested to identify features that affect prognosis and therapy choices. An AHN hematologist may perform:
- Flow cytometry: This identifies and characterizes clonal (genetically identical) plasma cells.
- Cytogenetic analysis: Health care providers use this to look for chromosome abnormalities in myeloma cells.
- Fluorescence in situ hybridization (FISH): This is used to detect specific genetic abnormalities in myeloma cells. Results help with staging and risk classification.
Imaging Tests
Imaging helps detect bone damage, measure disease extent, and monitor response to treatment. Modern guidelines favor whole-body imaging because it is more sensitive than traditional X-rays. Your care team will choose the imaging test that best fits your situation.
- Skeletal survey (X-rays): X-rays look for bone lesions and fractures.
- Magnetic resonance imaging (MRI): If an MRI shows multiple spots (focal lesions) in the bone marrow, that can help diagnose myeloma.
- Whole-body low-dose CT (WBLDCT): This imaging technique is a quicker and more accurate way to spot bone damage compared to standard X-rays.
- Positron emission tomography (PET) scan: A PET scan works to identify cells that are very active in the body and can also look for cells that aren’t as active. This will help your care team identify potential issues, including myeloma.
Types, stages, and related conditions
If you’ve been diagnosed with myeloma, it’s important and helpful to get an understanding of the various types. Your AHN care team will be available to answer questions and help you get the information you need to feel confident in your care. The various types of myeloma include:
- Secretory myeloma: This type makes an abnormal protein (called M-protein) that can be found in your blood and/or urine.
- Light-chain myeloma: This type only makes parts of the protein (light chains). It's less common but can sometimes cause more kidney problems.
- Nonsecretory/oligosecretory myeloma: This type makes very little or no M-protein. Doctors use bone marrow tests, imaging scans, and light chain tests to monitor it.
- Extramedullary disease and plasma cell leukemia: These are more aggressive forms where the myeloma is either outside the bone marrow or has spread into the bloodstream.
If there is a myeloma diagnosis, your doctor will determine its staging, or how advanced it is, so they can find the right treatment options. The R-ISS and R2-ISS are systems doctors use to determine how advanced the myeloma is (Stage 1, 2, or 3). They use blood tests (like beta-2 microglobulin, albumin, and LDH) and genetic tests on the myeloma cells to figure out the stage and risk level.
Related plasma cell conditions
There are different conditions that are not myeloma but are related and can potentially turn into myeloma. These include:
- MGUS: This is a pre-myeloma condition. You have a small amount of abnormal protein, but not enough to cause problems. Your AHN care team will watch it closely, but usually doesn't need treatment.
- Smoldering multiple myeloma: More abnormal cells than MGUS, but still not causing organ damage. It has a higher chance of turning into active myeloma, so it's monitored carefully.
- Solitary plasmacytoma: This is a single tumor of plasma cells in a bone or soft tissue. It's often treated with radiation.
- AL amyloidosis: A condition where light chains (from plasma cells) build up in organs and cause damage.
- POEMS syndrome: A rare syndrome linked to plasma cell disorders, causing nerve damage, bone problems, and other issues.
Myeloma treatment
Treatment is based on disease stage, biology, transplant eligibility, and a patient’s overall fitness. At AHN, care is coordinated by a multidisciplinary team that includes hematology, radiation oncology, nursing, pharmacy, and supportive care. The goal is simple: Pick the most effective therapy you can safely tolerate and keep adjusting as your disease and life change.
Initial therapy for newly diagnosed multiple myeloma
Treatment for multiple myeloma depend on if you are eligible for a stem cell transplant. For transplant-eligible patients you may have:
- Induction therapy: The goal is to reduce the number of myeloma presence before stem cell transplant. Common, preferred regimens include combinations of:
- Daratumumab, bortezomib, lenalidomide, dexamethasone (DVRd).
- Other options in select cases include CyBorD, KRd, or VRd, chosen based on comorbidities and risk factors.
- Stem cell transplant:
- Autologous stem cell transplant: The patient's own stem cells are collected, stored, and then reinfused after high-dose chemotherapy to help rebuild the bone marrow.
- Consolidation therapy: This may be given after transplant to further help responses. The therapy may involve similar drugs as induction (first treatment) therapy.
- Maintenance therapy: Given long-term to keep the myeloma in remission. Lenalidomide or daratumumab plus lenalidomide are commonly used based on risk and response.
For transplant-ineligible patients:
For patients who are not candidates for stem cell transplant, treatment is aimed at controlling the disease and improving quality of life. Common frontline options include:
- Combination drugs: This could include a combination of daratumumab, lenalidomide, and dexamethasone (DRd), which improved progression-free and overall survival.
- DVRd: Using different chemotherapy drugs, this treatment is dependent on the patient’s overall fitness and can help in treating myeloma.
- Dose-adjusted regimens: Dose-adjusted regimens mean changing the dose of medication based on an individual's needs and how their body is responding to the treatment. It's a personalized approach to medication.
Treatment for rarer presentations and related plasma cell disorders
Not all plasma cell disorders are the same as active myeloma. Treatment depends on the specific condition, and the doctors at AHN will create a treatment plan just for you. Some of the rarer condition types include:
- Smoldering multiple myeloma (SMM): Some patients with high-risk SMM may benefit from early treatment to delay progression to active myeloma. Others can be managed by active surveillance.
- Solitary plasmacytoma: Usually, this is treated with radiation therapy to target the tumor. Surgery might be needed if the tumor is causing problems with the bone structure or pressing on something.
- Plasma cell leukemia: This requires strong, fast-acting treatment with multiple drugs, often including special antibodies and proteasome inhibitors. A stem cell transplant and participation in clinical trials might also be considered. Because this condition is high-risk, it's best to be treated at a center with a lot of experience, like AHN.
Treatment for relapsed or refractory myeloma
Myeloma can relapse (come back) or become refractory (stop responding to treatment). The next treatment is chosen based on what you received before, how long the last response lasted, the side effects you experienced, your current health, and whether the disease is resistant to certain drug classes. Clinical trials are considered at every step. The general approach to care may include:
- New drugs: Using a different drug class from the one the disease is resistant to.
- Existing drugs: If you had a long remission and tolerated therapy well, your team may reuse a prior class with a new partner drug.
- Combination drugs: Most patients receive a three-drug combination. Two drugs may be used for frailty or specific health needs.
Supportive care
AHN provides comprehensive supportive care services for myeloma patients to help manage the side effects of treatment and improve their overall quality of life. We are there to help from diagnosis to survivorship. Common supportive care options include protecting your bones, blood clot prevention, pain control, physical therapy, and management of neuropath, kidney health, and anemia. Your AHN care provider will monitor your health to ensure you are getting the supportive care that is best for you.
Clinical trials
Clinical trials are a cornerstone of advancing myeloma treatments. They provide a framework for evaluating new therapies, improving existing treatments, and understanding the biology of this disease. AHN has active clinical trials for blood cancer that certain eligible patients can participate in if their care team determines that they would be a good fit.
Myeloma FAQs
Questions and concerns are common when are facing a myeloma diagnosis. Feeling overwhelmed is normal. Your AHN care team will guide you through each step, answer questions, and be a reliable resource. To help you get started, here are answers to frequently asked questions you can use in conversations with your care team.
Is myeloma a serious cancer?
Yes, multiple myeloma is a serious cancer. It affects plasma cells, a type of white blood cell in the bone marrow. It can lead to bone damage, kidney problems, anemia, high calcium levels, and increased infections. Treatments have improved greatly, and many people live for years with periods of remission. Most cases behave like a chronic, relapsing disease that can be managed even if not cured. Outcomes vary based on disease biology, response to therapy, overall health, and timely access to advanced treatments. If you have smoldering myeloma, it is not yet causing organ damage and is often managed with close monitoring rather than immediate treatment.
What is the life expectancy of a person with multiple myeloma?
There is no single number. Life expectancy varies widely based on disease biology, stage, genetics, response to treatment, age, overall health, and access to advanced therapies.
- Stage of the disease at diagnosis: Patients diagnosed at an earlier stage generally have a better prognosis.
- Genetic abnormalities: Certain chromosomal abnormalities are associated with a poorer prognosis.
- Overall health: A patient's overall health and fitness can impact their ability to tolerate treatment.
- Response to treatment: How well the patient responds to initial therapy is a critical factor.
- Availability of new treatments: The introduction of novel therapies has dramatically improved outcomes over the past two decades.
With modern treatments, many patients with multiple myeloma can live for five to 10 years or even longer after diagnosis. Some patients may achieve remission, where the disease is under control and there are no signs or symptoms of active myeloma. Many patients live for years, often with periods of remission. Some live a decade or longer, particularly in lower-risk groups and when deep responses are achieved. The most accurate way to discuss prognosis is with your AHN myeloma team, as they will factor in your stage, genetics, prior responses, fitness, and the treatments available to you now.
Can you fully recover from multiple myeloma?
No. Multiple myeloma is not considered curable. The focus is on achieving deep remission and keeping the disease controlled for as long as possible. With today’s treatments, many people live for years, often with long periods of remission. Some patients have multiyear, treatment-free intervals after therapies like transplant, CAR T, or bispecific antibodies. Relapses can still occur, so regular follow-up is essential. Your AHN team will tailor a plan to maximize time in remission, maintain quality of life, and keep future options open.
What is usually the first symptom of multiple myeloma?
There is no single "first" symptom for everyone. Many people have no symptoms at first and myeloma is found on routine blood tests. When symptoms do appear, the most common early clues are:
- Bone pain, often in the back, ribs, or hips
- Fatigue, usually from anemia
- Frequent infections or slower recovery from illnesses
- Kidney problems, sometimes noticed as rising creatinine or increased thirst
- Abnormal lab results, such as low hemoglobin, high calcium, or elevated total protein
Because these signs can have many causes, it is important to see your doctor for proper evaluation, especially if symptoms persist or labs are abnormal.
At what stage is multiple myeloma terminal?
There is no specific stage that makes myeloma terminal. The term applies when the disease keeps progressing despite available treatments or when a person chooses to stop anticancer therapy. At that point, the focus shifts to comfort-centered care to control symptoms and support quality of life. Many people with advanced myeloma still achieve meaningful remissions with newer therapies, so “advance” does not automatically mean terminal.
Contact us
Call the Division of Hematology and Cellular Therapy at 412-578-4484 to make an appointment with a hematologist. Patients needing immediate care are usually admitted to AHN West Penn Hospital and care is coordinated from there. Patients are otherwise seen in the outpatient office in the Mellon Pavilion. Once scheduled, our staff will instruct you on what is needed so that our doctors get access to your medical records.
Second opinions
If you have cancer, you have a team of oncology specialists ready to review your medical records and offer you a second opinion. After completing their review, they’ll talk with you about your goals to determine a course of treatment that’s right for you. To get started, fill out our Second Opinion Request form. A nurse navigator will contact you within the next 24 to 48 hours to discuss next steps and schedule.