Diagnosis

In some cases, your doctor may detect multiple myeloma accidentally when you undergo a blood test for some other condition. In other cases, your doctor may suspect multiple myeloma based on your signs and symptoms.

Tests and procedures used to diagnose multiple myeloma include:

  • Blood tests. Laboratory analysis of your blood may reveal the M proteins produced by myeloma cells. Another abnormal protein produced by myeloma cells — called beta-2-microglobulin — may be detected in your blood and give your doctor clues about the aggressiveness of your myeloma.

    Additionally, blood tests to examine your kidney function, blood cell counts, calcium levels and uric acid levels can give your doctor clues about your diagnosis.

  • Urine tests. Analysis of your urine may show M proteins, which are referred to as Bence Jones proteins when they're detected in urine.
  • Examination of your bone marrow. Your doctor may remove a sample of bone marrow for laboratory testing. The sample is collected with a long needle inserted into a bone (bone marrow aspiration and biopsy).

    In the lab, the sample is examined for myeloma cells. Specialized tests, such as fluorescence in situ hybridization (FISH) can analyze myeloma cells to understand their genetic abnormalities. Tests are also done to measure the rate at which the myeloma cells are dividing.

  • Imaging tests. Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include an X-ray, MRI, CT or positron emission tomography (PET).

Assigning a stage and a risk category

If tests indicate you have multiple myeloma, your doctor will use the information gathered from the diagnostic tests to classify your disease as stage I, stage II or stage III. Stage I indicates a less aggressive disease, and stage III indicates an aggressive disease that may affect bone, kidneys and other organs.

Your multiple myeloma may also be assigned a risk category, which indicates the aggressiveness of your disease.

Your multiple myeloma stage and risk category help your doctor understand your prognosis and your treatment options.

Treatment

If you're experiencing symptoms, treatment can help relieve pain, control complications of the disease, stabilize your condition and slow the progress of multiple myeloma.

Immediate treatment may not be necessary

If you have multiple myeloma but aren't experiencing any symptoms (also known as smoldering multiple myeloma), you may not need treatment. However, your doctor will regularly monitor your condition for signs that the disease is progressing. This may involve periodic blood and urine tests.

If you develop signs and symptoms or your multiple myeloma shows signs of progression, you and your doctor may decide to begin treatment.

Treatments for myeloma

Standard treatment options include:

  • Targeted therapy. Targeted drug treatment focuses on specific abnormalities within cancer cells that allow them to survive. Bortezomib (Velcade), carfilzomib (Kyprolis) and ixazomib (Ninlaro) are targeted drugs that block the action of a substance in myeloma cells that breaks down proteins. This action causes myeloma cells to die. Targeted-therapy drugs may be administered through a vein in your arm or in pill form.

    Other targeted-therapy treatments include monoclonal antibody drugs that bind to the specific proteins present on myeloma cells, causing them to die.

  • Biological therapy. Biological therapy drugs use your body's immune system to fight myeloma cells. The drugs thalidomide (Thalomid), lenalidomide (Revlimid) and pomalidomide (Pomalyst) enhance the immune system cells that identify and attack cancer cells. These medications are commonly taken in pill form.
  • Chemotherapy. Chemotherapy drugs kill fast-growing cells, including myeloma cells. Chemotherapy drugs can be given through a vein in your arm or taken in pill form. High doses of chemotherapy drugs are used before a bone marrow transplant.
  • Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, regulate the immune system to control inflammation in the body. They are also active against myeloma cells. Corticosteroids can be taken in pill form or administered through a vein in your arm.
  • Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, is a procedure to replace your diseased bone marrow with healthy bone marrow.

    Before a bone marrow transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow.

  • Radiation therapy. This treatment uses beams of energy, such as X-rays and protons, to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells form a tumor (plasmacytoma) that's causing pain or destroying a bone.

How treatments are used

Which combination of treatments you're likely to receive will depend on whether you're considered a good candidate for bone marrow transplant. This depends on the risk of your disease progressing, your age and your overall health.

  • If you're considered a candidate for bone marrow transplant, your initial therapy will likely include a combination of treatments, such as targeted therapy, biological therapy, corticosteroids and, sometimes, chemotherapy.

    Your stem cells will likely be collected after you've undergone a few months of treatment. You may undergo the bone marrow transplant soon after your cells are collected or the transplant may be delayed until after a relapse, if it occurs. In some cases, doctors recommend two bone marrow transplants for people with multiple myeloma.

    After your bone marrow transplant, you'll likely receive targeted therapy or biological therapy as a maintenance treatment to prevent a recurrence of myeloma.

  • If you're not considered a candidate for bone marrow transplant, your initial therapy will likely include chemotherapy combined with corticosteroids, targeted therapy or biological therapy.
  • If your myeloma recurs or doesn't respond to treatment, your doctor may recommend repeating another course of the treatment that initially helped you. Another option is trying one or more of the other treatments typically used as first line therapy, either alone or in combination.

    Research on a number of new treatment options is ongoing, and you may be eligible for a clinical trial in order to gain access to those experimental treatments. Talk to your doctor about what clinical trials may be available to you.

Treating complications

Because multiple myeloma can cause a number of complications, you may also need treatment for those specific conditions. For example:

  • Bone pain. Pain medications, radiation therapy and surgery may help control bone pain.
  • Kidney complications. People with severe kidney damage may need dialysis.
  • Infections. Your doctor may recommend certain vaccines to prevent infections, such as the flu and pneumonia.
  • Bone loss. Your doctor may recommend medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), to help prevent bone loss.
  • Anemia. If you have persistent anemia, your doctor may recommend medications to increase your red blood cell count.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Alternative medicine

No alternative medicines have been found to treat multiple myeloma. But alternative medicine may help you cope with the stress and side effects of myeloma and myeloma treatment.

Talk to your doctor about your options, such as:

  • Art therapy
  • Exercise
  • Meditation
  • Music therapy
  • Relaxation exercises
  • Spirituality

Talk with your doctor before trying any of these techniques to make sure they don't pose any risks for you.

Coping and support

A cancer diagnosis can be shocking and devastating. With time, you'll find ways to cope with the stress and uncertainty of living with cancer. Until you find what works best for you, consider trying to:

  • Learn enough to make decisions about your care. Learn enough about multiple myeloma so that you're able to participate in decisions about your treatment and care. Ask your doctor about your treatment options and their side effects.

    You may find additional help gathering information through your local library and online. Start with the National Cancer Institute and the International Myeloma Foundation.

  • Maintain a strong support system. Having a strong support system can help you cope with issues and anxieties that might occur. Your friends and family may be willing to offer support.

    You might also find that support from a formal support group or others coping with cancer may be helpful. Friends you meet in support groups may be willing to share practical advice for coping with cancer and cancer treatment. Support groups are also available online.

  • Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don't choose goals you can't possibly reach. You may not be able to work a 40-hour week, for example, but you may be able to work at least part time. In fact, many people find that continuing to work during cancer treatment can be helpful in maintaining some normalcy.
  • Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the downtimes when you may need to rest more or limit what you do.

Preparing for your appointment

If you have any signs or symptoms that worry you, make an appointment with your doctor.

If you're diagnosed with multiple myeloma, you'll likely be referred to a doctor who specializes in treating blood and bone marrow disorders (hematologist) or a doctor who specializes in treating cancer (oncologist).

Because appointments can be brief and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready and know what to expect from your doctor.

What you can do

  • Note symptoms you're experiencing. If you have had signs and symptoms of illness or are just not feeling well, write down those details before your appointment. Your doctor will also want to know when you first noticed these symptoms and whether they've changed over time.
  • List other medical conditions. Your doctor will be especially interested to know if you've been diagnosed with any other plasma disorders, such as monoclonal gammopathy of undetermined significance (MGUS).
  • Make a list of your medications. Include any prescription or over-the-counter medications you're taking, as well as all vitamins, supplements and herbal remedies.
  • Take a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Questions to ask your doctor at your initial appointment include:

  • What may be causing my symptoms or condition?
  • Are there any other possible causes?
  • What kinds of tests do I need?
  • What do you recommend for next steps in determining my diagnosis and treatment?
  • Are there any restrictions that I need to follow in the meantime?

Questions to consider if your doctor refers you to a specialist include:

  • Do I have multiple myeloma?
  • What stage of myeloma do I have?
  • Does my myeloma have any high-risk features?
  • What are the goals of treatment in my case?
  • What treatment do you recommend?
  • I have these other health problems. How can I best treat them together with multiple myeloma?
  • What are the possible side effects of treatment?
  • If the first treatment isn't successful, what will be the next option?
  • Am I a candidate for bone marrow transplantation?
  • Do I need a medicine to strengthen my bones?
  • What is the outlook for my condition?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Thinking about your answers ahead of time can help you make the most of your appointment. A doctor who sees you for possible multiple myeloma may ask:

  • What are your symptoms, if any?
  • When did you first begin experiencing symptoms?
  • How have your symptoms changed over time?
  • Do your symptoms include bone pain? Where?
  • Do your symptoms include nausea, loss of appetite or weight loss?
  • Do your symptoms include weakness or fatigue?
  • Have you had repeated infections, such as pneumonia, sinusitis, bladder or kidney infections, skin infections, or shingles?
  • Have you noticed any changes in your bowel habits?
  • Have you been more thirsty or urinated more than usual?
  • What else concerns you?
  • Do you have any family history of plasma disorders such as MGUS?
  • Have you been diagnosed or treated for any other medical conditions?
  • Do you have a history of blood clots?
  • What medications are you taking?

Multiple myeloma care at Mayo Clinic

Dec. 15, 2017
References
  1. Kaushansky K, et al., eds. Myeloma. In: Williams Hematology. 9th ed. New York, N.Y.: McGraw-Hill Education; 2016. http://accessmedicine.mhmedical.com. Accessed March 31, 2017.
  2. Ferri FF. Multiple myeloma. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed March 31, 2017.
  3. Niederhuber JE, et al., eds. Multiple myeloma and related disorders. In: Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. https://www.clinicalkey.com. Accessed April 23, 2017.
  4. Multiple myeloma. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed March 31, 2017.
  5. Plasma cell neoplasms (including multiple myeloma) treatment (PDQ). National Cancer Institute. https://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq. Accessed April 23, 2017.
  6. Goldman L, et al., eds. Plasma cell disorders. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed April 30, 2017.
  7. Kyprolis (prescribing information). South San Francisco, Calif.: Onyx Pharmaceuticals, Inc.; 2012. http://www.kyprolis-hcp.com/. Accessed April 23, 2017.
  8. Velcade (prescribing information). Cambridge, Mass.: Millennium Pharmaceuticals, Inc.; 2012. http://www.velcade.com. Accessed April 23, 2017.
  9. Distress management. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed August 2, 2017.
  10. Warner KJ. Allscripts EPSi. Mayo Clinic, Rochester, Minn. June 9, 2017.
  11. Russell SJ, et al. Remission of disseminated cancer after system oncolytic virotherapy. Mayo Clinic Proceedings. 2014;89:926.
  12. Ninlaro (prescribing information). Cambridge, Mass.: Millennium Pharmaceuticals, Inc.; 2016. https://www.ninlarohcp.com. Accessed April 30, 2017.
  13. AskMayoExpert. Multiple myeloma. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
  14. Kumar S, et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncology. 2016;17:e328.
  15. Cavo M, et al. Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: A consensus statement by the International Myeloma Working Group. Lancet Oncology. 2017;18:e206.
  16. Rajkumar SV, et al. Program genealogies: Myeloma at Mayo. The Hematologist. 2015;12:6.
  17. Kyle RA, et al. Diagnostic criteria for the electrophoretic patterns of serum and urinary proteins in multiple myeloma. JAMA. 1960;174:107.
  18. Gonsalves WI (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 4, 2017.