What is multiple myeloma?
Myeloma develops from plasma cells, immune cells that normally make antibodies. Cancerous plasma cells accumulate in marrow and often release one type of immunoglobulin or light chain, called an M protein, that can be measured in blood or urine. Disease can cause lytic bone lesions, anemia, high calcium, kidney injury, recurrent infection, or other defining biomarkers. Related conditions include monoclonal gammopathy of undetermined significance, smoldering myeloma, and solitary plasmacytoma; these do not all require the same treatment. Amyloidosis can occur when abnormal light-chain protein deposits in tissues. Myeloma is most common in older adults. Risk is higher with increasing age, male sex, Black ancestry, and a prior plasma-cell precursor condition, but the cause in an individual is usually unknown. Care depends on whether disease meets active-treatment criteria, stage, cytogenetic risk, organ damage, prior therapies, fitness for transplant, age, kidney function, frailty, and patient priorities.
Signs and symptoms
Multiple myeloma may be found through abnormal blood tests before symptoms appear. Bone pain, especially in the back, ribs, or hips, is common; weakened bones may fracture or compress the spinal cord. Anemia can cause fatigue, weakness, dizziness, or shortness of breath. Reduced immune function can lead to repeated infections. High calcium may cause thirst, frequent urination, constipation, nausea, sleepiness, or confusion. Kidney injury can cause swelling, reduced urine, or laboratory abnormalities, although it may be silent. Nerve symptoms can result from vertebral collapse, a mass, treatment, or amyloid deposits. These findings can also arise from osteoporosis, arthritis, infection, dehydration, medicines, kidney disease, and other noncancer conditions. New limb weakness, loss of bladder or bowel control, severe back pain, confusion, markedly reduced urine, or signs of infection require urgent assessment.
Diagnosis and staging
Evaluation includes a complete blood count, calcium, creatinine and other chemistry tests, serum protein electrophoresis with immunofixation, quantitative immunoglobulins, and serum free light chains. Urine protein studies may identify monoclonal light chains. Bone marrow aspiration and biopsy measure clonal plasma cells and provide flow cytometry, fluorescence in situ hybridization, chromosome, and molecular information. Whole-body low-dose CT, PET-CT, or MRI looks for lytic lesions, focal marrow disease, fractures, or soft-tissue plasmacytomas. Diagnosis distinguishes active myeloma from monoclonal gammopathy, smoldering myeloma, and solitary plasmacytoma using organ damage and myeloma-defining biomarkers. The Revised International Staging System or newer risk models combine beta-2 microglobulin, albumin, lactate dehydrogenase, and cytogenetic findings. Response is followed with protein or light-chain measurements, marrow tests, and imaging when appropriate. Baseline testing also records kidney and bone complications that need immediate management. Care depends on disease category, stage, biomarkers, organ effects, prior therapy, age, frailty, and kidney function.
Established treatment paths
People with monoclonal gammopathy or many cases of smoldering myeloma are monitored, while active myeloma requires systemic therapy. Initial treatment commonly combines several classes: a proteasome inhibitor, an immunomodulatory drug, a corticosteroid, and often an anti-CD38 monoclonal antibody. Exact combinations and doses are adjusted for transplant eligibility, frailty, kidney function, nerve problems, cytogenetic risk, and access. Eligible patients may have stem cells collected and receive high-dose chemotherapy followed by autologous stem cell transplant, either early or after initial therapy. Maintenance treatment, often using an immunomodulatory or targeted agent, can extend disease control. Radiation treats selected painful lesions, spinal cord compression, or plasmacytomas; surgery may stabilize fractures. Relapsed disease is treated with new combinations based on prior exposure and resistance, and may include CAR T-cell therapy, bispecific antibodies, antibody–drug conjugates, or clinical trials. Bone-modifying medicines can reduce skeletal complications. Care depends on active disease features, stage, biomarkers, organ function, treatment history, age, fitness, and preferences. Regular ongoing response monitoring helps determine duration, maintenance, and the timing of a different drug class.
Supportive care
Supportive care addresses bone health, kidney protection, infection risk, anemia, pain, neuropathy, fatigue, and mobility. Bisphosphonates or denosumab may be used with dental evaluation and kidney-aware monitoring. Teams may recommend vaccines, antiviral prevention, selected antibacterial measures, or immunoglobulin replacement based on treatment and infection history. Hydration and avoidance of kidney-stressing medicines may be important for some patients. Rehabilitation, fall prevention, braces, procedures, or radiation can help painful or unstable bones. Blood-clot prevention may accompany immunomodulatory drugs. Palliative care can support symptoms and goals throughout treatment. All medicines and supplements should be reviewed for kidney, bleeding, clotting, and interaction risks. Follow-up monitors monoclonal protein, blood counts, organ function, bones, and treatment effects.
Profiles documenting multiple myeloma care
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Sources
Source information checked: 2026-09-29. The links below identify the public and clinic-provided materials used for this page.
- NCI: Plasma Cell Neoplasms and Multiple Myeloma Treatment ↗Checked 2026-09-29
- NCI: Advances in Multiple Myeloma Research ↗Checked 2026-09-29
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