Multiple myeloma is a type of blood cancer that begins in plasma cells, a type of white blood cell found in the bone marrow. Plasma cells normally help the body fight infections by producing antibodies. In multiple myeloma, these cells become cancerous, multiply uncontrollably, and crowd out healthy blood-forming cells. They also produce abnormal proteins that can damage the bones, kidneys, and immune system.
Although multiple myeloma is still considered an incurable disease, treatment has improved dramatically over the past two decades. A recent review highlights how earlier diagnosis, better risk assessment, and the development of new targeted therapies are helping many patients live longer and maintain a better quality of life than ever before.
What Are the Symptoms of Multiple Myeloma?
One challenge with multiple myeloma is that symptoms often develop gradually and can be mistaken for other conditions. Some people are diagnosed after routine blood work, while others seek medical care because of persistent symptoms.
Common signs and symptoms include:
- Bone pain, especially in the back, ribs, or hips
- Fatigue caused by anemia, a condition in which the body does not have enough healthy red blood cells
- Frequent infections because the immune system is weakened
- Kidney problems caused by abnormal proteins produced by myeloma cells
- High calcium levels, which can lead to excessive thirst, constipation, confusion, or nausea
- Unexplained weight loss or weakness
Many patients are diagnosed after developing one or more of these complications. Researchers emphasize that persistent bone pain, repeated infections, or unexplained anemia should always be evaluated by a healthcare provider.
How Is Multiple Myeloma Diagnosed?
Diagnosing multiple myeloma requires several different tests because no single test can confirm the disease.
Doctors typically begin with blood and urine tests that look for abnormal proteins produced by myeloma cells. These proteins can provide important clues about the presence and activity of the disease.
Additional testing often includes:
- Bone marrow biopsy to measure the number of abnormal plasma cells
- Blood tests to evaluate kidney function, calcium levels, and blood cell counts
- Imaging studies such as low-dose whole-body CT scans, PET-CT scans, or MRI to look for bone damage
- Genetic testing of myeloma cells to identify chromosome changes that help predict how aggressive the cancer may be
The review also explains that doctors now use risk stratification, which means grouping patients based on genetic features and other disease characteristics. This helps determine how aggressive the cancer is and guides treatment decisions. Patients with higher-risk disease often require more intensive treatment and closer follow-up than those with standard-risk disease.
How Is Multiple Myeloma Treated?
Treatment depends on whether the disease is causing symptoms.
People with precursor conditions such as monoclonal gammopathy of undetermined significance (MGUS) or smoldering multiple myeloma are usually monitored closely because they do not always require immediate treatment. Once active multiple myeloma develops, therapy is recommended.
Modern treatment often combines several types of medications, including:
- Immunomodulatory drugs, which help the immune system fight cancer
- Proteasome inhibitors, which interfere with cancer cell survival
- Monoclonal antibodies that specifically target myeloma cells
- Corticosteroids that help destroy myeloma cells and reduce inflammation
Many eligible patients also receive an autologous stem cell transplant, a procedure in which a patient’s own blood-forming stem cells are collected before high-dose chemotherapy and then returned to help rebuild healthy bone marrow.
Supportive treatments are also an important part of care and may include medications to strengthen bones, reduce fractures, protect kidney function, and prevent infections.
Breakthroughs Are Changing the Outlook for Patients
The review highlights how rapidly multiple myeloma treatment has evolved.
One of the biggest advances has been the widespread use of combination therapy, where several medications with different mechanisms work together to produce deeper and longer-lasting responses than older treatments.
Researchers are also making progress with newer immune-based therapies.
These include:
- CAR T-cell therapy, which modifies a patient’s own immune cells to recognize and attack myeloma cells
- Bispecific antibodies, which help bring immune cells into direct contact with cancer cells so they can destroy them
These treatments have shown encouraging results in patients whose disease has returned after previous therapies and are expected to play an increasingly important role in future treatment strategies.
The review also emphasizes the growing role of precision medicine. By using genetic testing to better understand each patient’s cancer, doctors can increasingly tailor treatment based on the biology of the disease rather than using the same approach for everyone.
Looking Ahead
Multiple myeloma remains a serious disease, but the outlook for patients has improved dramatically. Earlier diagnosis, more accurate risk assessment, and a growing number of targeted and immune-based therapies are allowing many people to live longer and maintain a better quality of life.
Researchers continue to develop new treatments that are more precise and more effective, bringing the field closer to the goal of turning multiple myeloma into a disease that can be controlled for many years.
Source
Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk-stratification, and management. Am J Hematol. 2022;97(8):1086-1107. Accessed by: https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ajh.26590
