Multiple Myeloma

Multiple myeloma (MM) is a cancer of plasma cells, a type of white blood cell that lives in the bone marrow and normally helps your body fight infection by making antibodies. In myeloma, abnormal plasma cells grow out of control and make a single, ineffective antibody (an “M-protein”), crowding out healthy blood-forming cells and affecting bones, kidneys, and the immune system.

Understanding Plasma Cell Disorders

Plasma cell conditions exist on a spectrum:

MGUS (monoclonal gammopathy of undetermined significance) and smoldering myeloma are precursor conditions that may not cause symptoms but can progress, which is why monitoring is important.
Multiple myeloma involves multiple areas of marrow involvement and/or organ problems related to the disease.

Signs & Symptoms

Not everyone has symptoms at diagnosis, but possible signs include:

Bone pain or fractures, especially spine, ribs, hips (from bone weakening)
Anemia, fatigue, recurrent infections (crowding out normal blood cells/impaired antibodies)
High calcium, kidney problems, or nerve issues from disease effects and excess protein production

Risk Factors

Factors associated with higher risk include older age, male sex, Black race, and a personal history of a precursor plasma-cell disorder (e.g., MGUS). Environmental/occupational exposures and prior radiation have also been reported. (Many people with these factors never develop myeloma, and some people develop myeloma without known risks.)

Screening

There is no standard screening test for people at average risk. Instead, testing is done to evaluate symptoms, abnormal labs, or known precursor conditions.

Diagnosis

Your Illinois CancerCare team may use several steps to confirm myeloma and understand its extent:

(complete blood count; kidney function; calcium; serum protein electrophoresis, immunofixation, free light chains; beta2microglobulin; LDH) and urine tests for Mprotein (Bence Jones proteins)

to count plasma cells and perform cytogenetic/molecular testing (important for risk stratification)

(low-dose whole-body CT, PET/CT, or MRI) to look for bone involvement and focal lesions

Staging & Risk Stratification

The Revised International Staging System (RISS) combines beta2microglobulin, albumin, LDH, and high-risk cytogenetics to group myeloma from Stage I–III. This improves on older systems that relied only on beta2microglobulin and albumin, and it better predicts outcomes and helps tailor therapy.

Treatment Overview

Care is individualized based on your disease features (including cytogenetics/biomarkers), symptoms, fitness, and preferences. Most patients receive combinations of therapies over time, often with planned changes (“lines” of therapy) as the disease evolves.

When Treatment May Not Be Needed Right Away

For smoldering myeloma without organ damage, many patients are monitored closely; selected high risk smoldering cases may be offered clinical trials or early-intervention strategies.

First Treatment for Newly Diagnosed Myeloma

Triplet or quadruplet combinations (e.g., proteasome inhibitor + immunomodulatory drug + steroid, with or without an antiCD38 antibody) are common backbones, chosen by fitness and goals.
Stem cell transplant (autologous) is considered for eligible patients after initial cycles; others continue non-transplant therapy and move to maintenance if responding.

Maintenance

Ongoing maintenance therapy (often lenalidomidebased or risk-adapted) helps prolong remission after initial treatment +/- transplant.

Relapsed/Refractory Myeloma (R/R MM)

Options include different proteasome inhibitors, IMiDs, anti-CD38 antibodies, selinexor, belantamab mafodotin, bispecific antibodies (e.g., BCMA or GPRC5D-targeted), and CAR-T cell therapies targeting BCMA—selections depend on prior treatments and response.

Ongoing trials continue to move novel bispecifics earlier in the treatment journey. Your physician will discuss whether a clinical trial fits your situation. Because myeloma care changes rapidly, we’ll review current options and trials with you at every stage. Current Clinical Trials – Illinois CancerCare

Supportive Care (Staying Well During Treatment)

Bone health: medications (e.g., bisphosphonates or denosumab), vitamin D/calcium as appropriate, dental checks to reduce jaw risk, and fall-prevention strategies.
Infection prevention: vaccines, prompt treatment of infections, and specific prophylaxis when indicated.
Kidney protection: hydration guidance and avoiding medicines that strain the kidneys.
Blood/nerve/Clot care: monitoring for anemia; managing neuropathy; and blood clot prevention when using certain therapies (e.g., IMiDs) as appropriate.

Prognosis

Thanks to earlier detection of precursors, better combinations, and novel immunotherapies, outcomes have improved substantially. Survival depends on factors such as stage, genetic risk, response to therapy, and overall health. The 5 year relative survival is about 62% overall; statistics are population level and can’t predict an individual course—your doctor will explain what your features mean for you.

Follow-Up & Survivorship

After you start therapy, we’ll create a personalized follow-up plan that may include:

Regular visits, labs (including M-protein and/or free light chains) and imaging when indicated
Ongoing supportive care (bone health, vaccines, infection prevention, fatigue management, nutrition/exercise, and mental health resources)
Clear steps for what happens if labs change or symptoms recur, and discussion of clinical trials at each decision point

Why Choose Illinois CancerCare

Myeloma expertise with comprehensive diagnostics, risk-adapted treatment pathways, and supportive care—close to home
Access to clinical trials at Illinois CancerCare locations (e.g., DETERSMM for high-risk smoldering myeloma and other studies), plus referral pathways to additional research options when helpful
A multidisciplinary team focused on coordinated, compassionate care and your personal goals at every stage

Sources & Patient Friendly References

All information was taken from the NCI (National Cancer Institute) and ACS (American Cancer Society).