A Patient’s Guide to Multiple Myeloma
Published by Dr. Kasturi Mandal | Last updated: September 2025
What Is Myeloma?
Multiple Myeloma is a blood cancer that begins in plasma cells, a type of white blood cell found in the bone marrow. In myeloma, abnormal plasma cells multiply uncontrollably, crowding out healthy blood cells and producing abnormal "M proteins."
It is called “multiple” because it often affects multiple areas of the bone marrow, causing damage to bones, kidneys, and the immune system. While not curable, it is a treatable condition, and many people live for years with proper management.
Common Signs & Symptoms (CRAB)
The most common symptoms are often remembered by the acronym CRAB:
| Symptom | What It Means |
|---|---|
| C – Calcium Elevated | High calcium from bone breakdown, which can cause nausea, thirst, and confusion. |
| R – Renal (Kidney) Dysfunction | Caused by M proteins damaging the kidneys. |
| A – Anemia | A shortage of red blood cells leading to fatigue and weakness. |
| B – Bone Damage | Bone pain (especially in the spine or ribs), fractures, and osteoporosis. |
Other common symptoms include frequent infections due to a weakened immune system, weight loss, and nerve-related issues like numbness or tingling.
Diagnosis
Diagnosing myeloma involves several key tests:
- Blood and Urine Tests: To detect the abnormal M protein and check kidney function, calcium, and blood counts.
- Bone Marrow Biopsy: The definitive test to confirm the presence of abnormal plasma cells in the bone marrow.
- Imaging Tests: X-rays, MRI, CT, or PET scans are used to look for bone damage.
Treatment Options
Treatment is based on the patient's age, symptoms, and eligibility for a stem cell transplant. For most newly diagnosed patients, treatment involves a combination of therapies:
- Targeted Therapy & Immunomodulators: Modern drugs like proteasome inhibitors (e.g., bortezomib) and immunomodulators (e.g., lenalidomide) form the backbone of therapy.
- Monoclonal Antibodies: Immunotherapies like daratumumab help the patient's own immune system fight the myeloma.
- Stem cell transplant (ASCT): For eligible patients, an autologous stem cell transplant is used to allow for higher, more effective doses of chemotherapy.
- Supportive Care: Includes medications to strengthen bones (bisphosphonates) and radiation for painful bone lesions.
For relapsed or refractory myeloma, newer advanced treatments like CAR-T cell therapy and bispecific antibodies are becoming available.
Living with Myeloma
Living with myeloma is a journey that requires ongoing monitoring of kidney function, bone health, and infection risk. A healthy lifestyle, including a balanced diet and staying active as tolerated, is important. It is crucial to maintain open communication with your care team and seek support from family, counselors, or support groups.