Multiple Myeloma
Medically reviewed by: Craig Cole, MD
Last Updated: August 2026
What Is Multiple Myeloma?
Multiple myeloma is a rare blood cancer. It starts in plasma cells, which are a type of white blood cell found in the bone marrow. Bone marrow is the soft, spongy tissue inside bones where blood cells are made.
Healthy plasma cells help your body fight infections and other diseases. Multiple myeloma happens when normal plasma cells turn into abnormal or mutated cells, multiply, and grow out of control. These myeloma (cancer) cells build up in the bone marrow and crowd out healthy blood cells.
The myeloma cells keep trying to make antibodies — or tiny proteins in the blood that your body makes to help fight infections. But the antibodies myeloma cells make don’t work properly. Instead, these abnormal proteins (called M proteins) cause problems, such as damage to the kidneys, blood cells, bones, and immune system.
Risk Factors
Doctors don’t know exactly what causes multiple myeloma, but there are certain things that can increase a person’s chance of getting it:
- Age: Most people diagnosed are age 65 or older.
- Gender: Men are more likely to develop the disease than women.
- Race: Black people are more likely to develop multiple myeloma than people of other races.
- Weight: Having excess body weight increases a person’s risk of developing multiple myeloma.
- Genetics: Having a close family member with multiple myeloma may indicate a genetic condition that increases risk.
- Medical conditions: Having MGUS (monoclonal gammopathy of undetermined significance), a blood condition that can sometimes develop into multiple myeloma over time.
- Environmental factors: People who have been exposed to large amounts of radiation or harmful chemicals may be at higher risk for developing multiple myeloma.
Risk factors don’t tell us everything. People who have no risk factors can still get a disease. Also, having a risk factor or even several, doesn't mean that a person will get the disease.
Signs and Symptoms
Multiple myeloma symptoms depend on the stage of your disease and your body’s response. In the early stages, you may have no symptoms at all. When symptoms do appear, doctors often look for something called CRAB symptoms. These include high levels of calcium, renal (kidney) problems, anemia, and bone problems.
- High calcium: Too much calcium in your blood. This can cause extreme thirst, peeing a lot, dehydration, constipation, belly pain, loss of appetite, weight loss, and brain fog or confusion.
- Kidney problems: Your kidneys may not work as well or may start to fail. This can make you feel weak or very sleepy, short of breath, itchy, or cause swelling in your legs.
- Low blood counts: Multiple myeloma can lower different types of blood cells:
- Low red blood cells (anemia) can make you feel weak, tired, dizzy, and short of breath.
- Low white blood cells (leukopenia) can make it harder for your body to fight infections.
- Low platelets (thrombocytopenia) can cause easy bruising and bleeding.
- Bone problems: This can include bone pain or weak or broken bones.
Quick Guide to Multiple Myeloma
Welcome to this short guide on Multiple Myeloma. This Quick Guide will explain Multiple Myeloma and MGUS. This guide also explains the risk factors for Multiple Myeloma, the diagnosis, symptoms, and the types of Myeloma. Learn More About Multiple…
Diagnosis and Staging
Diagnosis
Multiple myeloma can be difficult to diagnose, and getting a complete diagnosis may take several months and more than one doctor’s visit. It is important to be an active part of your healthcare. Ask questions, share your concerns, and speak up if something does not feel right. You know your body best, and your care team needs your input to help guide the diagnosis process.
Your doctors may use many different tests to diagnose multiple myeloma and learn how advanced it is. The test results will help determine the best treatment plan for you.
These tests are used to help diagnose multiple myeloma:
- Blood Tests
- Urine Tests
- Imaging Tests (Scans)
- Bone Marrow Biopsy
- Biomarker Tests
- Measurable Residual Disease (MRD) Testing
Blood tests can help doctors look for signs of multiple myeloma and check how your body is working. Common blood tests for multiple myeloma are:
- Complete blood count (CBC) with differential: This test measures the number of blood cells (red blood cells, white blood cells, and platelets) in a blood sample. The differential looks at numbers of each type of white blood cell. Learn more about complete blood counts and normal results.
- Immunoglobulins (Ig) test: Immunoglobulins is another name for antibodies. This test measures the different antibodies in your blood, like IgA, IgG, and IgM. Abnormal levels of antibodies (too high or too low) could be a sign of multiple myeloma.
- Electrophoresis: This test separates proteins in your blood or urine to look at them more closely.
- Serum protein electrophoresis (SPEP) measures the amount of M protein (monoclonal protein) in the blood. M proteins are made by myeloma cells.
- Serum immunofixation electrophoresis (SIFE) identifies which type of M proteins are in the blood.
- Serum free light chain (SFLC) assay: This test measures the amounts of specific small proteins — called kappa or lambda light chains. Light chains are unattached protein pieces that are left over when your body makes antibodies. Too many light chains may be a sign of multiple myeloma.
- Blood chemistry and protein tests: These tests help show how well your organs are working and how active the multiple myeloma may be.
- Blood urea nitrogen (BUN) and creatinine show how your kidneys are working. Kidney problems are common in people with multiple myeloma.
- Albumin is a protein in your blood. Low albumin levels can sometimes happen in people with multiple myeloma.
- Calcium levels may be high in people with more advanced multiple myeloma.
- LDH (lactic dehydrogenase) and B2M (Beta‑2 microglobulin): High levels of these proteins may mean the multiple myeloma is more advanced.
- Comprehensive metabolic panel is a test that measures many chemicals in your blood. Abnormal levels may be a sign that an organ — like your kidneys or liver — is not working as well as it should.
Urine tests help diagnose multiple myeloma and show how well your kidneys are working.
- Total protein in urine: This test measures how much protein is in your urine. For this test, you usually collect your urine over 24 hours, at home and in a special container.
- Urine protein electrophoresis (UPEP): This test looks for M proteins and light chains in your urine. In urine, these are called Bence Jones proteins. Finding these proteins may be a sign of multiple myeloma. High levels of light chains can mean a higher risk of kidney damage.
- Urine immunofixation electrophoresis (UIFE): This test shows the exact type of Bence Jones proteins in your urine.
Scans help your doctor look for bone damage or places where multiple myeloma may be growing. These tests may include:
- X-rays
- CT scans
- MRI scans
- PET scans
A bone marrow biopsy removes a small amount of bone marrow, usually from the hip bone. This helps doctors understand:
- How many myeloma cells are present
- How active the multiple myeloma is
- Which mutations are present in the myeloma cancer cells
Your doctor may test the genes and proteins inside the cancer cells during the bone marrow biopsy. These tests help your doctor learn more about your cancer’s behavior and choose the best treatment plan. Types of tests include:
- Fluorescence in situ hybridization (FISH)
- Immunohistochemistry (IHC)
- Flow cytometry
- Cytogenetics (karyotyping)
Your doctor may use minimal residual disease (MRD) testing to see how well your treatment worked. MRD tests look for cancer cells that are still in your body after treatment. It is used for most blood cancers. It helps your doctor confirm if you are in remission or decide if you need new or different treatment.
Staging
Multiple myeloma can appear in four different ways. These depend on how many abnormal plasma cells are in the bone marrow, how much M‑protein is in the blood or urine, and whether there are symptoms or organ damage.
- MGUS (Monoclonal Gammopathy of Undetermined Significance): Multiple myeloma usually begins with MGUS. Patients feel normal and have no symptoms, but routine blood or urine tests show M proteins. In this case, you may only need regular blood tests to watch for any changes.
- Smoldering Multiple Myeloma (SMM): SMM is an intermediate stage, between MGUS and active multiple myeloma. Patients have higher amounts of M proteins in their blood/urine and more plasma cells in their bone marrow. Patients may have no symptoms but need to be watched closely and may need regular testing.
- Plasmacytoma: Plasmacytoma is a single mass (or clump) of myeloma cells found in an area of the body or bone. This can lead to symptoms like pain, weakness, or pressure — depending on where the mass is. This can lead to the development of multiple myeloma. Radiation therapy may be needed.
- Active Multiple Myeloma (also called symptomatic myeloma): The cancer cells grow quickly and begin to damage organs or tissues. Patients still may or may not have symptoms at early stages. At this point, treatment is needed. Doctors confirm active disease when a patient has:
- One or more CRAB symptoms: high calcium, renal (kidney) problems, anemia, or bone problems.
- SLiM signs (also called SLiM-CRAB): very high amount of light chains in the blood, high amount of myeloma cells in the bone marrow, or one or more bone lesions seen on an MRI or PET scan.
Treatment and Side Effects
There are many treatments available to manage multiple myeloma. Treatment options will depend on the stage of your disease, how far it has progressed, and your overall health.
Talk with your care team about your goals, needs, and preferences. Let them know what is important to you, and don’t be afraid to ask questions.
Treatments may include:
- Active Surveillance
- Targeted Therapy
- Chemotherapy
- Immunotherapy
- Stem Cell Transplant
- Corticosteroids
- Radiation Therapy
- Surgery
- Clinical Trials
- Supportive Care
Active surveillance — also called watch and wait, watchful waiting or observation — is used for people who have early or slow-growing forms of multiple myeloma. Instead of starting treatment right away, the healthcare team watches the disease closely with regular checkups and tests.
Treatment begins only if the myeloma starts causing symptoms, organ damage, or signs that it is getting worse. The goal is to avoid treatment side effects when treatment is not yet needed, while still keeping a close eye on the disease. Many people can stay on active surveillance for months or even years before needing treatment.
Active surveillance is most often used for:
- MGUS
- Smoldering multiple myeloma
- People with very slow-growing or stable disease after treatment
Common monitoring during active surveillance may include:
- Regular doctor visits
- Blood tests to check myeloma proteins, how well the kidneys are working, calcium levels, and the number of blood cells
- Urine tests to look for unusual proteins
- Bone marrow biopsies, where a small sample of bone marrow is taken to check for myeloma cells
- Imaging tests like MRI, PET, or CT scans to look for bone damage Patients should talk with their care team about how often they need monitoring, and what symptoms or changes they need to report right away.
Patients should talk with their care team about how often they need monitoring, and what symptoms or changes they need to report right away.
Targeted therapy is a type of treatment that uses special drugs to attack multiple myeloma cells. The type of targeted therapy you receive depends on the results of biomarker testing. These drugs block certain genes or proteins that cancer cells need to grow, divide, and spread. Because they target cancer cells more precisely, they may cause less damage to healthy cells.
There are different types of targeted therapy to treat multiple myeloma:
- Immunomodulatory drugs (IMiDs): Help the immune system work better so it can attack myeloma cells.
- Cereblon E3 ligase modulatory drugs (CELMoDs): Work in a similar way as IMiDs. They are newer and stronger medicines that are designed to work better, including against some myeloma that has become resistant to IMiDs.
- Proteasome inhibitor therapy (PIs): Stop myeloma cells from getting rid of their “protein trash.” When this waste builds up, the cancer cells become overwhelmed and die.
- Selective inhibitors of nuclear export (SINE): Block a specific protein inside myeloma cells called exportin 1 (XPO1).
Chemotherapy, or chemo, uses drugs to kill or damage cancer cells. These drugs are given through a vein, and some can also be given as a pill/tablet. It is a systemic (whole body) treatment.
Chemotherapy used to be one of the main treatments for multiple myeloma. Today, newer targeted therapy drugs are used more often, but it is still important in many situations. Chemo is used:
- Before a stem cell transplant and a CAR T-cell infusion. It lowers the number of myeloma cells in your body. It also helps stop your immune system from attacking the new cells you receive.
- After a transplant or treatment, to help keep the cancer from coming back.
- To relieve symptoms, such as bone pain.
- If the cancer returns or stops responding to earlier treatments.
Immunotherapy uses the body’s natural defenses (the immune system) to find, attack, and kill cancer cells. There are a few different kinds of immunotherapy used for multiple myeloma:
- CAR T‑cell therapy: In CAR T-cell therapy, a lab-made protein called chimeric antigen receptor (CAR) is added to the patient’s own T cells. T cells are a type of white blood cell found in the body. The CAR protein helps T cells recognize the cancer cells to be killed.
- Monoclonal antibody therapy (mAbs): mAbs are man‑made proteins that act like the body’s natural immune system antibodies. They attach to specific cancer cells and help destroy them.
- Antibody-drug conjugates (ADCs): An ADC is a monoclonal antibody connected to a chemotherapy drug. The antibody finds the myeloma cell, attaches to it, and delivers the chemo directly to the cancer.
- Bispecific T-cell engagers (BiTEs): BiTEs attach to the BCMA on the myeloma cell and to the CD3 on the patient’s T cells (a type of immune cell). By linking the cancer cell and the T cell together, the drug forces the immune system to attack and kill the cancer.
In a stem cell transplant (SCT), patients get an infusion of healthy blood-forming cells (stem cells). There are two major types of stem cell transplants:
- Allogeneic (“allo”) stem cell transplant: that uses stem cells of a donor.
- Autologous (“auto”) stem cell transplant: that uses a patient’s own stem cells. This is most often used to treat multiple myeloma. In an auto SCT, your own cells are collected and stored before you get high‑dose chemotherapy. A key benefit of this treatment is that it allows doctors to use very powerful chemotherapy to kill harder-to-reach cancer cells. Sometimes, your stored stem cells are “cleaned” in the lab to try to remove any remaining cancer cells. After you finish the high‑dose chemo, the stored stem cells are put back into your bloodstream. The stem cell transplant then replaces the blood‑forming cells that were destroyed by the chemo.
Corticosteroids, often called steroids, are medicines that can help kill myeloma cells when used in larger amounts. They also help reduce side effects from chemotherapy, such as nausea and vomiting. Some steroids are also used to treat inflammation, which is swelling or irritation in the body.
Radiation therapy uses high‑energy rays to kill or damage cancer cells. In multiple myeloma, it is mostly used to relieve bone pain or protect bones from more damage.
Radiation can also be used as the only treatment for a solitary plasmacytoma, which is a single lump of myeloma cells. In this case, radiation helps shrink the tumor and control its growth.
Surgery is not a common treatment for multiple myeloma, but it may be used in certain situations:
- To remove a single plasmacytomas.
- To treat spinal cord compression. If the cancer is pressing on your spinal cord and causing symptoms, surgery may be needed to relieve the pressure.
- To prevent or treat broken bones.
Clinical trials provide people with cancer access to new therapies. They are research studies to test new treatments or learn how to use current treatments better.
There are several therapies and drugs being tested for multiple myeloma. Trials are often recommended for refractory disease (when other treatments don’t work).
Multiple myeloma can make your bones weak. It can raise the risk of bone pain, fractures, and high calcium levels in your blood. Supportive treatments can help strengthen the bones, lower the chance of fractures, and reduce pain. Some patients may also receive radiation therapy or procedures to stabilize weak bones when needed. There are different types of bone-strengthening medicines that help prevent, reduce, and delay bone complications and damage caused by multiple myeloma and its treatments.
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ASK RUBY: What Does the African American Community Need to Know About Multiple Myeloma? This video helps explain what members of the Black and African American community need to know about multiple myeloma, the second most common blood cancer in…
When active myeloma is diagnosed, doctors classify the cancer into stages, from Stage I to Stage III:
This is the earliest and least aggressive stage. People in this stage usually have lower levels of myeloma in their body. The disease is growing more slowly, and many people do not have symptoms yet.
People in this stage do not fit fully into Stage I or Stage III. Some patients may have symptoms, while others may not. Treatment is usually recommended.
This is the most advanced stage. People in this stage usually have higher levels of myeloma in their body. The disease is more active and growing faster. Patients often have several signs and symptoms.
Treatment for Symptomatic Multiple Myeloma
Welcome to the Quick Guide to Treatment for Symptomatic Multiple Myeloma. This Quick Guide will cover different treatment options for Symptomatic Multiple Myeloma. We will also give a brief overview of symptoms and side effects. Learn More About…
Treatment for Relapsed Multiple Myeloma
Relapsed multiple myeloma means the cancer returned after treatment. Your doctor may recommend:
- Different drug combinations
- New therapies like CAR T-cell therapy, bispecific antibodies, antibody drug conjugates (ADCs), or CELMoDs
- Another stem cell transplant
- Clinical trials
Treatment for Refractory Multiple Myeloma
Refractory multiple myeloma means the disease does not respond to treatment. Your doctor may recommend:
- A different treatment approach
- Clinical trials
- Supportive or palliative care to manage symptoms and improve quality of life
Abby: Support Found at Cancer Support Community
Abby, a patient living with Multiple Myeloma, talks about the Cancer Support Community and the role it plays in her life.
Managing Symptoms & Side Effects
Receiving a cancer diagnosis and undergoing cancer treatment can be challenging for both you and your loved ones. Unwanted symptoms and side effects can make things feel even harder. Your care team can help you manage side effects during and after treatment. Ask them about supportive and palliative care. Supportive and palliative care focus on keeping you as healthy and comfortable as possible. It may help prevent or manage symptoms of multiple myeloma and the side effects of treatment. It can help with:
- Bone pain and weakness: Multiple myeloma can make your bones weak. Your healthcare team may make exercise recommendations to help with this problem. When this is not enough, bone strengthening drugs, radiation, orthopedic supports, or surgery can help. A healthy diet, exercise, and preventing falls can also help keep your bones strong.
- Infections: Multiple myeloma and its treatments can weaken the immune system. This means patients have a higher risk of infections during treatment. Supportive care can help prevent infections, strengthen the immune system, and lower the risk of serious complications.
- Anemia and kidney problems: Multiple myeloma and its treatments can affect the blood and the kidneys. Patients may develop anemia (low red blood cell counts), which can cause tiredness and weakness. Some treatments can also raise the risk of blood clots. Myeloma proteins can build up in the kidneys and cause kidney damage. Supportive treatments can help manage these problems, reduce symptoms, and protect overall health.
- Fatigue, weakness, appetite changes, and digestive issues: Nutrition plays a vital role in maintaining strength, supporting healing, and improving quality of life during and after treatment. Talk with your healthcare team if you are having trouble eating or experiencing a poor appetite, changes in taste, or digestive problems. You can also review these 10 practical tips to eat well with multiple myeloma.
Coping and Support
Coping with Multiple Myeloma
An important step in managing your cancer and its treatment is to be informed. Multiple myeloma may affect different areas of your life. If you are experiencing any challenges in these areas, there are resources that can help.
Choose a concern below and we will point you to tools and information that can help address your concern.
Treatment for multiple myeloma and follow-up care can be costly — and overwhelming. Many families say that financial worries about cancer costs are a big source of stress. Learn how to talk about the financial side of cancer and where to go for help.
The ripples of a cancer diagnosis extend to spouses, partners, siblings, children, and friends. Many of these family members will find they now need to take on the role of caregiver — something they may never have done before. This can be especially challenging with multiple myeloma, which is managed as a lifelong, chronic disease.
A cancer diagnosis can bring many feelings — fear, anger, sadness, or worry. These are normal. Support can help you feel more in control. Consider:
- Support groups (in person or online)
- Counseling with an oncology social worker
- Peer mentors (one‑on‑one connections with someone who has been through multiple myeloma)
- Stress‑reduction (mindfulness, gentle exercise, breathing techniques)
Tips for Talking With Your Care Team
Your multiple myeloma care team may include several healthcare professionals, such as a hematologist-oncologist, nurses, social workers, and other specialists. Each team member plays an important role in your care and is there to answer your questions and support you throughout treatment. Be open to asking them anything you don’t understand. You can bring these questions to your appointments:
- What type and stage of multiple myeloma do I have?
- Do I have high risk mutations in my myeloma cells?
- What are my treatment options? What are the pros and cons of each option?
- What side effects should I expect, and how can I manage them?
- What signs or symptoms should I tell you about right away?
- How long will treatment last, and how often are visits? Ask about the schedule and timing.
- Can I join a clinical trial?
- What support services are available for me and my caregivers? Consider support for nutrition, social work, mental health, sexual health, and financial counseling.
Getting the Support You Want and Need
Multiple myeloma is unique because it often has to be managed over a lifetime. There are periods of remission (when the cancer goes away) to periods of relapse (when the cancer returns). Managing the stress and anxiety of life with multiple myeloma can be difficult. It’s hard to be unsure of what the future holds.
You can regain control by taking an active role in the way you approach your life and care. Keep in mind the following:
- Focus on what you can control. Take things one small step at a time.
- Be gentle with yourself when you are feeling stressed. You may feel more anxious when it gets close to a doctor’s appointment. It may help to take someone with you to support you and be an extra set of eyes or ears during the visit.
- Share your feelings with trusted friends, family members, a case manager or counselor, or a clergyperson or spiritual advisor.
- Ask for help from friends and your community through CSC’s MyLifeLine — a free service offered by the Cancer Support Community.
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