Multiple Myeloma

Multiple myeloma is a blood cancer in which abnormal plasma cells build up in the bone marrow and make an abnormal protein. The marrow normally produces blood cells, so myeloma can affect red cells, healthy immune cells and platelets. It can also weaken bones and affect kidney function.

Persistent bone pain is a very common presentation of multiple myeloma, and persistent fatigue is also a very common presentation. Pain may affect the back, ribs, hips or other bones. Other features can include repeated infections, easy bruising, thirst, constipation, nausea, weakness or changes in urination. Some people have no symptoms when abnormal plasma cells are first found.

Myeloma starts when a plasma cell develops genetic changes and produces a clone of abnormal cells. These cells collect in the marrow and release a monoclonal protein, sometimes called an M protein. The original change is not usually something a person caused, and myeloma is not contagious.

Some plasma-cell disorders remain stable and need monitoring, while active myeloma can affect bones, blood counts, kidneys or calcium levels. MGUS and smouldering myeloma are related states that do not always require the same treatment as active disease. Blood tests, urine tests and imaging help the team track change over time.

Risk increases with age and may be higher when a close relative has had myeloma or a related plasma-cell disorder. Having MGUS is associated with a possibility of later progression, but it does not mean that active myeloma is present. The condition can occur in people without any recognised risk factor.

Doctors combine a blood count, kidney and calcium measurements, tests for abnormal proteins in blood or urine, and imaging of the bones. A bone-marrow sample can measure abnormal plasma cells and support classification. The team looks for evidence of organ or bone effects before deciding whether treatment for active myeloma is needed.

Treatment is selected according to disease activity, symptoms, organ function, fitness and previous therapy. Combinations may include chemotherapy, targeted therapy and medicines that support the immune response. An autologous stem cell transplant uses your own collected stem cells after intensive treatment in suitable patients. CAR T-cell therapy may be considered in selected relapsed or treatment-resistant disease. Radiotherapy can focus on a painful or structurally vulnerable bone, while bone-strengthening therapy helps reduce skeletal complications.

Keep a record of pain, temperature, medicines and changes in energy. Report fever, new weakness, reduced urine, confusion or sudden worsening pain promptly. Gentle movement, safe lifting, hydration advice and infection precautions should be tailored to your bone health and treatment. Ask for help with fatigue management, work planning and emotional support.

Myeloma can weaken bones, reduce blood counts, impair immune defence and strain the kidneys. High calcium may cause marked thirst, constipation, nausea, confusion or drowsiness. New severe back pain with leg weakness, numbness or loss of bladder or bowel control can signal spinal cord compression and needs emergency assessment.

There is no established way to prevent multiple myeloma. When MGUS or smouldering myeloma is known, scheduled monitoring can identify changes early. Protecting bones from falls, avoiding smoking and following treatment and infection-prevention advice can reduce avoidable problems, even though these steps do not remove the underlying condition.

A haematologist or medical oncologist with experience in plasma-cell disorders can coordinate diagnosis and treatment. Useful questions include whether the marrow and protein findings meet criteria for active disease, how bone and kidney health will be monitored, and which options fit your current fitness and treatment history.