Multiple Myeloma

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with multiple myeloma each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with multiple myeloma and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.

How many people are diagnosed with multiple myeloma?

In 2023, an estimated 35,730 adults (19,860 men and 15,870 women) in the United States will be diagnosed with multiple myeloma. Worldwide, an estimated 176,404 people were diagnosed with multiple myeloma in 2020.

It is estimated that 12,590 deaths (7,000 men and 5,590 women) from this disease will occur in the United States in 2023. In 2020, an estimated 117,077 people worldwide died from multiple myeloma.

What is the survival rate for multiple myeloma?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from multiple myeloma. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with multiple myeloma are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with multiple myeloma are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for multiple myeloma in the United States is about 58%.

The survival rates for multiple myeloma vary based on several factors. These include the stage of cancer, a person’s age and general health, and how well the treatment plan works. For instance, it is known that survival rates for multiple myeloma are higher in younger people than in older people.

There are 2 conditions that arise before myeloma. One is called monoclonal gammopathy of undetermined significance (MGUS), and the other is called smoldering myeloma (SMM). MGUS typically means that there are less than 10% plasma cells in the marrow and there is no evidence of organ damage. For people diagnosed with MGUS, the risk of progression to myeloma is 1% per year. A person with MGUS should be regularly monitored for health changes by their doctor. People who have SMM may develop myeloma and should also be monitored by their doctor. There is emerging evidence that suggests that people who have a high-risk type of SMM should be offered early treatment or be monitored.

Experts measure relative survival rate statistics for multiple myeloma every 5 years. This means the estimate may not reflect the results of advancements in how multiple myeloma is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics .

Statistics adapted from the American Cancer Society’s publication, Cancer Facts & Figures 2023 , the International Agency for Research on Cancer website, and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. (All sources accessed February 2023.)

The next section in this guide is Medical Illustrations . It offers drawings of body parts often affected by multiple myeloma. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about the factors that increase the chance of developing multiple myeloma. Use the menu to see other pages.

What are the risk factors for multiple myeloma?

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. But knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The causes of myeloma are not known or well understood. There are currently no known ways to prevent it. Currently, there are also no obvious, strong risk factors for myeloma.

Although the genetic mutations that cause myeloma are acquired and not inherited, family history is a known risk factor for multiple myeloma. First-degree relatives of people with multiple myeloma have a 2 to 3 times higher risk of developing the disease. First-degree relatives are parents, siblings, and children.

The following factors can raise a person's risk of developing myeloma:

• Age. Myeloma occurs most commonly in people over 60. The average age at diagnosis is 70. Only 2% of cases occur in people under 40.

• Race. Myeloma occurs twice as frequently in Black people than in White people. The reasons why are unclear, although the disease appears to also be more common in the Middle East, North Africa, and the Mediterranean.

• Exposure to radiation or chemicals. People who have been exposed to radiation or to asbestos, benzene, pesticides, and other chemicals used in rubber manufacturing may be at higher risk for developing myeloma. People often exposed to wood products, such as carpenters, furniture makers, and paper makers, are also at higher risk. There is also a high incidence of myeloma among professional firefighters and those exposed to herbicides, including Agent Orange .

• Personal history. People with a history of a solitary plasmacytoma of the bone are at greater risk for developing multiple myeloma.

• Monoclonal gammopathy of undetermined significance (MGUS). As explained in the Introduction , a person with a small amount of M protein in their blood has a 1% to 2% chance of developing myeloma, lymphoma , or another blood-related cancer called Waldenstrom macroglobulinemia per year (see the Stages section for more information).

• Sex. Myeloma is slightly more common in men.

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems multiple myeloma can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How multiple myeloma is diagnosed

There are different tests used for diagnosing multiple myeloma. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

The following tests may be used to diagnose multiple myeloma:

Blood and urine tests. Blood and urine tests play a key role in diagnosing myeloma.

• M protein. Myeloma cells often secrete the monoclonal antibody immunoglobulin, known as M protein. M protein levels in a patient's blood and urine are used to determine the extent of the disease, as well as to monitor how well treatment is working and whether the disease is progressing or coming back. In some people, the myeloma cells only secrete part of the antibody, which is called the light chain. The amount of M protein in the blood or urine is measured by serum protein electrophoresis (SPE or SPEP) or urine protein electrophoresis (UPE or UPEP).

• Immunoglobulin. Immunoglobulin levels are measured to help check the amount of antibody levels in the blood. These antibodies are immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM). In multiple myeloma, when the cancer protein level is up, the normal antibody levels are down.

• Light chains. The amount of free light chains in the blood can be measured before the blood is filtered by the kidneys. This test is called a serum free light chain assay. This is a more sensitive test than measuring M protein in the urine, but both are important to measure. When a light chain is found in the urine, it is called the Bence Jones protein.

• Serum albumin and serum beta-2 microglobulin (β2-M). The levels of serum albumin and serum β2-M are measured using blood tests. Serum albumin is a blood protein made by the liver that is necessary for maintaining proper blood volume and general health. β2-M is a small protein that plays a role in the body's immune response.

• Lactase dehydrogenase (LDH). LDH is an enzyme, which is a type of protein. It is in almost all tissues in the body. Damaged tissues release LDH into the bloodstream, so LDH is used as a sign that the body has been injured or a disease is present. In myeloma, LDH levels can be used to help determine prognosis, which is the chance of recovery, and the stage (see Stages ).

These test results are important for determining the stage of the myeloma. Blood tests are also used to measure kidney function, calcium levels, and blood cell counts for possible anemia and other low blood counts.

X-ray. An x-ray creates a picture of the structures inside of your body using a small amount of radiation. X-rays taken as part of the doctor’s evaluation of the patient’s skeletal system are typically the first step in evaluating bones when myeloma is suspected or diagnosed. An x-ray skeletal survey may not find myeloma as early as the more advanced tests described below.

Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. An MRI can show if normal bone marrow has been replaced by myeloma cells or by a plasmacytoma, especially in the skull, spine, and pelvis. A plasmacytoma is a plasma cell tumor growing in bone marrow or soft tissue. The detailed images may also show compression fractures of the spine or a tumor pressing on nerve roots. MRI can also be used to measure a tumor’s size.

Computed tomography (CT or CAT) scan. A CT scan creates a detailed, cross-sectional view that shows any abnormalities or tumors in soft tissues. A computer then combines these pictures into a 3-dimensional image of the inside of the body. It is important to note that the intravenous contrast dye often used for CT scans for other types of cancer is specifically avoided in people with multiple myeloma. Tell the radiologist or the radiology technician about your diagnosis before receiving dye injection into your vein, because this can cause kidney damage in people with myeloma.

Positron emission tomography (PET) or PET-CT scan. A PET scan is a way to create pictures of organs and tissues inside the body. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan . But you may hear your doctor refer to this procedure just as a PET scan.A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

Bone marrow aspiration and biopsy. These 2 procedures are done to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. These procedures are often done at the same time and may be called a bone marrow examination. This is important for making a diagnosis of myeloma.

A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The genetics of the malignant plasma cells are examined using cytogenetics (see below) and a special testing called fluorescence in situ hybridization (FISH). These tests determine the genetic makeup of the myeloma and whether it is standard or high risk. Samples can also be examined using genomic sequencing to determine with great accuracy exactly what changes have occurred in the DNA of the cancer cells.

A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. The skin in that area is numbed with medication beforehand. This medication is called local anesthesia. Other types of anesthesia may also be used to block the awareness of pain.

Fat pad aspirate. If certain M proteins that are misfolded in a particular way are deposited in body tissues, it can cause organs to stop functioning normally. This condition is called amyloidosis . If your doctor suspects you may have amyloidosis, then it may be necessary to take a sample of the abdominal fat pad (the collection of fat around a person's abdomen) to be examined under a microscope, called a biopsy .

Biomarker testing of the tumor. Your doctor may recommend running laboratory tests on a tumor and/or bone marrow sample to identify specific chromosomes (cytogenetics), genes (FISH or genomic sequencing; see above), proteins, and other factors unique to the tumor, as mentioned above. This may also be called molecular testing of the tumor. Results of these tests can help determine your treatment options .

• Cytogenetics. Cytogenetics, which is the study of genetic changes in cells, and molecular studies may be performed on a tissue sample removed during a biopsy to find out how aggressive the cancer is. In myeloma, the genetics in plasma cells are routinely studied using the FISH test to identify standard and high-risk disease. This may help guide treatment. More genetic tests are being developed, usually in ongoing research studies.

• Fluorescence in situ hybridization (FISH). The FISH test is a type of cytogenetic test that uses a fluorescent dye to find changes in a person's chromosomes. FISH helps the doctor know whether the myeloma is high risk and aggressive, and it helps predict the prognosis. The FISH test will be used for most people with myeloma.

• Minimal residual disease (MRD) tests. As treatments have become increasingly effective in treating myeloma, new approaches to measure how well a treatment works have been developed, including for MRD. The principle is that the harder it is to detect the disease, the better. If a very small amount of disease is found after treatment (called "MRD positive") by this testing, additional treatment may be offered to suppress the disease further.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is myeloma, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

The next section in this guide is Stages . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use to treat people with multiple myeloma. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for multiple myeloma. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for multiple myeloma in the United States. Treatment options can vary from one place to another.

When making treatment plan decisions, you are also encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Research for new myeloma treatments is very active, and many clinical trials are offered. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How multiple myeloma is treated

In cancer care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include other health care professionals, including physician assistants, nurse practitioners, oncology nurses, oncology social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.

The treatment of multiple myeloma depends on whether the patient is experiencing symptoms (see Stages ) and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. The goals of treatment are to eliminate myeloma cells, control tumor growth, control pain, and allow patients to have an active life. While there is no cure for multiple myeloma, the cancer can be managed successfully in many patients for years.

Take time to learn about all of your treatment options, including clinical trials, and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for multiple myeloma because there are different treatment options. Learn more about making treatment decisions .

The common types of treatments used for multiple myeloma are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. The information below explains the treatment options for people without symptoms and for people with symptoms. In addition, treatment options may depend on whether the patient is newly diagnosed with myeloma or is experiencing a recurrence of the disease.

READ MORE BELOW:

• Treatment overview for people with smoldering multiple myeloma

• Treatment overview for patients with symptoms

• Chemotherapy

• Targeted therapy

• Immunomodulatory drugs

• Steroids

• Bone-modifying drugs

• Immunotherapy

• Bone marrow/stem cell transplantation

• Radiation therapy

• Surgery

• Physical, social, and emotional effects of cancer

• Refractory myeloma

• Remission and the chance of recurrence

• If treatment does not work

Treatment overview for people with smoldering multiple myeloma

People with early-stage myeloma and no symptoms, called smoldering multiple myeloma or SMM (see Stages ), may simply be closely monitored by the doctor through checkups. This approach is called active surveillance or watchful waiting. As noted previously, if there is evidence of bone thinning, or osteoporosis , periodic infusions of bisphosphonates to reverse this process may be recommended. There are also clinical protocols, or processes, used to evaluate whether using medications called targeted therapy (see below) or immunotherapy (see below and Latest Research ) can prevent or delay myeloma from developing into a disease that requires treatment.

If symptoms appear, then active treatment starts. Two clinical trials in high-risk SMM have shown that early treatment can slow the progression to myeloma with symptoms for some patients, but whether this helps people live longer is not known.

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Treatment overview for patients with symptoms

Treatment for people with symptomatic myeloma includes both treatment to control the disease as well as supportive care to improve quality of life, such as by relieving symptoms and maintaining good nutrition. Disease-directed treatment typically includes therapy using medications, such as targeted therapy and/or chemotherapy, with or without steroids. Bone marrow/stem cell transplantation may be an option. Other types of treatments, such as radiation therapy and surgery, are used in specific circumstances.

The treatment plan includes different phases.

• Induction therapy for rapid control of cancer and to help relieve symptoms.

• Consolidation with more chemotherapy or a bone marrow/stem cell transplant.

• Maintenance therapy over a prolonged period to prevent cancer recurrence.

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for multiple myeloma include:

• Chemotherapy

• Targeted therapy

• Immunomodulatory drugs

• Steroids

• Bone-modifying drugs

• Immunotherapy

Each of these types of therapies are discussed below in more detail. A person usually receives a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

Combination regimens are an important part of the treatment of multiple myeloma. Combining different treatment effects from different types of drugs—such as a combination of an immunomodulatory drug, a proteasome inhibitor, and a steroid—can be an effective way of managing the disease. In addition, other targeted treatments may be added, depending on the individual's specific situation.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient usually receives combinations of different drugs at the same time.

Conventional chemotherapy has been used successfully for the treatment of myeloma. These drugs include cyclophosphamide (available as a generic drug), doxorubicin (available as a generic drug), melphalan (Evomela), etoposide (available as a generic drug), cisplatin (available as a generic drug), carmustine (BiCNU), and bendamustine (Bendeka). Chemotherapy drugs like these may be used in certain situations. For people newly diagnosed with myeloma, these treatments are used less commonly. For example, melphalan is most commonly used when a bone marrow transplantation (see below) is part of the treatment plan. A high dose of melphalan is used to suppress the myeloma for a long time, and the patient's own bone marrow cells are used to recover from this treatment.

It may also be recommended to combine chemotherapy with other types of treatment, including targeted therapies or steroids (see both, below). For instance, the combination of melphalan, the steroid prednisone (multiple brand names), and a targeted therapy called bortezomib (Velcade) is approved by the U.S. Food and Drug Administration (FDA) for the initial treatment of multiple myeloma. However, there are several more effective regimens described below that are used much more commonly.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea or constipation. Other side effects include peripheral neuropathy (tingling or numbness in feet or hands), blood clotting problems , and low blood counts . These side effects usually go away once treatment is finished. Occasionally an allergic reaction such as skin rash may occur, and the drug may have to be stopped.

The length of chemotherapy treatment varies from patient to patient and is usually given until the myeloma is well controlled.

Learn more about the basics of chemotherapy .

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Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells. In recent years, targeted treatment, sometimes called novel therapy, has proven to be increasingly successful at controlling myeloma and improving prognosis. Researchers continue to investigate new and evolving drugs for this disease in clinical trials.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests on cancer cells to identify genes, proteins, and other factors. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments .

Targeted therapy for multiple myeloma includes:

• Proteasome inhibitors. Bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro) are classified as proteasome inhibitors. They target specific enzymes called proteasomes that digest proteins in the cells. Because myeloma cells produce a lot of proteins (see the Introduction ), they are particularly vulnerable to this type of drug. These drugs may be used to treat newly diagnosed myeloma and recurrent myeloma.

• Monoclonal antibodies. Elotuzumab (Empliciti) and daratumumab (Darzalex) are monoclonal antibodies that bind to myeloma cells and label them for removal by the person's own immune system. Daratumumab may be given to treat newly diagnosed multiple myeloma. A drug combination of daratumumab and hyaluronidase-fihj (Darzalex Faspro) with or without pomalidomide (Pomalyst) and dexamethasone (multiple brand names) may also be used to treat multiple myeloma. This combination is given under the skin of the abdomen and is quicker than when it is given by injection through a vein. Daratumumab with or without hyaluronidase-fihj combined with carfilzomib and dexamethasone may be used to treat multiple myeloma that has stopped responding to 1 to 3 previous treatments. Isatuximab-irfc (Sarclisa) is a monoclonal antibody approved by the FDA for the treatment of adults with multiple myeloma who have received 1 to 3 previous treatments. Isatuximab-irfc may be given in combination with pomalidomide and dexamethasone or carfilzomib and dexamethasone.

• Nuclear export inhibitors. Selinexor (Xpovio) is a targeted therapy that is given in combination with dexamethasone. This combination is used to treat adults with multiple myeloma that has come back after 4 or more previous treatments. It may also be given in combination with bortezomib and dexamethasone to people who have received at least 1 previous treatment.

• B-cell maturation antigen (BCMA) targeting agent. Belantamab mafodotin-blmf (Blenrep) is an antibody-drug conjugate approved by the FDA to treat adults with recurrent or refractory multiple myeloma who have received at least 4 previous treatments. Belantamab mafodotin-blmf uses an antibody to bind to BCMA and delivers chemotherapy directly to the myeloma cell. BCMA is a protein on the surface of myeloma cells.

• Bispecific T-cell engagers ( updated 08/2023 ). Bispecific antibodies can attach to both a T cell and a myeloma cell at the same time, activating an immune attack on the cancer cells. Unlike CAR T cells, bispecific T-cell engagers can be delivered without removing a patient’s immune cells. Elranatamab (Elrexfio), talquetamab (Talvey), and teclistamab-cqyv (Tecvayli) are bispecific T-cell engagers that are approved for the treatment of recurrent or refractory multiple myeloma after at least 4 previous lines of treatment. Elranatamab and teclistamab target the BCMA protein, while talquetamab targets GPRC5D.

Targeted therapies may also be used in combination with chemotherapy (see above), immunomodulatory drugs, or steroid medications (see below), because certain combinations of drugs can sometimes have a better effect than a single drug. For example, the drugs lenalidomide, bortezomib, and dexamethasone, as well as bortezomib, cyclophosphamide, and dexamethasone, are offered in combination as initial treatment. Clinical trials are exploring whether the combination of lenalidomide, bortezomib, and dexamethasone may be as effective as lenalidomide, bortezomib, and dexamethasone followed by a bone marrow/stem cell transplant (see below).

Lenalidomide and bortezomib can also be effectively used as maintenance therapy to extend the disease's response to the initial therapy or after a bone marrow/stem cell transplant. However, the decision to undergo a transplant is complex and should be discussed carefully with your doctor.

Research has shown that maintenance therapy with lenalidomide and/or bortezomib increases how long patients survive and extends how long they live without active myeloma. Maintenance therapy has to be used with some caution, although recent studies have shown significant improvement with survival using this approach.

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Immunomodulatory drugs

Lenalidomide (Revlimid) and pomalidomide (Pomalyst) are classified as immunomodulatory drugs, which stimulate the immune system. These drugs also keep new blood vessels from forming and feeding myeloma cells. Thalidomide and lenalidomide are approved to treat newly diagnosed patients. Lenalidomide and pomalidomide are also effective for treating recurrent myeloma.

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Steroids

Steroids, such as prednisone and dexamethasone, may be given alone or at the same time as other medications, such as targeted therapy or chemotherapy (see above). Steroids are very effective at reducing the burden of plasma cells, but this effect is only temporary.

For example, lenalidomide and dexamethasone as induction and maintenance therapy is recommended for those who are not able to have bone marrow/stem cell transplantation. Adding bortezomib to this combination has recently been shown to be effective in a clinical trial.

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Bone-modifying drugs

Most people with myeloma receive treatment with bone-modifying drugs. These drugs help strengthen the bone and reduce bone pain and the risk of fractures.

There are 2 types of bone-modifying drugs available for treating bone loss from multiple myeloma. The choice of medications depends on your overall health and your individual risk of side effects.

• Bisphosphonates, such as zoledronic acid (Zometa) and pamidronate (Aredia), block the cells that dissolve bone, called osteoclasts. For multiple myeloma, either pamidronate or zoledronic acid is given by IV every 3 to 4 weeks. Each treatment of pamidronate lasts at least 2 hours, and each treatment of zoledronic acid lasts at least 15 minutes. Patients with existing severe kidney problems usually receive lower doses of pamidronate given over a longer time (such as 4 to 6 hours instead of 2 hours). Zoledronic acid is generally not recommended for people with severe kidney problems.

• Denosumab (Xgeva) is an osteoclast-targeted therapy called a RANK ligand inhibitor. It is approved to treat multiple myeloma and may be an option for people with severe kidney problems. Denosumab has been shown to have similar effectiveness to bisphosphonates.

Treatment with a bone-modifying drug is recommended for up to 2 years. At 2 years, treatment may be stopped if it is working. If the myeloma comes back and new bone problems develop, treatment with a bone-modifying drug is usually started again. Talk with your doctor for more information about stopping and restarting treatment with these medications.

Side effects of bisphosphonates may include flu-like symptoms, anemia, joint and muscle pain, and kidney problems. If you are taking pamidronate or zoledronic acid, you should have a blood test to check how well the kidneys are working before each time you receive the drug. Side effects of denosumab may include diarrhea, nausea, anemia, and back pain.

Osteonecrosis of the jaw is an uncommon but potentially serious side effect of both types of bone-modifying drugs. The symptoms may include pain, swelling, and infection of the jaw; loose teeth; and exposed bone. Before treatment, patients should receive a thorough dental examination, and any tooth or mouth infections should be treated. While receiving treatment with a bone-modifying drug, patients should avoid having any invasive dental work done, such as dental surgery. Take care of your teeth, gums, and tongue with regular brushing and flossing. Learn more about dental and oral health during cancer treatment .

Bone-modifying drugs are not always recommended for people with the following conditions:

• Solitary plasmacytoma (1 bone tumor)

• Smoldering or indolent myeloma

• Conditions of abnormal plasma cells that are not myeloma but may eventually become myeloma, such as monoclonal gammopathy of undetermined significance (MGUS)

This information on bone-modifying drugs is based on ASCO recommendations for bisphosphonate treatment for multiple myeloma . (Please note that this link takes you to a different ASCO website.)

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells.

The cellular immunotherapies approved to treat multiple myeloma are idecabtagene vicleucel (Abecma) and ciltacabtagene autoleucel (Carvykti). These are chimeric antigen receptor (CAR) T-cell therapies that target BCMA. BCMA is a protein on the surface of myeloma cells. These treatments may be used to treat multiple myeloma that has not been stopped by 4 or more treatments.

In CAR T-cell therapy, some T cells are removed from a patient’s blood. Then, the cells are changed so they have specific proteins called receptors. The receptors allow the changed T cells to recognize the cancer cells. In the case of idecabtagene vicleucel and ciltacabtagene autoleucel, the cells recognize the BCMA protein. The changed T cells are then returned to the patient’s body. Once there, they seek out and destroy cancer cells. Learn more about the basics of CAR T-cell therapy .

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

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Bone marrow transplant/stem cell transplant

A bone marrow transplant is a medical procedure in which bone marrow that contains cancer is replaced by highly specialized cells. These cells, called hematopoietic stem cells, develop into healthy red blood cells, white blood cells, and platelets in the bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. This procedure is also called a stem cell transplant.

Before recommending a transplant, doctors will talk with the patient about the risks of this treatment. They will also consider several other factors, such as the type of cancer, results of any previous treatment, and the patient’s age and general health.

There are 2 types of hematopoietic stem cell transplantation, depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). ALLO uses donated stem cells, while AUTO uses the patient’s own stem cells. For multiple myeloma, AUTO is more commonly used. ALLO is being studied in clinical trials. In both types, the goal is to destroy all of the cancer cells in the marrow, blood, and other parts of the body using high doses of chemotherapy (usually melphalan) and then allow replacement blood stem cells to create healthy bone marrow and restore the body's immune response.

Side effects depend on the type of transplant, your general health, and other factors. Learn more about the basics of bone marrow and stem cell transplant .

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Doctors may recommend radiation therapy for patients with bone pain when chemotherapy is not effective or to control pain. However, using radiation therapy is not an easy decision. In many instances, pain (especially back pain) is due to structural damage to the bone. Radiation therapy may not help relieve this type of pain and may affect the bone marrow's response to future treatment. Radiation therapy can be helpful in some situations, but for people with newly diagnosed myeloma, therapies using medication are preferred because of their greater effectiveness.

Side effects of radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy .

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Surgery

Surgery is not usually a treatment option for curing multiple myeloma, but it may be used to relieve specific symptoms. Surgery is used to treat bone disease, especially if there are fractures, and recent plasmacytomas, especially if they occur outside the bone. If surgery is recommended for you, talk with your health care team about the details of the surgery, including the recovery period. Learn more about the basics of cancer surgery .

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. It often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups for additional emotional support. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns .

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Refractory myeloma

The disease is called relapsed and refractory myeloma if the cancer no longer responds to the most recent treatment. If this happens, it is a good idea to talk with doctors who have experience in treating refractory myeloma. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials can be an important option.

Sometimes, medications that have gone through advanced phases of clinical trials and are awaiting FDA approval are made more readily available to patients with refractory myeloma through FDA’s Expanded Access Clinical Trial Program . For example, daratumumab was first approved in 2015 to be used alone to treat relapsed and refractory myeloma after other treatments had failed. In 2016, the FDA approved the use of daratumumab in combination with lenalidomide and dexamethasone or with bortezomib and dexamethasone to treat people who have already received at least 1 previous treatment. Since then, daratumumab has received 5 more approvals from the FDA and is now approved in combination with bortezomib, thalidomide, and dexamethasone to treat newly diagnosed patients with multiple myeloma who may also receive an AUTO bone marrow/stem cell transplant. You may want to talk to your doctor about which treatments are being studied in clinical trials.

Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

For people with refractory myeloma, palliative and supportive care may also be important to help relieve symptoms and side effects.

For many people, a diagnosis of relapsed or refractory myeloma is very stressful and difficult. You and your family are encouraged to talk about how you feel with your doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. It is important to talk with your doctor about the possibility of the cancer returning, which is common with myeloma, despite recent advances in treatments and testing. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent myeloma or relapsed myeloma. If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as targeted therapy and chemotherapy, but they may be used in a different combination or given at a different pace. Recent advances in newer therapies mean that the chances of effective treatment for relapsed myeloma are increasing.

Your doctor may also suggest clinical trials that are studying new ways to treat recurrent or relapsed myeloma. There are multiple medications currently being researched in the late stages of clinical trials that have shown promise as treatments for recurrent or relapsed myeloma. See the Latest Research section for more information. Whichever treatment plan you choose, palliative and supportive care will also be important for relieving symptoms and side effects.

People with relapsed myeloma sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from and a cure for myeloma are unlikely. The disease is still considered incurable despite recent progress. If the cancer cannot be controlled even with the newer treatments available, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable options for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about multiple myeloma and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about myeloma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you. With the fast pace of myeloma research, you are encouraged to ask about available clinical trials.

• New drugs. Myeloma represents a new treatment paradigm (a set of assumptions and practices) in cancer because the new drugs that target the tumor cell, tumor-bone marrow interaction, and bone marrow environment can overcome normal drug resistance. Drugs are first tested in clinical trials for advanced myeloma and then used to treat earlier-stage myeloma. A variety of new drugs are being studied for the treatment of relapsed myeloma and relapsed, refractory myeloma, including the examples below.

• B-cell maturation antigen (BCMA). BCMA is a marker on the plasma cells that can be targeted for the treatment of myeloma. As discussed in Types of Treatment , several treatments that target BCMA are now approved to treat myeloma. Antibodies that bring immune cells to destroy myeloma cells are called bispecific antibodies, and they work similarly to the way bispecific T-cell engagers work (see below). Antibody-drug conjugates (ADCs) are antibodies that carry a drug that kills cancer cells when the antibody binds to them. Belantamab mafadotin is the only antibody-drug conjugate approved to treat multiple myeloma at this time. There are also chimeric antigen receptor (CAR) T-cell therapies that target BCMA.

• Venetoclax (Venclexta, Venclyxto). This BCL-2 inhibitor has been used to treat some types of lymphoma and leukemia, and there may be benefit to using it to treat myeloma with a specific genetic mutation that appears in about 20% of patients with myeloma.

• Bispecific T-cell engagers. As described in Types of Treatment , bispecific antibodies are monoclonal antibodies that target a protein on the myeloma cell surface and a T cell. Clinical trials are studying this treatment in multiple myeloma, and the first bispecific T-cell engager that targets both BCMA (a myeloma marker) and CD3 (a T-cell marker) was approved to treat multiple myeloma in 2022.

• Drug combinations. Most myeloma cells will eventually become resistant to standard chemotherapy, a condition called multidrug resistance. Many new drug combinations have been developed and are being studied in various settings, including:

• Bortezomib and lenalidomide in combination with dexamethasone

• Bortezomib, cyclophosphamide, and dexamethasone

• Carfilzomib, lenalidomide, and dexamethasone

• Ixazomib, lenalidomide, and dexamethasone

• Pomalidomide, bortezomib, and dexamethasone

• Carfilzomib, pomalidomide, and dexamethasone

• Pomalidomide, ixazomib, and dexamethasone

• Pomalidomide, dexamethasone, and clarithromycin (Biaxin)

• Daratumumab, bortezomib, and dexamethasone

• Immunotherapy. This type of therapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. Vaccines are a type of immunotherapy being explored in the treatment of multiple myeloma. Research on using these therapies to treat advanced myeloma is ongoing. Learn more about the basics of immunotherapy .

• CAR T-cell immunotherapy. In this type of immunotherapy, some T cells are removed from a patient’s blood. Then, the cells are changed so they have specific proteins called receptors. The receptors allow the changed T cells to recognize the cancer cells. The changed T cells are then returned to the patient’s body. Once there, they seek out and destroy cancer cells. Two CAR T-cell therapies, idecabtagene vicleucel and ciltacabtagene autoleucel, have received FDA approval (see Types of Treatment ), and more clinical trials are studying other CAR T-cell therapies in myeloma. Researchers are also examining the effectiveness of BCMA-targeted CAR T cells in combination with other treatments, as well as working to identify other antigens found on myeloma cells that may be effective immunotherapy targets. Learn more about the basics of CAR T-cell therapy .

• Immune checkpoint inhibitors. Checkpoint inhibitor therapies include antibodies to block PD-L1 on multiple myeloma cells and PD-1 on immune cells. PD-1 is found on the surface of T cells, which are a type of white blood cell that directly helps the body’s immune system fight disease. Because PD-1 keeps the immune system from destroying cancer cells, blocking PD-1 allows the immune system to better eliminate the disease. Current research is trying to work out which patients benefit most from these treatments and in which combinations of other drugs they should be used. The FDA stopped all clinical trials using PD-1 checkpoint inhibitors in multiple myeloma. In 1 study of combination therapy that included pembrolizumab (Keytruda), researchers saw an increased death rate. Other checkpoint inhibitors targeting LAG3, TIM3, and TIGIT are being studied.

• Cancer vaccines. Vaccines are another type of immunotherapy being explored in the treatment of multiple myeloma. Learn more about therapeutic cancer vaccines .

• Palliative and supportive care. A limited number of clinical trials are underway to find better ways of reducing symptoms and side effects of current myeloma treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in myeloma, explore these related items that will take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

• Visit the Cancer.Net Blog to review news and information about myeloma, including research announced at recent scientific meetings or other news and information related to myeloma.

• Get updates from Cancer.Net delivered right to your inbox. Subscribe to the Inside Cancer.Net email newsletter .

• Visit the website of Conquer Cancer, the ASCO Foundation, to find out how to help support research for every cancer type. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with myeloma does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations and medical tests. Doctors want to keep track of your recovery in the months and years ahead. Your doctor may recommend maintenance therapy to prevent cancer recurrence. Most patients requiring treatment for systemic myeloma are also treated on a regular schedule with intravenous bisphosphonates. However, the development of kidney problems or osteonecrosis (a small area of dead bone) of the jaw in a small fraction of patients after long-term use may change how bisphosphonates are used in the future.

For myeloma, follow-up care typically includes blood tests, periodic imaging scans, and bone marrow evaluation every 1 to 3 months. Treatment usually continues in myeloma over the long term, so this is usually integrated with watching for a recurrence.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation .

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Over time, myeloma recurs and arises because small areas of this cancer may remain undetected and resistant to treatment in the body. In turn, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, treatments received, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• Can you explain my pathology report (laboratory test results) to me?

• What stage is the myeloma?

• Am I symptomatic or asymptomatic? What does this mean?

• Is my kidney function being affected?

• Should I consider cytogenetic or genomic testing? What is involved, and what do the results mean?

• Can you refer me to a social worker or psychologist who can help me cope with my diagnosis?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What types of research are being done for multiple myeloma in clinical trials? Do clinical trials offer additional treatment options for me?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• What are the possible side effects of this treatment, both in the short term and long term?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• Should I get a second opinion?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about having therapies using medication

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• When should I return to my primary care doctor for regular medical care?

• Who will be leading my follow-up care?

• What support services are available to me? To my family?

• Where can I get more information about myeloma?

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.