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Blood Cancers

Diagnosis & Treatment

Multiple Myeloma

Find a multiple myeloma specialist

Diagnosing Multiple Myeloma

Diagnosis

Multiple myeloma can be diagnosed after an abnormal result from a routine blood test. Doctors may also run tests if you present with multiple myeloma symptoms. Understanding the signs and symptoms of the disease is essential for you to know when to see a doctor. If your doctor notices abnormal proteins in your blood, hypercalcemia, anemia, or a kidney problem, they may suspect the disease and order additional tests to confirm a multiple myeloma diagnosis.

Your physician may reach a diagnosis after ordering blood tests for multiple myeloma, including a total blood count, and testing for blood urea nitrogen and creatinine. A urine test can also show M-proteins in the urine, a sign of multiple myeloma. To examine the bones, your doctor may order imaging tests, including an MRI, X-ray, or CT scan. These tests can detect suspicious areas of bone damage that could be cancer.

Finally, your physician may order a bone marrow biopsy or bone marrow aspiration. This test involves the removal of bone marrow with a thin needle inserted into the numbed pelvic bone. When examined in a laboratory, this tissue can reveal if you have too many plasma cells in your marrow.

How is Multiple Myeloma Treated?

Treatments

The specialists at NewYork-Presbyterian lead your care with cutting-edge technology and offer treatments for multiple myeloma that are not available elsewhere. Our physicians are recognized as authorities in the field and have served as principal investigators in establishing international guidelines for myeloma care. Our ultimate goal is to find a cure for your disease.

During diagnosis, your doctor will determine the stage of your disease (I, II, or III) and your risk level, which indicates how aggressive your myeloma is. These factors will help determine your course of multiple myeloma treatment.

If you've been diagnosed with multiple myeloma, NewYork-Presbyterian offers you comprehensive treatment plans that may include drug therapies, radiation therapy, bone marrow transplants, and stem cell transplantation.

We recognize that a cancer diagnosis is stressful for you and your loved ones. We dedicate as much time as you need to review information and discuss treatment options with our team. We’ll create an individualized treatment plan for you based on:

  • Your age, overall health, and medical history
  • Specific genomic characteristics of the type of myeloma you have
  • Your expectations, preferences, and health goals

We typically present several options and offer you the guidance and support of your entire care team in making a decision. Once you start treatment for multiple myeloma, we follow you closely to ensure you respond to therapy. After treatment, we continue to follow up with you to ensure that there’s no residual disease.

We work closely with the Columbia University Bone and Marrow Transplant Program to give you state-of-the-art treatment and follow-up care.

Drug therapies

Multiple myeloma is mainly treated with chemotherapy and immunotherapy. Chemotherapy is "systemic" medicine—it interferes with all fast-dividing cells in your body. Multiple myeloma often spreads throughout your body, so systemic medicine helps control the disease no matter where it started.

This action is why chemotherapy causes side effects such as hair loss. Depending on the medication, you'll either get chemotherapy through an IV in our infusion center or through a pill.

Agents are divided into several groups based upon how they work. The most commonly used groups and drugs are:

  • Immunomodulatory drugs: lenalidomide (Revlimid®), pomalidomide (Pomalyst®), thalidomide (Thalomid®)
  • Proteasome inhibitors: bortezomib (Velcade®), carfilzomib (Kyprolis®), ixazomib (Ninalro®)
  • DNA-damaging chemotherapy agents: cyclophosphamide, bendamustine, melphalan, vincristine, doxorubicin, carmustine, etoposide, cisplatin
  • Immunotherapies/monoclonal antibodies: daratumumab (Darzalex®), elotuzumab (Empliciti®), Isatuximab
  • Epigenetic modulator: panobinostat (Farydak®)
  • Corticosteroids: dexamethasone, prednisone

Usually, the drugs above are used in combination and treatment regimens contain two or three drugs at a given time. In addition to chemotherapy and immunotherapy, patients may choose to undergo stem cell transplant during their treatment course.

Immunotherapy drugs help your body's immune system fight cancer cells. Your body may not naturally recognize and attack cancer cells because they produce a specific protein that helps them hide from your body's immune system. Some immunotherapy drugs interfere with the process of creating those proteins. Another immunotherapy, known as Chimeric antigen receptor (CAR) T-cell therapy, involves engineering a patient's own white blood cells to attach to and destroy cancer cells.

Currently, there are two approved CART treatments for Multiple Myeloma. These are ABECMA and CARVYKTI, and both treatments have shown excellent activity for treatment. At NewYork-Presbyterian, we have been at the forefront of developing these treatments and have successfully treated many patients with CART treatment for this disease.

Radiation therapy

Radiation uses high-powered rays or particles to kill cancer cells. Radiation therapy can be used to shrink myeloma cells quickly or treat tumors that have not responded to chemotherapy or other therapies. It's the most common treatment for solitary plasmacytomas.

Stem cell transplant

Sometimes known as a bone marrow transplant, a stem cell transplant involves replacing diseased bone marrow with healthy, blood-forming stem cells. Most often, these stem cells are collected from a patient's blood, but can also come from a suitably matched donor. This procedure is a standard treatment for myeloma patients and can make the disease disappear for up to several years.

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FAQs

FAQs

Some multiple myeloma patients do not display any symptoms. Even then, symptoms can develop over time and not become apparent until the disease reaches a late stage. Those who do can present many symptoms, including fatigue, bone pain, and recurrent infections. Many patients are diagnosed after having abnormal laboratory tests such as anemia (low hemoglobin), renal dysfunction, and high protein or calcium levels.

The life expectancy of patients with multiple myeloma can vary widely, but with the development of newer and more effective therapies, there has been a significant increase in the average survival of patients. Survival rates have grown from about three years in the early 2000s to about 10 years currently.

Multiple myeloma is uncommon; the lifetime risk of developing the disease is 1 in 132 in the United States. Almost 35,000 cases are expected to occur each year.

Get Care

Trust NewYork-Presbyterian for Multiple Myeloma Treatment

Your multiple myeloma treatment plan is based on your disease characteristics, desired schedule, symptoms, and overall health. At NewYork-Presbyterian, our experts are prepared to handle every case of multiple myeloma.

We offer cutting-edge radiation therapies and have comfortable, state-of-the-art chemotherapy infusion centers. Our advanced transplant units offer individual monitoring and unique airflow systems for patients with weakened immune systems. We perform over 200 transplants per year, have special expertise in transplants from mismatched donors, and can provide approaches that reduce the risk of transplant-related complications.