How is multiple
Multiple myeloma can cause a range of different common symptoms. Some of these symptoms, such as fatigue and bone pain, are similar to symptoms of other illnesses. Your doctor will need to do specific tests before making a diagnosis.
In order to diagnose multiple myeloma with certainty or to rule it out, your doctor will ask questions about your symptoms and may run a variety of blood and/or urine tests, imaging scans, and genetic tests. The results of these tests will not only determine whether you have the disease, but also the extent of the disease, type of myeloma, what treatment options may be helpful, and how to monitor the effects of treatment.
Your doctor will evaluate the results of your laboratory tests—more specifically:
- Level of M-proteins (abnormal proteins produced by myeloma cells)
- Number of myeloma cells in a bone marrow sample (also called tumor burden)
- Presence, extent, and characteristics of bone damage
- Any cytogenetic (genomic) abnormalities
You and your doctor will evaluate other health factors such as your age, symptoms, general health, and lifestyle. Discuss treatment options with your doctor. Options may include stem cell transplant, chemotherapy, other medications, or a clinical trial. While there is no cure for multiple myeloma at this time, people may be able to manage their symptoms through treatment and guidance from their healthcare provider.
Managing multiple myeloma can differ from person to person. Together, you and your doctor will figure out the best treatment plan for you.
Starting treatment for
If you are diagnosed with multiple myeloma, your doctor will sit down with you to decide which is the most suitable course of treatment for you. The decision on whether treatment should start immediately depends on the results of a bone marrow examination, imaging and blood tests, and whether at least one of the so-called CRAB criteria is met.
CRAB criteria for deciding if treatment should be started:
The CRAB criteria are usually met if your multiple myeloma is already causing symptoms. If this is the case, your doctor will start treatment immediately.
Other factors that can influence the type of therapy you receive include:
- Other medical conditions you might have
- Your personal preference with regard to a particular treatment
- The stage of your multiple myeloma
with an autologous stem
Multiple myeloma can often be suppressed for an extended period of time using high-dose chemotherapy followed by an autologous stem cell transplant. High-dose chemotherapy aims to destroy as many myeloma cells as possible. Because the chemotherapy also destroys healthy bone marrow cells, the patient subsequently receives an infusion of healthy bone marrow cells that were removed from their blood on a previous occasion. This process is referred to as an autologous stem cell transplant. It is called “autologous” because the patient receives an infusion of their own healthy bone marrow cells.
Stem cell transplant may not be an option for every patient and might be more suitable for younger and fitter patients up to the age of about 65 years, because they often tolerate the side effects better than older patients.
When a stem cell transplant is not possible
If high-dose chemotherapy with a stem cell transplant is not possible in your case, other medications are currently available. Most patients with multiple myeloma will receive multiple types of treatment that may include:
- Antibody therapy
- Immunomodulators to help your immune system find and fight cancer
- Proteasome inhibitors that act on specific features of the myeloma cell
These treatments for multiple myeloma work in different ways and combination therapies are common.
How do you know if you are responding to your treatment?
Regular doctor visits are necessary during the course of treatment. Your doctor will assess during the check-ups whether and to what degree you are responding to the treatment. Many of the examinations for the assessment are the same as those during the diagnosis. This includes regular blood and urine tests. Imaging tests and bone marrow examinations are sometimes also necessary.
Signs that you are responding to the treatment:
- Reduced amount of M-proteins in your blood
- Improvement of your symptoms and possible complications (CRAB criteria, see above)
- Fewer myeloma cells in your bone marrow
- Improvement in your overall state of health
Not all patients respond to a treatment in the same way. Some patients respond such that there is no detectable disease left, and some patients linger with continued but stable disease. Some patients don't respond at all to the treatments they're given. This is called refractory multiple myeloma. Some patients stop responding after an initial and prolonged positive response. This is referred to as relapsed multiple myeloma. In the case of relapsed or refractory multiple myeloma, your doctor will suggest another course of treatment and may ask whether you can participate in a clinical trial.
Antibody-drug conjugates (ADCs)1,8,9
There are a lot of ADCs in research right now across several tumor types.1,8,9 In fact, more than 100 clinical trials have tested the safety and effectiveness of ADCs for a variety of targets, including BCMA.1,8,9
ADCs are made up of 2 main components: an antibody and the actual medicine.1,8 The antibody targets specific areas on the outside of cells, including cancer cells.1,8,9 This helps the ADC attach to the cancer cell.1,8,9 Once attached, medicine is delivered inside the cancer cell to kill it.1,8,9
Bispecific antibodies have 2 arms that can attach to 2 different areas at the same time.1,10,11
One arm attaches to the body’s T cells.1,10,11 T cells are like soldiers of the immune system.1,10,11 They find and help fight disease.1,10,11
The other arm attaches to the cancer cell.1,10,11 This brings the body’s T cells and the cancer cells close together. 1,10,11 That way, the T cells have a better chance of killing the cancer cells.1,10,11
CAR T cell
Chimeric antigen receptor (CAR) T-cell (CAR T cell)1,11,12
CAR T cell therapy is a personalized type of treatment that uses a patient’s cells to fight cancer.1,11 Specific cells, called T cells, are taken from the blood and then enhanced in a laboratory.1,11,12 Then, the enhanced T cells are put back into the patient’s body so they can attack the cancer cells.1,11,12
When multiple myeloma
People living with multiple myeloma face a difficult reality as they look ahead. The disease is incurable, and though they may experience periods of remission, a relapse can occur. A relapse is multiple myeloma that has come back after treatment. Their multiple myeloma may also become refractory (not respond to treatment).
A relapse can feature both physical and emotional effects. Signs of a relapse can include:
- Return of symptoms
- Changes in blood cell counts
- Problems with organs
- Evidence of cancer growth
At the same time, knowing that a relapse may occur or that the cancer may not respond to treatment, a person may experience fear, anxiety, and other negative feelings that weigh heavily on them and those who are close to them. Finding and connecting, or reconnecting, with sources of support is another important way to take care of yourself at this time.