With myeloma, lots of abnormal (cancerous) plasma cells are made. These are called myeloma cells. Myeloma cells may be found in the bone marrow of different bones around the body. So it may also be called multiple myeloma.
The myeloma cells fill up the bone marrow which makes it harder for the bone marrow to make enough other normal blood cells. This causes some of the symptoms of myeloma, including difficulty fighting infection.
Normal plasma cells make different types of antibodies. Antibodies travel in the blood and help to fight any viruses or bacteria in the body. These antibodies are also called immunoglobulins.
Myeloma cells usually make an abnormal immunoglobulin. Abnormal immunoglobulins are sometimes called a paraprotein, or M protein.
We have more information about immunoglobulins and myeloma.
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Types of myeloma
There are different types of myeloma. Each type of myeloma is named after the abnormal immunoglobulin (paraprotein) the myeloma cells make. They may cause different symptoms, but they are all usually treated in the same way.
Myeloma may not cause any symptoms in its early stages. It may be diagnosed after a routine blood test, before any symptoms are noticed. Or it may be diagnosed after going to your GP or to hospital with symptoms.
Symptoms of myeloma can include:
- constant bone pain in 1 area (such as in the back, ribs, hip or pelvis)
- an increase in the risk of infection or having infections, one after another, that need antibiotics to treat them
- becoming anaemic and bruising and bleeding more easily – anaemia is when the number of red blood cells in your blood is low
- feeling extremely tired (fatigue)
- tingling or numbness in the hands or feet, though this is rare.
Myeloma may also cause symptoms because it has caused damage to the bones. This can include bone thinning and sometimes fractures. Bone damage can also cause high levels of calcium in the blood, called hypercalcaemia.
Myeloma can also cause symptoms if the kidneys are affected. These include feeling tired or confused and having problems peeing.
These symptoms can be caused by other conditions. But if you have any of these symptoms, it is important to get them checked by your GP.
There are different ways of managing myeloma symptoms.
We have more information about the causes and risk factors of myeloma.
Myeloma can be diagnosed in different ways. Some people may see their GP about symptoms. These include:
- pain in the bones
- having infections one after the other (recurrent infections)
Your GP may arrange for some blood tests or scans. If necessary, they then refer you to a doctor who specialises in blood conditions (heamatologist) at the hospital for more tests and treatment.
Some people are diagnosed with myeloma after going into hospital with more severe symptoms such as:
At the hospital the haematologist will examine you and arrange more tests. These can include:
You may be asked to collect samples of your urine (pee). This is to test for Bence Jones protein in your urine and to test how well your kidneys are working. Sometimes you may need to take a container home and collect your pee over 24 hours. The nurses will explain more about how to do this test.
Bone marrow biopsy
If myeloma cells are found, further tests called cytogenetic tests, may be done on bone marrow sample. Cytogenetics is the study of chromosomes. Chromosomes are made up of genes. Genes carry the instructions cells need to work properly. Cytogenetic tests look for changes in the chromosomes of the myeloma cells to find out more about the cells and how they might respond to treatment.
One type of test is called a FISH test (fluorescence in situ hybridisation test). Your doctor may use the terms high-risk or low-risk when they talk about the results of your FISH test or other cytogenetic tests.
You may also have scans, such as a CT scan or an MRI scan to look at the bones. An MRI scan is often used as well as a CT scan. Further tests may include:
In rare situations, x-ray of the bones are done, if an MRI and CT are not suitable. This is called a skeletal survey x-ray.
Waiting for test results can be a worrying time. We have more information to help.
The stage describes how advanced the myeloma may be and how effective treatment might be. Myeloma is usually staged from stage 1 to 3. The stage of the myeloma does not usually affect the treatment offered so doctors do not always talk about staging.
We have more information about staging of myeloma.
There are different treatments for myeloma. A team of specialists meet to discuss and plan the best treatment for you. This is called a multidisciplinary team (MDT).
Your doctor and nurse will explain the different treatments and their side effects. They can talk to you about things to consider when making treatment decisions.
The type of treatment your doctor offers you depends on a number of things, including your general health.
If the myeloma is not causing symptoms you do not usually need treatment straight away. Myeloma with no symptoms, is called smouldering or asymptomatic myeloma. You will have regular check-ups and tests. This is called active monitoring.
If the myeloma begins to cause symptoms, you will start treatment. Myeloma with symptoms, is called active or symptomatic myeloma. If you have active myeloma, you may have intensive treatment or less intensive treatment.
Less intensive treatments include:
Usually, a combination of these treatments is used.
Some people might be have intensive treatment. This depends on how the myeloma is affecting you and your general health. If your doctor thinks this treatment is suitable for you, they will talk with you about this.
Maintenance or continuous treatment
Your doctor may suggest continuing treatment until they get the best possible response for you. Or you may be given treatment for as long as it controls the myeloma. This is called continuous or maintenance treatment.
We have more information about treatment for myeloma.
You may be offered some treatments as part of a clinical trial.
Myeloma can cause symptoms if it affects areas of the body such as the bones, kidneys, blood or nerves. Symptom control is important part of treatment for anyone diagnosed with myeloma.
We have more information about:
Treating myeloma that comes back
You usually have regular follow-up appointments at the hospital during your treatment and when you are in remission. Or you may have follow-up appointments with your GP. This is sometimes called a shared care agreement (follow-up care).
If you have smouldering myeloma (myeloma without symptoms) you will also have follow‑up checks every few months.
If you have any problems, or notice any new symptoms between appointments, tell your doctor or specialist nurse as soon as possible.
Coping with myeloma after treatment
There are different things you can do after treatment to look after yourself and recover from treatment. We have more information on living with treatment.
Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse.
Macmillan can offer emotional, practical and financial help and support. If you would like to talk, you can:
- Call the Macmillan Support Line on 0808 808 00 00.
- Chat to our specialists online.
- Visit our myeloma forum to talk with people who have been affected by myeloma, share your experience, and ask an expert your questions.
The organisations below also offer information and support:
- ACLT (African Caribbean Leukaemia Trust)
ACLT offers support for people from ethnic minorities affected by leukaemia and related illnesses.
- Anthony Nolan
Anthony Nolan is the UK’s largest stem cell and bone marrow register.
- Blood Cancer UK
Blood Cancer UK is a blood cancer research charity that provides information and support on any type of blood cancer.
Below is a sample of the sources used in our myeloma information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
National Institute for Health and Care Excellence (NICE). Myeloma: diagnosis and management. NICE guideline [NG35]. Published: 10 February 2016 Last updated: 25 October 2018. Available from: https://www.nice.org.uk/guidance/ng35/chapter/recommendations Accessed: 19/07/22
Jonathan Sive et al., on behalf of the British Society of Haematology. British Journal of Haematology. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Published: 21 March 2021 Available from: https://onlinelibrary.wiley.com/doi/10.1111/bjh.17410 Accessed: 19/07/22
M.A. Dimopoulos et al. Annals of oncology. European Society for Medical Oncology (ESMO). Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Volume 32, ISSUE 3, P309-322, March 01, 2021. Available from: https://www.annalsofoncology.org/article/S0923-7534(20)43169-2/fulltext Accessed: 19/07/22
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.
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