Multiple Myeloma

What is multiple myeloma?

Multiple myeloma is a cancer of plasma cells which are white blood cells that specialize in the production of antibodies. Plasma cells are an integral part of our adaptative immune systems. In multiple myeloma, abnormal plasma cells multiply uncontrollably within the bone marrow which can affect the production of healthy blood cells, damage bones and other organs.

Multiple myeloma accounts for about 1–2% of all cancers and is a relatively common blood cancer in adults. It is technically an incurable malignancy but advances in treatment of the past years has dramatically improved survival in multiple myeloma patients. Recent data shows that the median survival in newly diagnosed multiple myeloma patients is over 150 months.

Key fact: The term 'multiple' in multiple myeloma refers to the involvement of different bone marrow sites throughout the body (e.g., spine, ribs, hips, and skulls).

What are the symptoms of multiple myeloma?

Multiple myeloma often develops slowly without causing obvious symptoms early on. It can be discovered incidentally during blood or urine tests ordered for work-up of other conditions. When symptoms do appear, they typically reflect how multiple myeloma disrupts normal bone marrow function and bone structure.

Symptoms can include:

• Bone pain

• Bone fractures with minimal trauma

• Frequent infections (due to a weak immune system)

• Unusual bruising or prolonged bleeding

• Unexplained fever

• Fatigue

• Shortness of breath or trouble breathing

• Numbness or tingling in the legs (if the spine is involved)

• Excessive thirst or urination (from elevated calcium levels)

• Kidney problems or decreased urine output

When to see a doctor: If you experience unexplained bone pain, recurrent infections, or unusual fatigue, speak with your physician. Early detection gives you access to more treatment options and better outcomes.

How is multiple myeloma diagnosed?

Diagnosing multiple myeloma typically begins with blood and urine tests, often ordered because a patient reported symptoms or because something unusual appeared in routine lab work. If initial results suggest multiple myeloma, your care team will pursue additional testing to confirm the diagnosis, determine how advanced the cancer is (staging), and guide treatment planning.

• Blood & urine tests: A complete blood count (CBC) checks for anemia and low platelet counts. Serum protein electrophoresis (SPEP) and urine protein electrophoresis (UPEP) detect abnormal antibody proteins (M-proteins) produced by multiple myeloma cells. Kidney function, calcium levels, and beta-2 microglobulin are also measured.

• Bone marrow biopsy: A small sample of bone marrow is removed and analyzed to confirm the presence of multiple myeloma cells, determine the percentage of plasma cells, and evaluate specific genetic markers that affect prognosis and treatment decisions.

• Imaging studies: X-rays, CT scans, MRI, and PET scans help identify bone lesions, fractures, or areas where multiple myeloma has spread. Hoag was the first in the nation to open Phase 2 clinical trials using molecular imaging to detect multiple myeloma with greater precision.

• Genetic & molecular testing: Cytogenetic and FISH (fluorescence in situ hybridization) testing identify chromosomal abnormalities in multiple myeloma cells. These results help classify your multiple myeloma as standard- or high-risk and guide personalized treatment through Hoag's Precision Medicine Program.

Call 949-722-6237 to schedule an appointment or request a second opinion consultation with our specialists.

What are some treatment options for multiple myeloma?

Treatment for multiple myeloma is highly individualized. Your oncology team at Hoag will consider your age, overall health, kidney function, genetic risk profile, and prior treatments to decide the best approach. In general, treatment for newly-diagnosed multiple myeloma is divided in stages (induction, consolidation, and maintenance). Utilizing different agents is of utmost importance to ensure a long term remission in patients with multiple myeloma. Some of the agents we use are outlined below.

• Chemotherapy and systemic therapy: We rarely use conventional chemotherapy to treat multiple myeloma in the modern day. The most commonly used systemic non-immunotherapy agents are a class of medications called proteasome inhibitors. They are often combined with other agents other agents for enhanced effect. Hoag's infusion center provides a comfortable and well equipped center with expertise to deliver these treatments.

• Immunotherapy: Immunotherapies harnesses your own immune system to recognize and fight multiple myeloma cells. Treatments include monoclonal antibodies (such as daratumumab), immunomodulatory drugs (IMiDs), and bispecific antibodies. These treatments are amongst the most significant advances in the care for multiple myeloma in recent years.

• CAR-T Cell Therapy: Hoag is one of only two centers in Orange County to offer CAR-T cell therapy — a groundbreaking treatment that reprograms your own T-cells to seek and destroy multiple myeloma cells.

• Autologous Stem Cell Transplant: An autologous stem cell transplant (using your own stem cells) is sometimes offered for eligible multiple myeloma patients. High-dose chemotherapy is followed by reinfusion of previously collected stem cells to restore healthy bone marrow function.

• Radiation therapy: Targeted radiation is used to shrink specific tumors (i.e., plasmacytomas) or to relieve bone pain. Hoag has been named a Radiopharmaceutical Therapy Center of Excellence by the Society of Nuclear Medicine and Molecular Imaging. One of only 17 such centers in the U.S., alongside Stanford and Harvard Medical School.

• Corticosteroids: Medications such as dexamethasone reduce inflammation and directly suppress the growth of multiple myeloma cells. They are almost always given in combination with other multiple myeloma drugs.

• Palliative & Supportive Care: Palliative care runs alongside active treatment to manage symptoms like bone pain, fatigue, and nausea while supporting your emotional well-being. They are crucial in helping you feel better throughout your treatment journey.

Tumor Boards at Hoag: Complex multiple myeloma cases are reviewed by Hoag's multidisciplinary tumor board. This is a collaborative meeting that involves hematologists/oncologists, radiologists, pathologists, and care coordinators designed to ensure every patient benefits from the most informed, comprehensive care plan possible.

Supportive care resources for multiple myeloma

At Hoag Family Cancer Institute, we believe that caring for the whole person is essential to treatment success and quality of life. Hoag's Integrated Cancer Support Services are available to all patients, regardless of cancer stage, prognosis, or phase of recovery.

Our Clinical Nurse Navigator Program connects multiple myeloma patients and their families with specially trained nurses who guide you through every step of your journey. We answer questions, coordinate appointments, and provide trusted, science-backed information from diagnosis through recovery.

• Classes & Workshops

• Counseling Services

• Brighter Image Program

• Support Groups

• Hoag Rehabilitation Services

• Spiritual Care Services

• Oncology Massage

• Oncology Nutrition

• Pastoral Care Services

• Financial Navigators for cancer-related care

Find more information about Integrated Cancer Support Services at Hoag at this link.

Survivorship and support for multiple myeloma at Hoag

A multiple myeloma diagnosis changes life in ways that extend well beyond the clinic. Hoag is committed to supporting patients and their loved ones before, during, and after treatment. Our team is dedicated at helping you manage the physical effects of cancer treatment, navigating relationships, work, or finding a new sense of normal.

Our survivorship philosophy: Survivorship at Hoag begins at diagnosis, not after treatment ends. We provide resources to help you manage side effects, maintain your identity and relationships, return to the activities you love, and feel empowered in your everyday life.

Our oncology social workers, counselors, and nurse navigators work together to address the emotional, practical, and physical dimensions of living with and beyond multiple myeloma.

Because the treatment for multiple myeloma often requires multiple phases, including treatment cycles, maintenance therapy, and monitoring for remission, Hoag's survivorship team is equipped to support you through every phase and not just the acute treatment period.

Areas of Survivorship Support

• Emotional & psychological support for patients and families

• Oncology nutrition and physical rehabilitation

• Financial navigation for treatment-related expenses

• Spiritual and pastoral care

• Support for returning to work while living with cancer

• Guidance for talking to friends and family about your diagnosis

• Ongoing monitoring and management of long-term side effects

Clinical Trials for multiple myeloma

Clinical trials are research studies that evaluate new treatments, new combinations of existing treatments, and new ways to diagnose or prevent cancer. For multiple myeloma patients, participating in a clinical trial may provide access to promising therapies not yet widely available and can directly contribute to improving outcomes for future patients.

Hoag has been a national leader in multiple myeloma research. Notably, Hoag was the first institution in the nation to open a Phase 2 clinical trial using molecular imaging technology to detect multiple myeloma with greater sensitivity and precision than conventional imaging.

Hoag's clinical research team is committed to protecting the well-being of every trial participant while advancing the science of multiple myeloma care. Trials may study new drugs, drug combinations, cellular therapies, or novel uses of existing treatments.

View available clinical trials at Hoag here. Contact us at (949) 764-4577 to see if joining a clinical trial is right for you.