Quick Answer
From protein studies to transplant and MRD — a clear overview of modern myeloma care.
Medically reviewed by Dr. Sachita Baniya • NMC 20158 • Kathmandu Neurology Clinic & Cognitive Center
Multiple myeloma is a cancer of plasma cells, the immune cells that produce antibodies. It can cause bone pain, anaemia, kidney problems, high calcium and frequent infections. It is not usually curable with standard therapy, but it is highly treatable and many patients live for years with good disease control.
How myeloma is diagnosed
Diagnosis requires clonal plasma cells plus myeloma-defining events. The work-up includes serum and urine protein electrophoresis, immunofixation, serum free light chains, bone marrow aspiration and biopsy, FISH for risk, and imaging for bone or extramedullary disease. Blood counts, calcium, kidney function and albumin complete the picture.
MGUS, smouldering and active myeloma
MGUS has a small monoclonal protein without organ damage and is monitored. Smouldering myeloma meets some laboratory criteria but has no organ damage and is usually observed. Active myeloma requires treatment.
Treatment
Modern treatment combines proteasome inhibitors, immunomodulatory drugs, steroids and anti-CD38 antibodies. Eligible patients may proceed to autologous transplant, followed by maintenance. Response is assessed by protein studies and, where available, measurable residual disease testing.
- Induction therapy to reduce the cancer
- Autologous transplant for eligible patients
- Maintenance therapy after transplant or induction
- Bone protection with bisphosphonates or denosumab
- Infection prevention and thrombosis prophylaxis
Supportive care matters
Myeloma care is not only anti-cancer therapy. Bone health, pain control, kidney protection, vaccination and prompt treatment of infection are essential. Patients should report fever, new back pain, weakness in the legs or problems passing urine urgently.
What is MRD?
Measurable residual disease testing looks for small numbers of myeloma cells remaining after treatment. It gives prognostic information and is increasingly used in trials and selected practice.
Living with myeloma
Treatment is often given in cycles over months, with breaks. Fatigue, infection risk and emotional strain are common. A written treatment summary and a clear follow-up schedule help patients and families plan.
Frequently asked questions
Answers reviewed by Dr. Jitendra Prasad Yadav • MBBS, MD (Internal Medicine), FICN (Neurology), FCNV, FIHM • NMC 8029
Myeloma is generally not considered curable with standard therapy, but it is highly treatable and many patients live for years with good disease control. Treatment is individualised.
It uses the patient's own stem cells after high-dose melphalan to deepen response. Eligibility depends on age, fitness, response and patient preference.
No. Most people with MGUS never develop myeloma. The annual progression risk is low but persists, so monitoring is recommended.
Monitoring is usually every few months initially and then less often for stable low-risk disease. The schedule is individualised.
More: All FAQs → · Ask Dr. Jitendra →
Related articles
MGUS: What It Means and How Often to Monitor
Monoclonal gammopathy of undetermined significance is a common precursor condition. Most people with MGUS never develop myeloma.
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Measurable Residual Disease: Why 'No Blasts Seen' Is Not Always Remission
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References & Review
Reviewed by Dr. Jitendra Prasad Yadav • Last reviewed: 2026-11-10
- International Classification of Headache Disorders, 3rd edition (ICHD-3).
- Harrison's Principles of Internal Medicine — Neurology sections.
- American Academy of Neurology guidelines for selected conditions (where applicable).
Content is educational and aligns with standard medical references; individual evaluation may vary. External links provide context and do not imply endorsement.