Multiple Myeloma Treatment Timeline: What to Expect From Start to Finish

Few people have multiple myeloma symptoms early in the disease. Sometimes it's a blood test done for another reason that raises suspicion. Once it progresses, you may get bone pain or a fracture, fatigue from the loss of red blood cells (anemia), or repeated infections. It usually takes many different tests to diagnose multiple myeloma, see how advanced it is, and come up with the right treatment plan for you. Most tests take an hour or less, but results could take up to a few days or longer.

Your doctor will likely start with a blood test that looks for M proteins and beta-2-microglobulin, which are markers of multiple myeloma. Your blood cell counts, levels of calcium and uric acid, and markers of kidney disease will also be measured. Blood tests take only a few minutes, with results available within days. Another common test is a 24-hour urine sample. It will be tested for Bence Jones proteins, made by cancerous plasma cells. Results should be available in three to five days.

This test looks for cancer cells in your bone marrow. Bone marrow has solid and liquid parts, and samples of both can be collected using different needles, usually from a hip bone. The procedure takes about 30 minutes. A few different tests might be done on the samples, including genetic testing to learn more about your specific cancer. Some results are available in a few days, while others can take up to three weeks.

Your doctors will order one or more imaging tests to help diagnose multiple myeloma and see where and how widespread the cancer is. Common imaging tests are PET and MRI. A PET (positron emission tomography) scan looks at how glucose is used in various parts of the body. Areas with cancer cells often stand out because they use more glucose than healthy cells. It takes two to three hours, with results available often within a day. MRI (magnetic resonance imaging) uses a large magnet and radio waves to generate images of your bones, organs, muscles, and other tissues, also to look for signs of multiple myeloma. Results are often available within a few days.

Your doctor will analyze results of your tests to find out how far along the cancer is. Stages of multiple myeloma are 1, 2, 3, and, in some rating systems, 4. The stage is based on how much beta-2-microglobin, albumin, and lactate dehydrogenase are in your blood and the gene abnormalities seen in cancer cells. Stage 1 means the cancer is growing slowly. The more aggressive it is, the higher the stage.

Treatment starts with what's called induction therapy. The goal is to get rid of the cancer and put you in remission. You'll take a combination of three or four drugs. These include an immunomodulator, a proteasome inhibitor, a steroid, and possibly a monoclonal antibody. Usually, you can take them by mouth. The drugs are prescribed in cycles of 21 to 28 days each, sometimes more, sometimes less. You may need to repeat the cycle up to six times.

This second part of treatment is very individualized to your needs and your response to the first phase. You may get a short-term high dose of chemotherapy to get rid of all leftover cancer cells in preparation for a stem cell transplant. Or you might be given a lower dose of your induction medicines.

A stem cell transplant puts healthy blood stem cells into your system. They are usually collected from your bone marrow once the cancer has been cleared. When your doctor determines the time is right, these cells are injected into one of your veins over the course of a few hours. The goal is for them to reach your bone marrow and grow. There are no hard and fast rules about who can have the transplant, but you're a good candidate if you're in otherwise good health and don't have advanced liver or heart disease.

Because multiple myeloma can return, staying on a scaled-down version of your induction therapy is the usual course. Many people take just one drug, the immunomodulator lenalidomide. Your doctor will determine your exact maintenance plan and how long you'll stay on it based on results of tests, like blood and imaging tests, used to monitor your condition. Some people are able to stop after two years.