For myeloma, it is important, to begin with, whether the patient is experiencing symptoms. It is common to classify patients with newly diagnosed myeloma as being either
Symptomatic from the disease (having symptoms and signs) or
Asymptomatic/Smoldering (without any symptoms).
Smoldering myeloma is a slow-growing blood cancer that can affect plasma cells, which are the white blood cells that produce antibodies. People diagnosed with smoldering myeloma have slightly higher levels of M protein. They have more plasma cells in the bone marrow than people with MGUS (Monoclonal gammopathy of unknown significance). They are monitored closely for signs of growing cancer. If the disease progresses then it is known as multiple myeloma and the word “smoldering” is dropped because the disease is no longer suppressed. A routine blood test is often the first step in diagnosing smoldering myeloma.
There is still no evidence of symptoms or signs of myeloma. But, a person with SMM may be prescribed bisphosphonates for symptoms of osteoporosis or osteopenia (a low density of bone minerals).
The treatment of multiple myeloma depends on whether the patient is experiencing symptoms and the patient’s overall health.
The goals of treatment are to
Eliminate myeloma cells
Control tumour growth
And allow patients to have an active life
While there is no cure for multiple myeloma, cancer can be managed successfully in many patients for years. Doctors help patients manage the symptoms of myeloma so patients can lead an active life.
Patients with early-stage myeloma and SMM or MGUS are simply closely monitored. This approach is called active surveillance or watchful waiting. If symptoms appear, then active treatment starts. Current research shows that starting active therapy for people with no symptoms does not result in longer survival as compared to those who have active surveillance. However, patients with asymptomatic myeloma may participate in clinical trials designed to prevent the disease from turning into symptomatic myeloma.