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Multiple-Myeloma Cancer and MGUS

multiple-myeloma-doctor-patientAnuj Mahindra, M.D., answers questions via email about the plasma-cell cancer multiple myeloma. Dr. Mahindra is an attending physician at the Center for Multiple Myeloma at Massachusetts General Hospital and an instructor at Harvard Medical School.

The questions are based on queries readers posted on our original article about the blood disorder MGUS. (Some people with MGUS eventually develop multiple myeloma.) Answers are only meant as general information, not individual advice.

This article will make the most sense to people who are already familiar with MGUS and multiple myeloma. For an introduction to MGUS, please see our previously mentioned original article on the topic.


Blood Tests and Your M-Protein Level

Q. What's the significance of the M-protein level?
A. If you have M-protein, you may have:

  • A plasma-cell disorder such as MGUS
  • A plasma-cell cancer such as multiple myeloma
  • Organ dysfunction caused by the M-protein being deposited in tissues (amyloidosis)

The significance of an M-protein is to evaluate the patient and diagnose the underlying disorder.


Q. When is the M-protein level too high? When does it become multiple myeloma?
A. Plasma-cell disorders are a spectrum that includes MGUS, smoldering myeloma and multiple myeloma.

newsletter-graphicYou have smoldering myeloma if:

  1. Your M-protein level is more than 3 g/dl or your bone marrow has more than 10 percent plasma cells AND
  2. Your body has no significant changes related to the plasma cells' uncontrolled growth (such as bone changes, anemia, high calcium levels or kidney damage).

Smoldering myeloma has progressed to what's called symptomatic multiple myeloma if damage to the body starts, no matter what your M-protein level is.

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Q. One reader has yearly blood tests but is worried that that's too long to go between checks. Is it? She asks, what if it gets worse?
A. The recommendation is to get a repeat blood test six months after your diagnosis of MGUS. This should include:

  • Serum protein electrophoresis
  • Serum-free light chain analysis
  • Hemoglobin
  • Serum creatinine
  • Calcium

If your levels are unchanged and the diagnosis remains MGUS, once-a-year blood tests are appropriate in most cases.


Smoldering Myeloma and Multiple Myeloma

Q. Another reader says she has smoldering multiple myeloma. Her doctor doesn't want to start treatment until it becomes more active. How long will this be?
A.
This is variable, but on average, you have a 10 percent chance per year for the first five years of smoldering myeloma progressing to multiple myeloma or amyloidosis. You have a 3 percent chance per year for the next five years and 1 to 2 percent per year for the next 10 years.

People with smoldering multiple myeloma should get repeat blood tests two months after they're diagnosed. If the results are stable, the recommendation is to get them every three to four months after that (in some cases six months).


Q. Does smoldering myeloma always become active? What percentage does?
A. It doesn't always progress to multiple myeloma, but considering that it does in most cases, close follow-up is recommended. The cumulative probability of progression to multiple myeloma or amyloidosis at 15 years is 70 to 75 percent.

Q. Why do doctors wait to treat smoldering myeloma? Why don't you catch it in the bud?
A. Smoldering myeloma is a focus of ongoing clinical trials. Studies done in the era before we had newer treatments showed that, while early treatment did delay the progression of disease, it did not make people live longer.

There are many new treatment options, and it remains to be seen if studies will find that they lengthen life spans.

There are risks associated with the older treatments, such as second cancers, and we're waiting to see if the newer treatments will be safe and effective in the long run. Hence, treatment for smoldering myeloma is considered in the context of clinical trials.


Q. What are the treatments?
A. Right now, unless you're enrolled in a clinical trial, close observation is recommended for people with smoldering myeloma.

There is no cure for multiple myeloma yet, but we can slow its progression and address symptoms. Treatments include chemotherapy, immunotherapy and bone-marrow transplants.


Thank you to Andrea Slesinski of the American Society of Hematology for putting us in touch with Dr. Mahindra.


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Last updated and/or approved: November 2011.
This general health-care information is not meant as individual advice. Please see our disclaimer.

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Smoldering Myeloma
written by Sister Mary Sharon Verbeck , November 06, 2013

I have smoldering myeloma at high risk. My oncologist/hemotologist has me on 20 mg. of dexamethasone once a week. Will this dosage increase if my blood work and bone survey
doesn't improve?

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