Cancer Type Category: Multiple Myeloma

What causes multiple myeloma? 

Researchers do not know exactly what triggers the gene changes that cause myeloma. What they do know is which groups have a higher risk than others. Having risk factors does not mean you will develop the disease, but it may mean careful monitoring makes sense for you. 

Who is at risk for getting multiple myeloma? 

No test can predict with certainty whether you will develop multiple myeloma. But some groups face a higher risk, and knowing your risk helps you and your doctor stay ahead of it. 

The risk of multiple myeloma can increase for a few reasons: 

• Age: older or aging adults 
• Gender: men (more than women) 
• Racial background: African Americans (more than other groups) 
• Health history: diagnosis of MGUS or plasmacytoma 
• Family history: diagnosis plasma cell neoplasms in your immediate or extended family 
• Environment: exposure to harmful chemicals or radiation 

How can I lower my risk of multiple myeloma?  

Some risk factors, like your age and sex, cannot be changed. But if you have several risk factors, talk with your doctor. Monitoring over time can catch early signs before they become harder to treat. At Siteman, we regularly see patients with MGUS and smoldering myeloma. These are conditions that need watching, not waiting. 

The WashU Medicine physicians at Siteman are the most experienced myeloma specialists in the region. They treat this disease every day, and they build your plan around your specific diagnosis. 

Myeloma as a Chronic Disease

There is not a cure for multiple myeloma yet. But our WashU Medicine specialists are skilled at managing it as a chronic disease. We can slow or stop its progression, control your symptoms, and in many cases achieve long-term remission. Our goal is to increase your survivability and help you live well, not just longer. 

Most people with myeloma are treated with combinations of medications. These drug regimens are highly effective at controlling the disease. 

The right treatment depends on your specific diagnosis, your genetics, your overall health, and your prior therapies. That is why specialist experience matters. At Siteman, a dedicated myeloma team matches you with the right therapies at the right time. 

Research is changing what is possible for our patients. Our WashU Medicine physicians at Siteman lead clinical trials that produced two of myeloma’s most important recent advances: CAR T-cell therapy and bispecific antibodies. When you are treated here, that research is available to you. 

What treatment could I have for my multiple myeloma? 

Your treatment plan may include one or more of the following: 

• Drug therapy (This is sometimes called “medical therapy.”) 
• Immunotherapy 
  • Monoclonal antibodies 
  • CAR T-cell therapy 
  • Bispecific antibody therapy 
• Stem cell transplant 
• Radiation therapy 
• Surgery (This is rare.)  

What is drug therapy for multiple myeloma? 

Drug therapy is the most common first treatment for myeloma. These combinations of medicines target myeloma cells and keep the disease in check. Drug therapies include: 

• Proteasome inhibitors 
• Immunomodulatory drugs  
• Chemotherapy 
• Immunotherapy 
  • Monoclonal antibodies 
  • CAR T-cell therapy 
  • Bispecific antibodies 
• Corticosteroids  

What are proteasome inhibitors? 

Proteasome inhibitors are the first line of drug therapy for multiple myeloma patients. They can be given as an injection, IV infusions, or in pills.  

These drugs block proteasomes. Proteasomes are like recycling centers in cells. Myeloma cells need proteasomes to survive. When the drug blocks them, the myeloma cells die. 

What are immunomodulatory drugs? 

Immunomodulatory drugs are taken as pills. There are many kinds of these medications, but each can alter the immune cells and how they behave. Because these medications change how B cells, T cells, or other immune cells work, they disrupt how multiple myeloma cells are growing. Patients might receive immunomodulatory drugs in combination with other therapies to increase their effectiveness. 

Chemotherapy for multiple myeloma 

Chemotherapies are drugs that kill cancer cells. Doctors usually give them through an IV, although some chemotherapies are now available as pills or injections. 

Chemotherapy is almost always given alongside other treatments. Because so many effective new options now exist, it is rarely used on its own. 

Immunotherapy for multiple myeloma

Immunotherapies help a patient’s immune system recognize and destroy cancer cells that are in their body. Cancer cells do a good job of hiding from the body’s natural immune system. Immunotherapies show the body where harmful cells are and give them a way to kill them. The current FDA-approved immunotherapy drugs kill myeloma cells by attaching themselves to them cells. This is how antibodies and T cells are able to attack multiple myeloma. 

There are a few different types of immunotherapies:  

• CAR T-cell therapy 
• Monocolonal antibodies 
• Bispecific antibodies   
  

CAR T-cell therapy: CAR T-cell therapy uses a patient’s T ells and changes them to have a small molecule added to it. This molecule is called a “chimeric antigen receptor,” or “CAR.” Before they are changed, multiple myeloma cells are able to hide from T cells. But the created CAR T-cells can see that multiple myeloma cells are dangerous. The CAR part of the T cell sticks to the myeloma cells and attacks them.  

Monocolonal antibodies: Patients with multiple myeloma are most often treated with monoclonal antibodies, which are lab-created antibodies that attach to cancer cells and prompt the immune system to attack them. 

Bispecific antibodies: A bispecific antibody is another kind of monocolonal antibody. A bispecific antibody attaches to two (bi) parts of the myeloma cell, and a monocolonal antibody attaches to just one (mono). 

Stem cell transplant for multiple myeloma 

Some patients with myeloma receive a stem cell transplant, also called a bone marrow transplant. The transplant returns healthy stem cells in your bone marrow so your body can make new, healthy blood cells. The goal is to achieve long-term remission, one where the myeloma cells are no longer active. 

Multiple myeloma is treated with autologous transplants, where your own stem cells are used. Other transplants are rarely, if ever, used for myeloma.  

What is an autologous transplant? 

In an autologous transplant, your own stem cells are collected and stored before treatment begins. Think of it as donating to yourself. No outside donor is needed.  

After your stem cells are stored, you receive intensive chemotherapy to destroy the myeloma cells. Then your stored stem cells are returned through an IV. Because they were never exposed to chemotherapy, they are still healthy. These cells act quickly to rebuild your immune system.  

When do patients with multiple myeloma receive radiation therapy? 

Radiation is not used for survivability with myeloma, but it is an important tool for managing symptoms. It can reduce bone pain and help prevent fractures where myeloma has weakened the bone.  

If your radiation oncologist recommends radiation for you, they will be precise with how they use it. To make sure you only get the radiation you need, they use CT simulations to target radiation beams. This directs the radiation beams to keep healthy tissue safe.  

Is surgery ever used to treat multiple myeloma? 

Surgery is almost never used to treat multiple myeloma. Rarely, a lymph node may need to be removed, but this is highly uncommon. 

Myeloma cells can occasionally form tumors, but surgery for them is uncommon. Plasmacytoma is a related but distinct condition that can sometimes be treated with surgery. But it is not the same as multiple myeloma. 

Diagnosing Multiple Myeloma  

Hearing you have multiple myeloma is never easy. But getting a diagnosis is the first step toward feeling better. Many patients lived with symptoms for months before they had an answer. Now you have one, plus a path forward. 

What is the first step in a multiple myeloma diagnosis?  

A myeloma diagnosis often begins with routine bloodwork. A complete blood count (CBC) can flag abnormal white blood cell levels. If your results are out of the normal range, your doctor will refer you to a specialist for more testing. Often, that is when Siteman comes in. 

What are the symptoms of multiple myeloma? 

Multiple myeloma can affect many parts of the body at once. You may notice one or more of these signs: 

• Fragile or brittle bones 
• Pain in the bones 
• Fatigue and weakness 
• Increased bruising and bleeding 
• Unexplained fevers 
• Recurring infections 
• Difficulty breathing 

Are there any specific symptoms and signs of multiple myeloma? 

Most myeloma symptoms, like pain, fatigue, and fever, aren’t specific enough to point to one condition. But hypercalcemia and amyloidosis are specific findings that prompt your doctor to investigate further.  

Hypercalcemia means too much calcium in your blood. It does not automatically mean myeloma, but it is a red flag your doctor will investigate with further testing. 

What are symptoms of hypercalcemia?  
 

• Increased thirst and need to use the bathroom 
• Loss of appetite, nausea, or vomiting 
• Changes in the bathroom (constipation or diarrhea) 
• Muscle weakness  
• Problems thinking and confusion 

Amyloidosis is a condition where abnormal proteins, called amyeloids, build up in your organs and tissues, interfering with how they work.

What are signs of amyloidosis? 

• Purple spots appearing on their skin 
• A swollen tongue 
• Tingling or numbness in the feet and legs 
• Swelling in the hands and feet 

Why Choose Siteman for Your Multiple Myeloma Diagnosis? 

At Siteman, your diagnosis is the foundation of everything we do. Our myeloma specialists build your treatment plan around a precise understanding of your specific disease. 

We need to know exactly what kind of myeloma you have, where it is, and how it is affecting your body. We go beyond evaluating your past records. Advanced screening and imaging give us a current picture, so your care is based on where you are today. 

Your WashU Medicine physicians are specialists in myeloma, not just generalists in oncology. They will get your diagnosis correct the first time and build a treatment plan around your specific case. 

We know your time matters. Whenever possible, we schedule multiple tests and appointments on the same day, so you make fewer trips for your care. 

What to expect during a diagnosis 

A myeloma diagnosis requires specialized tests that primary care physicians do not perform. You can come to Siteman directly without a referral for these.  

For an accurate myeloma diagnosis, we order these tests: 

• Lab work and blood tests 
• Internal tests, like bone biopsies
• Imaging and scans, like PET, CT, and X-ray 

Lab work

For many people, the first hint of myeloma shows up during a routine visit. After a physical exam and review of your medical history, your doctor may order blood and urine tests to look for signs of the disease. 

If these tests show you have an issue with your white blood cells, you will need more advanced tests. This is when you may be referred to Siteman, or you can decide if you want to come here. You don’t need a referral to make an appointment with us.

Advanced and internal tests 

A bone marrow biopsy is a key step in confirming a myeloma diagnosis. Your doctor collects a small sample of bone marrow — usually from the hip — and examines it for myeloma cells. You will receive local anesthesia to stay comfortable for this procedure. 

Imaging and Scans 

Imaging helps us see the full picture. PET and CT scans identify myeloma cells, tumors, and affected areas throughout your body. Because myeloma can damage bones, your physician may also order X-rays. 

Staging multiple myeloma 

Staging tells us how far the myeloma has spread. There are three stages — Stage 1 is the earliest, Stage 3 is the most advanced. 

Your Siteman team reviews all of your test results alongside your overall health to determine your stage. That staging directly shapes your treatment plan. 

If you have been diagnosed with multiple myeloma, are concerned about abnormal blood test results, or want a second opinion on your current treatment plan, you can come to Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine. Here you will receive care from team whose entire focus is on the disease.  

The multiple myeloma specialists within our Blood Cancer Center at Siteman Cancer Center treat multiple myeloma every day — in every form, at every stage. Our physicians and researchers at WashU Medicine are among the most experienced in the nation. They are also advancing the science of this complex disease, which means new options reach our patients first. 

Multiple myeloma, often simply called “myeloma,” is a cancer of plasma cells. It is usually preceded by a noncancerous condition called monoclonal gammopathy of undetermined significance (MGUS), which can remain stable for many years. In some people, MGUS progresses to myeloma—a chronic disease that requires lifelong expert treatment and monitoring, with periods of remission and relapse.

At Siteman, we make treatment decisions based on our deep knowledge of the disease. We treat multiple myeloma and other plasma cell disorders every day. We consider the likelihood of relapse even at your initial diagnosis to select the best approach to take now.  

Whether you are a patient, a family member, or a physician referring your patient, our care coordinators — oncology nurses who help with scheduling and navigation — will guide you from your first call. Ask about a second opinion. 

Why Choose Siteman for Multiple Myeloma? 

Siteman Cancer Center is internationally recognized for blood cancer and cellular therapies — and is the region’s only NCI-designated Comprehensive Cancer Center. It’s a designation that has direct meaning for your care. It means our research and treatment are interconnected. New therapies developed here set national standards, and our patients benefit from that work first.  

Multiple myeloma treatment has transformed over the past five years. The cancer centers achieving the best outcomes are those with dedicated specialists, access to every FDA-approved therapy, and active clinical trials that offer options unavailable elsewhere. Our Blood Cancer Center at Siteman, gives you access to all of them.   

National excellence for myeloma in St. Louis 

Our WashU Medicine physician-researchers developed ChromoSeq, which can quickly and accurately scan a patient’s whole genome for abnormalities that lead to myeloma and other blood cancers. It is a breakthrough in testing with insights on how to treat the specific cause of a patient’s disease. 

We also contribute to national guidelines and cooperative group clinical trials that define how multiple myeloma is treated across the country. Treatments proven here become standard practice elsewhere. 

Our myeloma specialists are also active researchers, making the discoveries that set the standard of care. That means our patients have access to new options at the earliest possible point, often through clinical trials unavailable anywhere else in our region. 

Subspecialized multiple myeloma physician-researchers 

Multiple myeloma is complex enough that specialist experience changes outcomes. Our WashU Medicine physicians focus on just plasma cell neoplasms, including myeloma — not different kinds of cancers.  

They know which genetic patterns predict treatment responses. They know how to sequence therapies to protect your future options. And they know when to move beyond standard treatment to something newer. 

They are also experts in multiple myeloma genetics. Specific gene changes in your cancer cells determine your risk level and guide which treatment fits your disease. Your care plan at Siteman starts with that precision. 

A second opinion that widens options

You do not need a physician referral to come to Siteman. You can refer yourself directly.  

Many patients who come for a second opinion for multiple myeloma discover that their care plan changes significantly. Our Siteman assessment and precise diagnosis could change your outcome, if you have: 

• Smoldering multiple myeloma (SMM), an early, pre-active stage of myeloma 
• Monoclonal gammopathy of undetermined significance (MGUS), an abnormal protein in the blood that is watched closely but not treated
• Solitary plasmacytoma
• Light chain amyloidosis

Because our physicians dedicate their careers to multiple myeloma, they see patterns and options that others may miss — including clinical trial eligibility, genetic features that change treatment strategy, or sequencing decisions that protect future treatment options. 

Start your second opinon.

Team-Based Care for a Complex, Chronic Disease 

The best myeloma care requires a team. At Siteman you have a care team of multiple specialists. Oncologists, transplant specialists, radiation oncologists, nephrologists, and others all work closely and collaboratively for you. Together, they create a care plan personalized just for you.   

Our multiple myeloma tumor board meets every week. In these meetings, your team of experts meet to discuss your specific situation. After reviewing your genetics, your test results, and your treatment history, they agree on a treatment plan. 

Research shows that this kind of team review improves outcomes. In many cases, the recommended treatment changes after a group review. At Siteman, you get the best thinking from every specialist before treatment begins.

Multiple myeloma is a disease that often changes over time. Your team will monitor you carefully, even after remission. In fact, WashU Medicine researchers are actively creating a large-scale immune cell atlas to better understand and predict relapse. 

If your situation changes, your team adapts so you get the care you need. They will reassemble and evaluate what options you have, especially if you experience a relapse. 

Learn more about our myeloma specialists 

Advanced Multiple Myeloma Treatment. All at Siteman. 

Recent breakthroughs have caused multiple myeloma treatment options to widen. You can find them all at Siteman. The FDA has approved multiple new therapies that have extended the time patients stay in remission. Plus, these treatments have transformed what is possible at relapse. 

Your treatment at Siteman is precise and personalized. We analyze your myeloma cells’ genetics, your overall health, your organ function and bone strength, your prior treatments, and your goals.    

Siteman’s leadership in CAR T-cell therapy 

CAR T-cell therapy is one of the most significant advances in multiple myeloma treatment in the past decade. It’s approved for patients whose disease has returned or stopped responding to other treatments. In CAR T-cell therapy, your own immune cells are collected, genetically engineered in a laboratory to recognize and destroy myeloma cells, and then infused back into your body. 

Right now, CAR T-cell therapy is approved for patients with relapsed or refractory myeloma. Trials are studying if it is helpful at even earlier stages.   

Siteman is one of the only centers in the country that processes CAR T-cells on-site, at WashU Medicine’s Center for Gene and Cellular Immunotherapy (CGCI). That means we start your treatment faster. Most of our patients begin CAR T-cell therapy in about a week, compared to several weeks at most other centers. 

Siteman is an authorized treatment center for FDA-approved CAR T-cell therapies for myeloma, including cilta-cel (Carvykti) and ide-cel (Abecma). Both target BCMA, a protein found on myeloma cells. Our team evaluates every eligible patient for CAR-T as part of treatment planning at relapse. 

Bispecific antibodies: a new kind of immunotherapy 

Bispecific antibodies give patients whose multiple myeloma has stopped responding to other treatments renewed options and hope. renewed options and hope. 

Bispecific antibodies are a newly approved class of immunotherapy. They work by binding your immune cells directly to myeloma cells, so the body’s defenses recognize them as a threat and destroy them. Teclistamab (Tecvayli) and talquetamab (Talvey) are both FDA-approved and available for eligible patients with relapsed and refractory myeloma.  

The most experienced stem cell transplant program 

Our program is the most experienced in the region. In 2024, our Blood and Marrow Transplant program celebrated its 10,000 transplant, making us the most experienced program in the region. Autologous stem cell transplants remain an important part of the standard treatment approach for eligible myeloma patients. 

Patients with multiple myeloma have their own stem cells collected to use after treatment to cause the disease to go into remission. Siteman has performed 1900 transplants for myeloma and is among the highest-volume stem cell transplant programs in our region.  

We evaluate each patient’s eligibility for a transplant during your first appointment. This isn’t age dependent. Instead, we consider your overall health. We find a holistic approach means many patients in their 70s are excellent candidates. 

The Outpatient Cellular Therapy Center at Siteman makes receiving a stem cell transplant easier for some patients with blood cancers. This means eligible patients with myeloma can get treatment without being admitted for inpatient care.   

Maintenance therapy for long-term remission 

After a patient’s initial treatment or a stem cell transplant, most continue maintenance therapy to keep multiple myeloma suppressed. Many patients on maintenance therapy live their normal lives: working, traveling, and staying active. Siteman’s specialists manage maintenance therapy with regular monitoring, adjusting your plan to balance effectiveness and quality of life. 

Open Clinical Trials Only at Siteman 

Clinical trials are a strong first option at Siteman. We evaluate every patient for available trials at their first appointment. Trials open new options for treatment, so you will be considered for them on an ongoing basis.

Siteman has more active multiple myeloma clinical trials than any other cancer center in the region. Our trials span every stage of the disease. 

Siteman is also a participant in national cooperative group trials. These are the studies that set national treatment standards for all patients in the U.S. Being enrolled at Siteman means access to more unique therapies that you can only find in a clinical trial. 

Our active multiple myeloma trials include options for: 

• Newly diagnosed patients with quadruplet induction regimens and novel maintenance strategies 
• Patients with smoldering myeloma, with trials studying whether early intervention delays or prevents progression 
• Relapsed and refractory patients, with trials of next-generation bispecific antibodies, CELMoD agents, and combination immunotherapy regimens 
• CAR T-cell studies, with trials studying if it’s effective treating multiple myeloma at earlier stages 
  
  

Search open multiple myeloma clinical trials at Siteman 

Research at Siteman Is Changing Multiple Myeloma 

Multiple myeloma is one of the most rapidly evolving fields in oncology. Siteman’s physician-researchers are at the center of that progress. 

Because our researchers have created an extensive tissue bank, our experts in multiple myeloma are able to accurately model the disease sequence, enabling them to develop effective, novel therapies.   

Our researchers are currently investigating: 

• Minimal residual disease (MRD) testing — a highly sensitive test that can find as few as one myeloma cell in a million, helping guide decisions about how long to continue treatment 
• High-risk cytogenetics — why certain gene changes make multiple myeloma more aggressive, and how to overcome them with newer or more intensive treatment 
• Next-generation immunotherapy — CAR T-cell therapies that target multiple myeloma proteins at once, and bispecific antibodies aimed at new targets including GPRC5D and FcRH5 
• Venetoclax in t(11;14) myeloma — a targeted therapy with strong results in patients whose myeloma carries a specific gene change called t(11;14) 

When you come to Siteman, your care team will review whether any clinical trial or research program applies to your diagnosis.

Advanced Options for Relapsed Multiple Myeloma  

Our experts know that most patients with multiple myeloma could experience a relapse. That is the nature of this disease. A relapse is something we plan for, and it won’t mean you are at the end of your treatment options. In many cases, relapse is the beginning of a new treatment strategy with therapies that were not available or appropriate at diagnosis. 

At Siteman, we plan for a possible relapse from the beginning by basing early treatment decisions on such things as which drugs to use, their sequence, and dosage. That’s why a team of dedicated multiple myeloma specialists is so crucial for care. Their collective experience and judgment inform how to sequence therapies effectively. 

At relapse, Siteman evaluates every patient for: 

• CAR T-cell therapy  
• Bispecific antibodies 
• Open clinical trials  
• Re-treatment with prior regimens 

If you were not initially treated at Siteman, you can self-refer for care here now. Many of our patients transfer their care to Siteman after a relapse for new and more advanced options for treatment and clinical trials.   

Talk to a care coordinator about second opinions or to refer a relapsed patient.

For Referring Physicians 

To start a referral, connect directly with a Siteman care coordinator. Our team of registered nurses works closely with referring providers to guide each case with speed and personal touch. They ensure your patient is connected to the right specialist, the right diagnosis, and the right next step. With deep experience across cancer types and the Siteman system, they serve as your single point of contact from referral through consultation. 

Siteman has the expertise and cutting-edge research your patient needs if they are facing a multiple myeloma diagnosis or their labs and symptoms suggest a plasma cell disorder.  

Here, your patient will have everything they need for the best outcome, including CAR T-cell therapy, bispecific antibodies, and clinical trials. 
 
Refer directly to our care coordinators if your patient has: 

• A new diagnosis or strong suspicion of multiple myeloma (M-protein, elevated free light chains, unexplained anemia plus bone pain) 
• MGUS or smoldering multiple myeloma requiring specialist monitoring or clinical trial evaluation 
• Active multiple myeloma being considered for stem cell transplantation 
• Relapsed or refractory disease requiring CAR T-cell evaluation, bispecific antibody therapy, or clinical trial access 
• High-risk cytogenetic features (del(17p), t(4;14), t(14;16)) requiring intensified or novel treatment strategy 
• A need for a second opinion on diagnosis or treatment plan 
  

Ready to Get Started? 

Whether you are a patient seeking care, a family member helping with research, or a physician with a patient who needs a multiple myeloma specialist, our care coordinators will guide you. They are your first connection to care at Siteman. They offer support as you schedule your first appointment, can answer questions about what to expect, and will connect you with the right specialist from the first conversation. 

Second opinions for multiple myeloma are always available for patients. You can request an appointment at any stage: newly diagnosed, in treatment, in remission, or at relapse. You never need a physician referral to get started.