Treatment of Stage I Multiple Myeloma

This content has been reviewed and approved by

Kenneth C. Anderson, MD
Chief, Division of Hematologic Neoplasia

Dana-Farber Cancer Institute

Stage I multiple myeloma occurs when there is a relatively small amount of cancer in the body. This stage is also described as “smoldering” myeloma.

The major decision for a person with multiple myeloma is whether treatment should be started, and if so, when? It may be useful to think of the disease as a gradual progression. If you have the condition known as monoclonal gammopathy of undetermined significance (MGUS), this means that you have just a small amount of the M protein (monoclonal protein) that is produced by abnormal plasma cells. If you have stage I multiple myeloma, you have more M protein and more abnormal plasma cells. However, the disease is not yet causing symptoms, nor is it causing major damage to the bones. Stage I multiple myeloma requires no therapy.

Many people live with MGUS or stage I myeloma for many years without experiencing any worsening of the disease. Their doctors need to monitor them at regular intervals for any signs or symptoms that could indicate the myeloma is progressing. These may include:

• A steady increase in the amount of M protein in the blood or urine
• Development of bone lesions
• Worsening kidney function
• Anemia (not having enough red blood cells and/or hemoglobin, the oxygen-carrying protein these cells produce)
• Hypercalcemia (too high amounts of calcium, which are a sign of bone damage)

If you are uncomfortable with “watching and waiting” to see if your myeloma progresses, you may wish to consider taking part in a clinical trial. Clinical trials are research studies that evaluate the effectiveness of new drugs or treatment strategies in patients. They are available for most stages of cancer, and they could offer you access to new treatment strategies. You might begin by asking your doctor if he or she knows about any current clinical trials for stage I myeloma. There also are a number of online databases that provide information about clinical trials. One good starting point is www.clinicaltrials.gov.