Everything you need to know about multiple myeloma — from symptoms and staging to treatment options and life after diagnosis — explained clearly by Dr. Aditya Sarin.
This page is for informational purposes only and does not constitute medical advice, diagnosis or treatment. Every case of multiple myeloma is different. Please consult Dr Aditya Sarin or a qualified oncologist for evaluation, diagnosis and a treatment plan specific to your condition.
3
R-ISS stages, from Stage I to Stage III
82%
Stage I 5-year survival rate
20+
Approved treatment classes
22 yrs
Median survival, long-term Indian transplant responders (AIIMS 2025)
Unexplained bone pain, fatigue, or abnormal blood tests deserve prompt evaluation. Schedule an evaluation with Dr. Aditya Sarin today.
Section 01
What is Multiple Myeloma?
Multiple myeloma is a cancer of plasma cells — a type of white blood cell made in the bone marrow that normally produces antibodies to fight infection. In myeloma, abnormal plasma cells multiply uncontrollably, crowd out healthy blood cells, and produce an abnormal protein that can damage the kidneys and other organs.
Unlike leukemia, which usually circulates freely in the blood, myeloma cells typically build up within the bone marrow at multiple sites throughout the skeleton — which is where the disease gets its name. It most often affects older adults, with a median age at diagnosis of around 70.
Section 02
Types & Related Conditions
Multiple myeloma exists on a spectrum, and understanding where a patient falls on it is essential to deciding whether treatment is needed immediately or whether monitoring is appropriate. Dr. Aditya Sarin evaluates each case individually, including biomarker and cytogenetic testing, to determine the right course of action.
Precursor · No Treatment
MGUS
Monoclonal gammopathy of undetermined significance — abnormal protein present but no symptoms or organ damage. Requires monitoring, not treatment.
Intermediate
Smouldering Myeloma
Higher abnormal protein level than MGUS, but still without organ damage. Some patients progress to active myeloma; others do not.
Requires Treatment
Active (Symptomatic) Multiple Myeloma
Myeloma causing measurable organ damage, such as kidney impairment, anaemia, bone lesions, or high calcium levels.
Localised
Solitary Plasmacytoma
A single tumour of abnormal plasma cells, either in bone or in soft tissue, without the widespread bone marrow involvement seen in multiple myeloma.
Section 03
Symptoms of Multiple Myeloma
Multiple myeloma symptoms are often summarised by doctors using the acronym CRAB — calcium, renal, anaemia, and bone — the four classic types of organ damage the disease can cause.
Bone pain, particularly in the back, hips, or ribs
Fatigue and weakness from anaemia
Frequent infections
Excessive thirst, frequent urination, or confusion from high calcium
Swelling in the legs or reduced urine output from kidney impairment
Unexplained weight loss
Bone fractures with minimal trauma
Note: Many patients have no symptoms in the early stages, and myeloma is sometimes first suspected when an abnormal protein level is found incidentally on routine blood work.
Section 04
Causes & Risk Factors
The exact cause of multiple myeloma is not fully understood, but several factors are known to increase risk. Being aware of your risk profile allows for earlier and more targeted evaluation.
Age
The median age at diagnosis is around 70, and risk rises steadily with age.
MGUS
Nearly all cases of multiple myeloma develop from a pre-existing MGUS, though only a small percentage of people with MGUS ever progress.
Race
Myeloma occurs roughly twice as often in Black individuals compared with White individuals, for reasons not fully understood.
Family History
Having a first-degree relative with multiple myeloma or MGUS modestly increases risk.
Having one or more risk factors does not mean a person will develop multiple myeloma, and many people diagnosed have no identifiable risk factor beyond age.
Section 05
Multiple Myeloma Screening & Early Detection
There is no routine population-wide screening test for multiple myeloma. Early detection depends on recognising symptoms and, in some cases, incidental findings on routine blood or urine tests.
Blood Tests
Complete blood count, kidney function, calcium level, and tests for the abnormal protein produced by myeloma cells.
Urine Tests
Checks for Bence Jones protein, a marker of abnormal antibody fragments produced by myeloma cells.
Bone Marrow Biopsy
Confirms the diagnosis by measuring the percentage of abnormal plasma cells in the bone marrow.
Imaging
Whole-body MRI, low-dose CT, or PET-CT scans identify bone lesions and assess disease extent.
An abnormal protein level on a blood test does not confirm active myeloma. It may indicate MGUS or smouldering myeloma, both of which require monitoring rather than immediate treatment.
Section 06
Staging of Multiple Myeloma
Multiple myeloma is staged using the Revised International Staging System (R-ISS), which is based on blood markers rather than tumour size, since myeloma spreads through the bone marrow rather than forming a single, measurable mass. This staging guidance is current as of 2026.
Stage
What it means
R-ISS I
Low beta-2-microglobulin and normal albumin, no high-risk chromosomal changes, and normal LDH. The most favourable prognostic group.
R-ISS II
Does not meet the criteria for Stage I or Stage III. The intermediate prognostic group, and the most common stage at diagnosis.
R-ISS III
High beta-2-microglobulin, combined with high-risk chromosomal changes or elevated LDH. The most advanced prognostic group.
Staging is based on beta-2-microglobulin and albumin levels in the blood, lactate dehydrogenase (LDH), and specific chromosomal abnormalities identified through bone marrow testing, rather than the size or location of a tumour.
Survival statistics are population averages. They describe outcomes across large groups of patients and do not predict what will happen to any individual patient.
Multiple myeloma survival outcomes in India
Measure
Value
Long-term survivors (10+ years) after stem cell transplant, AIIMS New Delhi
21.9%
Median overall survival among these long-term survivors
264 mo (22 yrs)
Median progression-free survival among these long-term survivors
This is one of the most encouraging outcome studies published from an Indian centre, and it reflects results in transplant-eligible patients specifically, not all myeloma patients broadly.
Section 08
Treatment Options for Multiple Myeloma
Treatment has changed dramatically over the past two decades and is tailored to the patient's stage, cytogenetic risk, and eligibility for stem cell transplant. Dr. Aditya Sarin develops a comprehensive, personalised treatment plan for every patient.
Quadruplet Induction Therapy
A combination of an anti-CD38 antibody, a proteasome inhibitor, an immunomodulatory drug, and a steroid — now the standard starting regimen for transplant-eligible patients.
Autologous Stem Cell Transplant
High-dose chemotherapy followed by reinfusion of the patient's own stem cells, a cornerstone of treatment for eligible patients.
Maintenance Therapy
Lower-intensity, ongoing treatment after initial therapy or transplant to extend remission.
Monoclonal Antibodies
Antibody-based drugs, such as anti-CD38 therapies, that target specific proteins on myeloma cells.
Bispecific Antibodies
Lab-made antibodies that bring a patient's T-cells into direct contact with myeloma cells, increasingly used earlier in the treatment course.
CAR-T Cell Therapy
A patient's own T-cells are engineered to target the BCMA protein on myeloma cells, an option for eligible patients with relapsed or refractory disease.
Proteasome Inhibitors & IMiDs
Two established drug classes that remain central to both induction and relapse treatment.
Radiation Therapy
Used selectively to treat painful bone lesions or a solitary plasmacytoma.
Section 09
Latest Advances in Multiple Myeloma Treatment
Multiple myeloma treatment has changed substantially over the past year, particularly with bispecific antibodies and antibody combinations being used earlier in therapy. As of 2026, notable developments include the following.
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FDA Approval · March 2026 · Early Relapse
Bispecific therapy moves to early relapse
In March 2026, the FDA approved teclistamab in combination with daratumumab and hyaluronidase-fihj for adults with relapsed or refractory multiple myeloma who have received at least one prior line of therapy, expanding this bispecific antibody combination from a late-line option into the early relapse setting. The supporting Phase 3 MajesTEC-3 trial showed a substantial improvement in progression-free survival.
FDA Approval · January 2026 · Frontline, Transplant-Ineligible
A new frontline option for transplant-ineligible patients
In January 2026, the FDA approved daratumumab and hyaluronidase-fihj in combination with bortezomib, lenalidomide, and dexamethasone for adult patients with newly diagnosed multiple myeloma who are not eligible for autologous stem cell transplant.
Whether either of these developments applies to a given patient depends on prior treatment history, transplant eligibility, and cytogenetic risk, and should be discussed directly with an oncologist.
Section 10
Living with Multiple Myeloma
A multiple myeloma diagnosis affects not just physical health but emotional well-being and quality of life. Comprehensive support — from bone health to emotional care — is an integral part of treatment at every stage.
Bone Health Management
Bone-strengthening medications and physiotherapy to reduce fracture risk and manage bone pain.
Counselling & Support Groups
Professional emotional support and peer groups for patients and families navigating a long-term treatment journey.
Infection Prevention & Nutrition
Practical guidance on reducing infection risk and maintaining strength through extended treatment periods.
Section 11
Why Early Detection Matters
Myeloma used to mean a survival measured in a few years. Today, with the right treatment started early, many of our patients are planning for decades, not years.
— Dr. Aditya Sarin, Medical Oncologist
Patients diagnosed at R-ISS Stage I have a notably better 5-year survival rate than those diagnosed at Stage III.
Kidney damage from myeloma can sometimes be prevented or reduced with prompt diagnosis and treatment.
Bone lesions found early can be managed before a fracture occurs.
An abnormal blood protein level found incidentally is worth discussing with a doctor, even without symptoms.
Unexplained, persistent bone pain in an older adult deserves a blood test, not just a painkiller.
Section 12
Frequently Asked Questions about Multiple Myeloma
What is the first sign of multiple myeloma?
Bone pain, particularly in the back or ribs, and persistent fatigue from anaemia are among the most common early signs. Many cases are first suspected from an abnormal protein level found incidentally on a blood test.
Can multiple myeloma be cured?
Multiple myeloma is generally considered treatable rather than curable, though outcomes have improved dramatically. Some long-term survivors, particularly after stem cell transplant, now live 15 to 20 years or more, and a growing number of specialists believe a genuinely curative approach may be possible for some patients in the coming years.
What is the difference between MGUS and multiple myeloma?
MGUS is a precursor condition characterised by the presence of an abnormal protein, with no organ damage or symptoms, and requires only monitoring. Multiple myeloma causes measurable organ damage and requires treatment. Only a small percentage of people with MGUS ever progress to active myeloma.
How is multiple myeloma staged?
Multiple myeloma is staged using the Revised International Staging System, which is based on blood levels of beta-2-microglobulin and albumin, combined with chromosomal testing and LDH levels, rather than on tumour size.
Is multiple myeloma hereditary?
Most cases are not directly inherited, though having a first-degree relative with multiple myeloma or MGUS modestly increases risk.
Is a stem cell transplant always necessary?
No. Transplant eligibility depends on age, overall health, and organ function. Transplant-ineligible patients now have effective frontline treatment options as well.
What is the best treatment approach for Multiple Myeloma in Delhi?
Effective multiple myeloma treatment in Delhi starts with accurate staging using blood, urine, and bone marrow tests, as treatment intensity depends heavily on the R-ISS stage and cytogenetic risk. Dr. Aditya Sarin, ESMO board-certified and trained in precision oncology, offers this biomarker-driven, personalised approach to multiple myeloma patients in Delhi.
Section 13 · Why Dr. Aditya Sarin
Why Trust Dr. Aditya Sarin for Multiple Myeloma Care?
ESMO Board Certified · Harvard Trained · Sir Ganga Ram Hospital, New Delhi
Experienced Myeloma Specialist
ESMO Board Certified oncologist with advanced training in precision oncology and cancer genomics from Harvard Medical School.
Advanced Treatment Options
Access to the latest bispecific antibodies, targeted therapy, and personalised treatment protocols tailored to your specific myeloma risk profile.
Comprehensive Support
Personalised treatment plans, emotional counselling, and end-to-end support for patients and their families.
Affordable & Accessible Care
High-quality oncology care with insurance assistance, flexible appointment options, and both in-person and remote consultations.
Mon – Fri (Morning) 10:00 AM – 12:00 PM
Mon – Fri (Evening) 4:00 PM – 6:00 PM
Saturday - Sunday Closed
Early Detection Saves Lives
Don't wait for a fracture — an unexplained ache deserves an answer today. If you've noticed persistent bone pain, unexplained fatigue, or simply want expert guidance on an abnormal blood test result, speak with Dr. Aditya Sarin — a trusted multiple myeloma specialist in New Delhi.
