What shapes your multiple myeloma care? Insights from Dr. Saad Z. Usmani

What is multiple myeloma?

Multiple myeloma is a type of blood cancer that affects plasma cells, a key part of your immune system. These cells live in your bone marrow, which Dr. Usmani describes as “the factory that makes these blood cells.” When plasma cells become cancerous, they grow uncontrollably and disrupt normal blood production. 

Dr. Usmani adds that these abnormal cells can also crowd out healthy cells, causing:

• Anemia (low red blood cells)
• Increased risk of infections
• Low white blood cell counts

In addition, myeloma cells produce abnormal proteins (called M-proteins), which can damage organs, especially the kidneys.

Evidence-based guidance powered by NCCN Guidelines®

Personalized treatment plans shaped by the latest oncology standards—tailored to your diagnosis.

Get started

View your personalized treatment plan in the Outcomes4Me app

Use your diagnosis to unlock personalized NCCN Guidelines®-aligned recommendations.

Continue in app

Why symptoms and treatments vary

One of the most important things to understand about multiple myeloma is that it doesn’t look the same for everyone.

“The thing that makes myeloma unique,” Dr. Usmani says, “is that patients can have either a lot of myeloma or a little myeloma.”

This means:

• Some people are diagnosed early with mild symptoms, like slight anemia
• Others may have more advanced disease, with kidney issues or bone fractures

Because of this range, treatment plans are not one-size-fits-all. They’re tailored based on how much disease is present and how it’s affecting your body. Beyond how much myeloma is present, doctors also look closely at what kind of myeloma you have.

Dr. Usmani shares, “Myeloma comes in different ‘flavors’. You can have more of a vanilla variety of myeloma, which is what we call standard risk, where patients don’t have any aggressive features. We treat them with the standard treatments, and the likelihood of their myeloma coming back sooner is low.” 

For patients who are at high risk, adjusting care is key. “We have to pick treatments smartly for those patients, because there’s a higher chance that if patients have those aggressive features, the myeloma can come back sooner than expected, even with the right treatment. We have to tweak those treatments accordingly, ” he says.

The tests that shape your treatment plan

Your risk level can often be identified through genomic testing, which helps predict how the disease might behave. To build the most effective treatment plan personalized to you, Dr. Usmani highlights the following tests:

• Blood tests: These include complete blood counts and chemistry panels to check kidney function, calcium levels, electrolytes, and more.
• Protein studies: Specialized tests detect abnormal proteins made by myeloma cells. As Dr. Usmani notes, these help identify the presence of M-protein and light chains in the blood.
• Urine tests: A 24-hour urine collection can show whether abnormal proteins are affecting your kidneys.
• Bone marrow biopsy: This test shows how many myeloma cells are present and allows for further genetic analysis.
• Imaging: Scans like CT, PET-CT, or MRI help identify bone damage or lesions caused by the disease.

Doctors may also use additional markers, like beta-2 microglobulin and LDH, to better understand how aggressive the myeloma may be.

How does this lead to a personalized plan?

As your care team puts the pieces together, they’ll determine two important things: how much myeloma and what kind. Dr. Usmani emphasizes that combining this information will allow your doctor to determine which treatments are most likely to work, the treatment intensity, and how much monitoring you’ll need.

A multiple myeloma diagnosis comes with a lot of complexities. Don’t be afraid to ask your care team questions, and remember that seeking a second opinion is always encouraged. 

Want more expert insights on multiple myeloma? Watch the full discussion with Dr. Usmani here.