Multiple myeloma is a complex yet manageable form of blood cancer that affected over 188,000 people in 2022. It begins in plasma cells (immune cells found in the bone marrow) and disturbs the body's ability to fight infection, maintain healthy blood counts, and protect bones and kidneys.

Treatment options today are more advanced than ever, and early diagnosis can lead to significantly better outcomes. For those exploring treatment abroad, it's helpful to know that the cost of multiple myeloma treatment in India can range from $6,000 to $35,000, depending on the stage of disease and treatment choices.

What is Multiple Myeloma?

Multiple myeloma is a subtype of blood cancer that originates in plasma cells. In normal conditions, plasma cells produce antibodies that help the body fight infections. However, in multiple myeloma, these cells become cancerous and begin to grow uncontrollably.

The abnormal plasma cells begin to build up in the marrow, crowding out healthy cells. They also produce large amounts of a dysfunctional antibody known as monoclonal protein or M-protein, which does not help fight infection and can harm the kidneys and other organs.

As the disease progresses, it can weaken bones, impair kidney function, lower red blood cell levels (causing anemia), and suppress the immune system, making the body more vulnerable to infections.

Multiple myeloma is a chronic and relapsing condition, meaning patients often go through cycles of treatment, remission, and recurrence. While it is not usually considered curable, it is highly treatable. With modern therapies, many patients live for years with a good quality of life.

It is more common in older adults, typically diagnosed around the age of 65 or older, and affects men slightly more often than women.

What are the Different Types of Multiple Myeloma?

Multiple myeloma is not a single, uniform disease. It presents in several different forms, depending on how aggressively it behaves and the extent to which it affects the body. Understanding the type of multiple myeloma helps doctors decide the best treatment strategy.

• Smoldering Multiple Myeloma (SMM): This is an early or inactive form of the disease. Patients have abnormal plasma cells and M-protein in the blood or urine, but they don't show any symptoms or organ damage. Smoldering myeloma may not need immediate treatment, but it requires close monitoring to detect any signs of progression.
• Active (Symptomatic) Multiple Myeloma: This is the most commonly diagnosed form, where patients experience symptoms such as bone pain, anemia, kidney issues, or high calcium levels. Active myeloma requires immediate treatment to control the disease and prevent complications.
• Non-Secretory Multiple Myeloma: In this rare type, abnormal plasma cells do not produce detectable M-protein in the blood or urine. It makes diagnosis and monitoring more difficult, often requiring bone marrow testing or imaging to assess disease activity.
• Light Chain Myeloma (Bence Jones Myeloma): Some myeloma cells produce only light chains (parts of antibodies) instead of whole antibodies. These light chains can be harmful to the kidneys and are typically found in the urine.
• Plasmacytoma: This form involves a single mass of abnormal plasma cells, typically located in the bone or soft tissue. It may be treated with localized radiation, but in many cases, it can progress to full-blown multiple myeloma over time.

How is Multiple Myeloma Staging Done?

Staging is a vital step in determining the severity of a patient's multiple myeloma and planning the most effective treatment. Unlike many cancers that are staged based on tumor size or spread to other organs, multiple myeloma is staged based on specific blood test results, protein levels, and genetic findings. These factors help doctors estimate the disease burden, the aggressiveness of the cancer, and the patient's expected outcome (prognosis).

Why Is Staging Important?

Staging helps to:

• Determine the severity of the disease.
• Predict how the myeloma might progress.
• Guide treatment planning (for example, whether to start with chemotherapy or proceed to a stem cell transplant).
• Compare results across different patients and clinical trials.

Staging Systems Used for Multiple Myeloma

The two most widely recognized systems are the Revised International Staging System (R-ISS) and the Durie-Salmon Staging System.

1. Revised International Staging System (R-ISS)

The R-ISS is the most commonly used method today. It improves upon the older system by including both biochemical markers and genetic factors. The staging is based on the following four criteria:

• The level of β2-microglobulin in the blood helps estimate the number of myeloma cells in the body and gives insight into kidney function.
• The serum albumin level indicates the body's nutritional and overall health status; lower albumin levels may point to a more advanced disease.
• The LDH (lactate dehydrogenase) level is a marker of cell turnover; elevated LDH suggests that the myeloma is growing more rapidly.
• The presence of high-risk chromosomal changes, such as del(17p), t(4;14), or t(14;16), is detected using a test called fluorescence in situ hybridization (FISH), which indicates a more aggressive disease course.

Based on these factors, multiple myeloma is staged into three distinct categories:

• Stage I is defined by low β2-microglobulin levels, normal LDH, high albumin levels, and no high-risk chromosomal changes, suggesting an early stage of disease with a favorable prognosis.
• Stage II encompasses cases that do not meet the criteria for either stage I or stage III, representing an intermediate level of risk.
• Stage III is characterized by high β2-microglobulin levels, elevated LDH, and the presence of high-risk genetic changes, indicating advanced and potentially more aggressive disease.

2. Durie-Salmon Staging System (Less Common Today)

Although this older system is no longer widely used, it still provides a clinical understanding of disease burden. It focuses on several key aspects:

• The number of myeloma cells in the body is estimated based on M-protein levels and the extent of bone marrow involvement.
• The level of calcium in the blood is checked because myeloma cells can cause bone destruction, which in turn releases calcium into the bloodstream.
• The amount of hemoglobin is measured, as lower levels may reflect anemia caused by reduced healthy red blood cell production.
• The presence and extent of bone damage typically detected through X-rays or scans, are taken into consideration when assessing skeletal involvement.

Although the Durie-Salmon system helped define early concepts of staging, the R-ISS is now preferred due to its ability to incorporate molecular and genetic risk features.

How Does Multiple Myeloma Affect the Body?

Multiple myeloma can affect the body in various ways, particularly because it originates in the bone marrow—the soft tissue inside bones where blood cells are produced. As cancerous plasma cells proliferate and metastasize, they disrupt the body's ability to maintain normal health and function.

Here's how multiple myeloma impacts various systems:

• Bone damage: Myeloma cells produce substances that break down bone tissue, leading to bone thinning, fractures, and severe bone pain, particularly in the spine, ribs, and hips.
• Anemia and fatigue: As healthy red blood cells are replaced by cancerous plasma cells, oxygen-carrying capacity drops. This results in chronic tiredness, weakness, and shortness of breath.
• Increased risk of infections: Abnormal plasma cells crowd out normal ones, weakening the immune system. Patients become more susceptible to diseases such as pneumonia, urinary tract infections, and shingles.
• Kidney problems: High levels of M-protein and light chains produced by myeloma cells can cause renal damage. In extreme cases, it can also lead to renal failure.
• High calcium levels (hypercalcemia): Bone breakdown releases calcium into the blood, which causes symptoms such as nausea, vomiting, confusion, and constipation.
• Nerve damage (neuropathy): Myeloma or its treatments can damage nerves, causing tingling, numbness, or pain, usually in the hands and feet.

Because it affects multiple organs and systems, myeloma requires a multidisciplinary approach for effective management. It includes not only treating the cancer cells but also addressing the complications that arise from the disease.

What are the Signs and Symptoms of Multiple Myeloma?

Multiple myeloma develops slowly, and in its early stages, it does not cause any noticeable symptoms. As the disease progresses, however, the abnormal plasma cells begin to affect bone marrow function and damage other organs, especially the bones and kidneys. Identifying the signs and symptoms early helps in timely diagnosis and better treatment outcomes.

• Bone pain is one of the most common symptoms, particularly in the spine, ribs, and hips, resulting from the weakening or thinning of bone tissue.
• Fatigue and weakness often occur as a result of anemia, which happens when cancerous cells crowd out healthy red blood cells in the bone marrow.
• Frequent infections may occur because multiple myeloma weakens the immune system, making it difficult for the body to fight off viruses and bacteria.
• Weight loss and reduced appetite are common due to systemic effects of the disease and related metabolic changes.
• Excessive thirst, frequent urination, nausea, or confusion can be signs of high blood calcium levels (hypercalcemia), which occurs when the disease breaks down bones.
• Numbness or tingling in the hands or feet may develop if the myeloma causes nerve damage or if spinal cord compression occurs.
• Paleness and shortness of breath may result from low red blood cell counts, which reduce the blood's ability to carry oxygen.
• Kidney problems or swelling in the legs can occur when excess M-protein produced by myeloma cells accumulates and damages the kidneys.

Some people may be diagnosed before symptoms appear, especially if routine blood tests show abnormalities. That is why anyone experiencing unexplained bone pain, persistent fatigue, or frequent infections (especially those over 60 years of age) should consult a hematologist for further evaluation and diagnosis.

What are the Causes and Risk Factors of Multiple Myeloma?

While the exact cause of multiple myeloma is not fully understood, it is believed to be a result of a combination of genetic changes and environmental exposures that lead plasma cells to grow uncontrollably. While researchers continue to study the specific triggers, several risk factors can increase the chances of developing this disease.

• Older age is the most significant risk factor, as most cases are diagnosed in people over the age of 60.
• Gender plays a role, with men being slightly more likely than women to develop it.
• Race and ethnicity are important, as African Americans are nearly two times as likely to be diagnosed compared to white individuals, although the reasons for this are still being investigated.
• A personal history of monoclonal gammopathy of undetermined significance (MGUS), a benign condition where abnormal M-protein is present in the blood, significantly increases the risk of developing multiple myeloma.
• Having a close relative, such as a parent or sibling, with multiple myeloma or another plasma cell disorder increases your risk, though most patients have no family history.
• Exposure to certain environmental toxins, such as benzene, pesticides, radiation, or industrial chemicals, may raise the risk in some individuals.
• Obesity and a sedentary lifestyle contribute to chronic inflammation and immune system imbalance, which could influence cancer development.

While the above-mentioned factors can increase the likelihood of developing multiple myeloma, many people with the disease do not have any known risk factors. Likewise, having one or more risk factors does not guarantee that someone will develop cancer.

How is Multiple Myeloma Diagnosed?

Diagnosing multiple myeloma involves various tests designed to detect abnormal plasma cells, measure the amount of M-protein in the body, and assess the disease's effects on bones, blood, and other organs. Because the symptoms of myeloma (such as fatigue or bone pain) can be vague and overlap with different conditions, proper diagnosis often requires a combination of laboratory, imaging, and bone marrow studies.

• Blood tests are typically the first step and may reveal anemia, elevated calcium levels, kidney dysfunction, and increased total protein levels. A specific test called serum protein electrophoresis (SPEP) is used to detect M-protein, the abnormal antibody produced by myeloma cells.
• Urine tests help identify Bence Jones proteins, which are free light chains of antibodies that are often present in multiple myeloma and can be toxic to the kidneys.
• A bone marrow biopsy is performed to directly examine the bone marrow, typically taken from the hip bone. A high percentage of plasma cells in the marrow confirms the diagnosis and helps determine the severity of the disease.
• Imaging studies such as CT scans, X-rays, MRI, or PET scans are used to detect bone lesions, fractures, or areas where the cancer has weakened the bone.
• Serum-free light chain assay measures the amount of free light chains in the blood, providing information that helps in diagnosing both multiple myeloma and its precursor condition, MGUS.
• Cytogenetic testing (like FISH analysis) is conducted on bone marrow samples to identify specific genetic abnormalities. These genetic markers help determine the aggressiveness of the myeloma and influence treatment decisions.

A diagnosis of multiple myeloma typically requires:

1. Presence of at least 10% abnormal plasma cells in the marrow or a biopsy-proven plasmacytoma.
2. A measurable level of M-protein in the blood or urine.
3. Evidence of organ damage caused by the disease (such as high calcium levels, kidney problems, anemia, or bone lesions) is commonly referred to as the CRAB criteria.

What are the Treatment Options for Multiple Myeloma?

Multiple myeloma treatment has advanced significantly in recent years, offering patients a range of options that can help control the disease, reduce symptoms, and improve survival. Although the condition is generally considered incurable, it is highly treatable, especially when diagnosed early. The treatment plan is usually personalized based on the patient's age, overall health, stage of the disease, and genetic risk factors.

• Chemotherapy uses drugs to kill rapidly dividing myeloma cells. It may be used alone or in combination with other therapies, especially before a stem cell transplant.
• Targeted therapy involves medications that specifically target the functions of cancer cells. For example, proteasome inhibitors such as bortezomib and carfilzomib block enzymes that help cancer cells survive, while immunomodulatory drugs like lenalidomide and thalidomide enhance the immune response against myeloma cells.
• Immunotherapy helps strengthen the body's immune system, enabling it to recognize and destroy myeloma cells more effectively. Monoclonal antibodies, such as daratumumab and elotuzumab, exemplify this approach.
• CAR T-cell therapy is a cutting-edge option where a patient's T-cells are modified in a laboratory to identify and attack myeloma cells more effectively. It's typically used in relapsed or refractory cases and shows promise in extending remission.
• Corticosteroids, such as dexamethasone or prednisone, are often included in treatment regimens to reduce inflammation and suppress the growth of myeloma cells.
• Stem cell transplant (bone marrow transplant) is often recommended for eligible patients after initial chemotherapy. In an autologous transplant, the patient's own stem cells are collected, the body is treated with high-dose chemotherapy, and then the healthy stem cells are returned to rebuild the bone marrow.
• Radiation therapy may be used to provide relief from bone pain or treat localized areas of bone damage or tumors.
• Supportive care is crucial for managing symptoms and enhancing quality of life. It includes bone-strengthening medications (such as bisphosphonates), antibiotics to prevent infections, and treatments for kidney support or anemia.

Treatment is typically administered in phases, starting with induction therapy (to reduce the disease burden), followed by consolidation (such as a stem cell transplant), and finally, maintenance therapy to prolong remission.

Multiple myeloma patients are now living longer and more comfortably than ever before, thanks to the growing number of therapeutic options available. Many patients go through cycles of remission and relapse, and new treatments can be introduced at each stage to keep the disease under control.

What is the Cost of Multiple Myeloma Treatment in India?

India is today one of the most preferred destinations for overseas patients seeking affordable and high-quality cancer care. Multiple myeloma treatment in India is significantly less expensive compared to Western countries, often costing 70–90% less without compromising on treatment standards or medical technology.

The total cost of multiple myeloma treatment in India ranges from ₹5,00,000 to ₹25,00,000 ( $6,000 to $35,000). The exact cost depends on factors like treatment plan, hospital location, length of stay, and patient condition. Below is an approximate cost breakdown of the most commonly used therapies:

• Chemotherapy: The cost of complete chemotherapy cycles typically ranges from ₹3,00,000 to ₹10,00,000 (approximately $3,600 to $12,000) depending on the type and number of cycles required.
• Targeted therapy (e.g., Bortezomib, Lenalidomide): Each cycle may cost between ₹80,000 to ₹2,50,000 ($950 to $3,000) based on the drug regimen.
• Immunotherapy (e.g., Daratumumab, Elotuzumab): These newer therapies can range from ₹2,00,000 to ₹5,00,000 per dose ($2,400 to $6,000) and are often used in cases of relapse or combination with other treatments.
• Stem Cell Transplant (Autologous): A full autologous bone marrow transplant in India costs around ₹12,00,000 to ₹20,00,000 ($15,000 to $25,000), including pre-transplant preparation, hospital stay, and post-care.
• CAR T-Cell Therapy: Though still emerging in India, this advanced therapy may cost around ₹30,00,000 to ₹40,00,000 ($36,000 to $48,000), which is still much more affordable than in the U.S. or Europe.
• Supportive care (e.g., bone health meds, antibiotics, lab tests): These may add ₹50,000 to ₹2,00,000 ($600 to $2,400) over the course of treatment.

Why Is Treatment Affordable in India?

• The availability of generic drugs and biosimilars significantly lowers medication costs.
• Hospital infrastructure and labor costs are lower, yet the quality of care remains comparable to international standards.
• Many hospitals in India adhere to globally accepted treatment protocols, utilizing the latest technologies, including PET-CT, FISH testing, and autologous transplant facilities.
• International patients receive comprehensive treatment packages, which include hospital stays, diagnostics, medications, and follow-up care.

Patients traveling from Africa, the Middle East, Southeast Asia, and other regions can expect world-class care at a fraction of the cost they might pay in their home country or the West. Most importantly, Indian hospitals offer personalized assistance, including medical visa support, accommodation help, and language interpretation, to ensure a smooth and comfortable journey.

What is the Prognosis of Multiple Myeloma?

The prognosis for multiple myeloma varies significantly from person to person. While multiple myeloma is generally considered a chronic and incurable disease, many patients live for years with effective treatment, and some achieve long-term remission. The outlook has improved significantly over the past two decades due to the development of immunotherapies, targeted therapies, and advancements in transplant techniques.

Factors That Influence Prognosis:

• The stage of multiple myeloma at diagnosis plays a significant role in prognosis. Patients diagnosed at stage I typically have a better outlook than those diagnosed at a more advanced stage.
• The presence of high-risk genetic abnormalities, such as del(17p), t(4;14), or t(14;16), can make the disease more aggressive and may reduce response to standard treatment.
• The patient's overall health and organ function, especially kidney and heart health, can impact how well they tolerate treatment and recover.
• The speed of response to initial therapy is also essential. Patients who achieve deep remission (characterized by very low or undetectable M-protein levels) early in treatment generally have better long-term outcomes.
• Age is a consideration, but it is not the only factor in determining eligibility. Many older adults perform well with therapies tailored to their specific needs and health status.
• Access to advanced treatment options, including CAR T-cell therapy or stem cell transplant, may improve outcomes in eligible patients.

What are the Survival Rates of Multiple Myeloma?

There has been a significant improvement in survival rates for multiple myeloma over the past two decades, primarily due to the development of advanced therapies, including proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and CAR T-cell therapy. While individual outcomes vary, many patients now live longer, healthier lives with adequate disease control.

General Survival Statistics:

• The average 5-year survival rate for multiple myeloma in the United States is approximately 58%, according to recent data from the American Cancer Society. It means that about 58 out of 100 people diagnosed with the disease are still alive five years after diagnosis.
• For patients diagnosed at an early stage, the 5-year survival rate may exceed 75%, especially in those who respond well to initial treatment and undergo a successful stem cell transplant.
• Advanced-stage multiple myeloma or high-risk cytogenetic features may lower the 5-year survival rate to around 30–40%, though outcomes continue to improve with access to newer therapies.
• Patients who receive modern treatment protocols, including maintenance therapy after transplant, can experience a median survival of 8 to 10 years, with some patients living even longer.

Why Survival Rates Vary:

• Age and overall health play a role, as older patients may have other medical conditions that impact treatment tolerance.
• The genetic features of cancer cells influence the disease's aggressiveness and its response to therapy.
• Access to comprehensive care, such as stem cell transplant and immunotherapy, significantly improves the chances of long-term remission.
• Response to initial treatment is a major predictor—patients who achieve complete or very good partial response tend to have more prolonged survival.

Recovery Timeline for Multiple Myeloma

Recovery from multiple myeloma is not a single event but an ongoing process that varies based on the type of treatment received, the patient's age and health, and the disease's behavior. While multiple myeloma is usually considered a chronic condition, many patients experience long periods of remission and return to a good quality of life with proper care and follow-up.

What to Expect During Recovery:

• Immediately after diagnosis, treatment usually begins with induction therapy (a combination of medications like chemotherapy, targeted therapy, or immunotherapy). The phase lasts for 3–6 months and reduces the number of cancer cells.
• If a stem cell transplant is planned, the next phase involves high-dose chemotherapy followed by reinfusion of stem cells. Recovery from a transplant often requires a hospital stay of 2–3 weeks, followed by 1–3 months of at-home recovery, during which patients must avoid infections and gradually regain strength.
• After the initial intensive treatment, many patients begin maintenance therapy. It is a lower-dose treatment designed to prolong remission. Maintenance can continue for several months to several years.
• Within 6–12 months of starting treatment, many patients experience a significant improvement in energy levels, appetite, and physical function. Most can resume work or normal activities during or after maintenance therapy, depending on individual progress.
• Regular follow-up appointments are crucial throughout the recovery process. These include blood tests (to check M-protein and light chains), imaging scans, and sometimes bone marrow biopsies to monitor for relapse or complications.
• Psychological and emotional recovery is equally important. Patients may need time and support to adjust to living with a chronic illness, manage fatigue, and handle the uncertainty of relapse.

Timeline Overview:

• 0–6 months: Active treatment phase with possible hospitalization (especially during transplant).
• 6–12 months: Recovery from side effects and return to partial or complete normalcy.
• 1 year and beyond: Maintenance therapy, routine follow-ups, and long-term remission management.

Every patient's journey is unique, but with today's treatment options and support services, many people living with multiple myeloma achieve stability and lead active, fulfilling lives.

Conclusion

Multiple myeloma is a complex form of blood cancer. With modern medical advances, many patients are living longer, healthier lives despite the chronic nature of the disease. Early detection, accurate staging, and a tailored treatment plan are essential for achieving the best outcomes.

Thanks to therapies such as proteasome inhibitors, immunomodulatory drugs, stem cell transplantation, and CAR-T cell therapy, the treatment landscape has undergone a significant transformation over the last two decades. Patients today have more options than ever, and many can achieve long-term remission and a good quality of life.

Though multiple myeloma remains incurable for most, it is no longer the life-limiting diagnosis it once was. With timely medical care, holistic support, and growing access to cutting-edge therapies worldwide, there is real hope for those facing this disease.