Follow-up after treatment for multiple myeloma

Last medical review: July 2024

Follow-up care lets your healthcare team keep track of your health for a period of time after treatment ends or while you are on maintenance therapy. This important part of cancer care is often shared among the cancer specialists and your family doctor. They will help you recover from treatment side effects and monitor you for any signs that the cancer has come back (relapsed).

Follow-up care may not seem that important to you, especially if your treatment was long or very hard. You may find the idea of follow-up care stressful because it reminds you of your cancer experience or because you are worried about what a test might reveal. Talk to your healthcare team about how you feel and about why follow-up matters. Your healthcare team is there to help.

Schedule for follow-up visits

Don't wait until your next scheduled appointment to report any new symptoms and symptoms that don't go away. Tell your healthcare team if you have:

bone pain
signs of an infection, such as redness
bleeding
dizziness
leg swelling
numbness, tingling or weakness in the feet or legs

Multiple myeloma often relapses, so you may have treatment again after treatment has stopped for a while. Follow-up visits for multiple myeloma are usually scheduled every 1 to 4 months.

During follow-up visits

Follow-up visits may be different if you were able to have a stem cell transplant (called transplant eligible multiple myeloma) or if you were unable to have a stem cell transplant (called transplant ineligible multiple myeloma).

If multiple myeloma relapses, your healthcare team will assess you to determine the best treatment options.

Transplant eliglible multiple myeloma

Your healthcare team will usually ask questions about the side effects of treatment and how you're coping during a follow-up visit.

Your doctor may do a physical exam to check for lumps or tenderness of the bones.

Tests are often part of follow-up care. They help your doctor to find out how well your treatment is working or if the cancer looks like it may be coming back. Not all follow-up tests will be done each time you have a follow-up visit. You may have:

blood tests to check blood cell counts, M-protein levels (the abnormal type of immunoglobulin) , free light chains and other chemicals in the blood
urine tests to check M-protein levels in the urine
a bone marrow biopsy to check the number of myeloma cells in the bone marrow
CT scans, PET-CT scans, MRIs or x-rays to check the bones for breaks, areas of weakness or signs of a tumour

Transplant ineligible multiple myeloma

During your follow-up visit, your healthcare team will ask questions to assess your quality of life, including how you are managing the side effects of treatment and how you are coping. This will determine if the goals of treatment that you and your doctor set are being met or if adjustments need to be made to the maintenance therapy.

Maintenance therapy may need to be adjusted if:

you are experiencing many side effects
you have low white blood cell counts (called neutropenia)
you have a fever or infection
you are unable to manage or cope with side effects
your performance status has lowered
your kidneys and liver are not working well

You may also have these tests as part of your follow-up:

blood tests to check blood cell counts, M-protein levels (the abnormal type of immunoglobulin) , free light chains and other chemicals in the blood
urine tests to check M-protein levels in the urine
a bone marrow biopsy to check the number of myeloma cells in the bone marrow
CT scans, PET-CT scans, MRIs or x-rays to check the bones for breaks, areas of weakness or signs of a tumour

Find out more about follow-up

The following are questions that you can ask the healthcare team about follow-up after treatment for cancer. Choose the questions that fit your situation and add questions of your own. You may find it helpful to take the list to the next appointment and to write down the answers.

What is the schedule for follow-up visits?
How often is follow-up scheduled with the cancer specialist?
Who is responsible for follow-up visits?
What will happen at a follow-up visit?
What tests are done on a regular basis? How often are they done?
Are there any symptoms that should be reported right away? Who do I call?
Who can help me cope with long-term side effects of treatment?

Guido Lancman, MD, MSc

Côté J, Kotb R, Bergstrom DJ, et al. First line treatment of newly diagnosed transplant ineligible multiple myeloma: recommendations from the Canadian Myeloma Research Group Consensus Guideline Consortium. Clinical Lymphoma, Myeloma and Leukemia. 2023: 23(5):340–354.
Dimopoulos MA, Moreau P, Terpos E, et al. Multiple myeloma: EHA-ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2021: 32(3):309–322.
Mikhael J, Ismaila N, Cheung MC, et al. Treatment of multiple myeloma: ASCO and CCO joint clinical practice guideline. Journal of Clinical Oncology. 2019: 37(14):1228–1263.
Rajkumar V, Kumar S. Plasma Cell Neoplasms. DeVita VT Jr, Lawrence TS, Rosenberg S. eds. DeVita Hellman and Rosenberg's Cancer: Principles and Practice of Oncology. 12th ed. Philadelphia, PA: Wolters Kluwer; 2023: Kindle version, [chapter 74], https://read.amazon.ca/?asin=B0BG3DPT4Q&language=en-CA.

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