Watchful waiting for multiple myeloma

If you have multiple myeloma but don’t have any symptoms, you may be offered watchful waiting. Multiple myeloma that doesn’t have any symptoms is also called smouldering or indolent or asymptomatic multiple myeloma. If you have this type of multiple myeloma, your healthcare team watches your cancer closely rather than giving treatment right away. They will use tests and exams every 3–6 months to check if the myeloma is progressing or your condition is getting worse. Treatment is given when you develop symptoms or the cancer changes.

This approach helps avoid problems or side effects that can happen with treatments such as surgery or radiation therapy. There isn’t any evidence so far that watchful waiting lessens long-term survival or has other negative effects.

You will have watchful waiting if you have smouldering multiple myeloma that does not have a high risk of progressing to active multiple myeloma within 2 years of your diagnosis.

But if you have a very high risk of smouldering multiple myeloma developing into active multiple myeloma within 2 years of your diagnosis, you may have treatment. People with smouldering multiple myeloma may begin treatment if:

  • Plasma cells make up 60% or more of the blood cells in the bone marrow.
  • The serum free light chain ratio is 100 or greater.
  • An MRI shows more than one area of bone or bone marrow destruction (breakdown).

Tests and exams to check for the smouldering multiple myeloma progressing to active multiple myeloma include:

  • complete blood count (CBC)
  • blood chemistry tests
  • quantitative immunoglobulin (Ig) test
  • protein electrophoresis
  • serum free light chain test
  • urinalysis
  • x-rays (once per year)

Learn more about smouldering multiple myeloma, active multiple myeloma and the tests and exams used to diagnose multiple myeloma.

Expert review and references