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
- x-rays (once per year)
Alberta Health Services. Multiple Myeloma Clinical Practice Guideline LYHE-003. Alberta Health Services; 2015: http://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-lyhe003-multi-myeloma.pdf.
American Society of Clinical Oncology. Multiple Myeloma. 2014: http://www.cancer.net/cancer-types/multiple-myeloma/view-all.
Myeloma Canada. Multiple Myeloma Patient Handbook. Third ed. Kirkland, QC: Myeloma Canada; 2014.
National Comprehensive Cancer Network. Multiple Myeloma (Version 4.2015). National Comprehensive Cancer Network; http://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf.
Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al . International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncology.
The Leukemia & Lymphoma Society. Myeloma. Revised ed. White Plains, NY: The Leukemia & Lymphoma Society; 2013: http://www.llscanada.org/content/nationalcontent/resourcecenter/freeeducationmaterials/myeloma/pdf/myeloma.pdf.