Watchful Waiting for Multiple Myeloma

Medically Reviewed by Melinda Ratini, MS, DO on May 27, 2023
2 min read

Many types of cancer grow so slowly that doctors recommend not treating them until they start to cause problems. This approach is called watchful waiting. It’s what doctors usually suggest for people with multiple myeloma in its earliest phase, known as asymptomatic or smoldering multiple myeloma. In this stage, the cancer is there, but you aren’t having any symptoms.

It may be hard to know that you’re sick and do nothing about it. But for most people, treatment doesn’t seem to help when multiple myeloma has no symptoms. And it opens you up to the risks and side effects that go along with cancer treatments.

If your doctor recommends this approach, you’ll have regular checkups -- likely every 3 to 6 months. Your doctor will be looking for signs your cancer is getting worse.

You’ll have some of the same tests that you got to diagnose multiple myeloma in the first place, like blood and urine tests. You may also need more imaging tests or another bone marrow biopsy.

Tests you might get 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)

It’s important to keep track of how you’re feeling and let your doctor know if you’re having symptoms like fatigue or bone pain. You may get treatment to strengthen your bones if your doctor sees signs they’re becoming thin.

If you’re diagnosed with multiple myeloma in an active stage, you’ll start treatment right away.

Most people with smoldering multiple myeloma start treatment only when their condition becomes active. You and your doctor will know you’ve reached that point when test results show at least one other symptom, such as:

  • Your bone marrow is 60% or more cancer cells.
  • A major imbalance of certain proteins in your blood
  • High level of calcium in your blood
  • Signs your kidneys aren’t working well
  • A low number of red blood cells, called anemia
  • Damage to your bones

Some people live with multiple myeloma for many years without any symptoms. But for other people, the disease gets worse quickly. Scientists are trying to figure out how to tell whose cancer will get worse faster and whether early treatment can slow it down.

They’ve already found some things that make you more likely to get sick sooner, including:

  • Anemia that’s getting worse
  • Certain genetic changes in the cancer cells
  • Specific defective antibodies
  • High levels of defective antibodies and low levels of healthy ones

If your doctor thinks it seems likely you’ll start having symptoms within 2 years, you might want to think about starting treatment. Researchers are testing drugs that slow the growth of tumors and others that fight inflammation to see whether they can keep you healthy longer.