Watchful Waiting for Multiple Myeloma

Watchful waiting is the process of monitoring a condition but not treating it because it is not causing any symptoms.

Often, multiple myeloma does not cause any symptoms. However, doctors may detect the condition during routine blood tests when they find an abnormal amount of one type of immune protein, or antibody, in the blood.

In healthy people, plasma cells—a type of white blood cell—produce antibodies, also called immunoglobulins, which help fight infection in the body. With multiple myeloma, a plasma cell becomes malignant, multiplies uncontrollably, and produces a large amount of a single type of abnormal antibody, a condition called monoclonal gammopathy.

Most of the time, multiple myeloma starts as a noncancerous condition called monoclonal gammopathy of undetermined significance (MGUS), which means the blood contains increased levels of proteins called immunoglobulin G, A, or M, but the number of plasma cells is only increased slightly and usually does not cause symptoms.

If doctors detect monoclonal gammopathy with a blood test, they may suspect that your body is producing a high number of malignant plasma cells. A diagnosis of multiple myeloma can be confirmed by the results of a series of sophisticated imaging and tissue tests. If multiple myeloma is diagnosed, but is not causing any symptoms, it is called smoldering multiple myeloma.

The risk of developing multiple myeloma that causes symptoms is higher for people with smoldering multiple myeloma than it is for those with monoclonal gammopathy of undetermined significance. However, people with either one of these conditions need to be closely monitored by their doctors for signs that their disease has progressed—a process called watchful waiting.

NYU Langone doctors may recommend watchful waiting for many people without symptoms. Some people are not comfortable with watchful waiting, however, and choose instead to start managing the cancer with medical therapy.

Doctors usually decide to start treatment when people with early multiple myeloma begin experiencing symptoms. Symptoms can be caused by high levels of calcium in the blood, which can lead to bone loss or pain; low levels of red blood cells, which can cause fatigue and anemia; or low levels of healthy white blood cells, which can lead to fevers, recurrent infections, and kidney damage.

Months or years may pass before multiple myeloma becomes more active. Usually, blood and imaging tests are performed to confirm that multiple myeloma has progressed. Doctors may occasionally perform a bone marrow aspiration with biopsy for this purpose.  

During watchful waiting, NYU Langone doctors strongly encourage you to contact them if you notice symptoms of multiple myeloma or have any concerns.

While watchful waiting is an option for people with early myeloma or monoclonal gammopathy of undetermined significance, NYU Langone also offers clinical trials of newer therapies, including herbal therapies, that may help to prevent these conditions from progressing to more serious disease.

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