Multiple Myeloma: Causes, Symptoms, Stages, Treatment and Cost in India

Multiple myeloma is a blood cancer that develops from plasma cells, the white blood cells in the bone marrow that make antibodies to fight infection. It mainly affects people over 60, but in India, Africa and the Middle East it is often seen in people in their 40s and 50s. Because its early symptoms, such as back pain, tiredness and repeated infections, are so common, myeloma is frequently diagnosed late, sometimes only after a fracture or kidney failure. Fortunately, treatment has transformed over the last two decades. New drugs, immunotherapy and stem cell transplantation mean that many patients now live for many years with a good quality of life, and myeloma is increasingly managed like a long-term chronic condition.

What is Multiple Myeloma?

In multiple myeloma, abnormal plasma cells (myeloma cells) multiply in the bone marrow. They crowd out normal blood cells and produce large amounts of a single abnormal antibody called M-protein (paraprotein) or its fragments (light chains). The disease is called multiple because it usually affects several areas of bone at once.

Related Conditions

• MGUS (monoclonal gammopathy of undetermined significance): a small amount of M-protein without symptoms. It needs monitoring only, as only a small proportion progress to myeloma each year.
• Smouldering myeloma: more abnormal plasma cells but no organ damage; high-risk cases may be treated early.
• Active (symptomatic) myeloma: causes organ damage and needs treatment.
• Solitary plasmacytoma: a single tumour of plasma cells, often treated with radiotherapy.
• AL amyloidosis: a related condition where light chains deposit in the heart, kidneys and other organs.

Stages of Multiple Myeloma

Doctors use the Revised International Staging System (R-ISS), based on beta-2 microglobulin, albumin, LDH and high-risk chromosome changes:

• Stage I: lower disease burden and standard-risk genetics
• Stage II: neither stage I nor III
• Stage III: high beta-2 microglobulin with high LDH or high-risk genetics

Causes and Risk Factors

The exact cause is unknown. Factors linked to a higher risk include:

• Age: risk rises after 50 to 60
• Gender: slightly more common in men
• Ethnicity: myeloma and MGUS are about twice as common in people of African descent, which is relevant for patients from Africa
• MGUS: almost all myeloma is preceded by MGUS
• Family history of myeloma or MGUS
• Obesity and exposure to radiation or certain pesticides and chemicals

Symptoms of Multiple Myeloma

Doctors remember the main problems with the word CRAB:

• C - Calcium raised: thirst, frequent urination, constipation, nausea and confusion
• R - Renal (kidney) damage: swelling, reduced urine, foamy urine and fatigue
• A - Anaemia: tiredness, weakness and breathlessness
• B - Bone disease: persistent back, rib or hip pain, fractures after minor injury and loss of height

Other symptoms include repeated chest and urinary infections, weight loss, numbness in the hands and feet, and in rare cases blurred vision, headaches or bleeding from very thick blood (hyperviscosity).

Warning Signs That Need Urgent Care

• Sudden severe back pain with weakness or numbness in the legs, or loss of bladder or bowel control, which may mean spinal cord compression and needs treatment within hours
• Confusion, extreme thirst and drowsiness from very high calcium
• Sharp drop in urine output
• High fever, especially during treatment

How is Multiple Myeloma Diagnosed?

• Blood tests: CBC, calcium, creatinine, albumin, beta-2 microglobulin and LDH
• Serum protein electrophoresis (SPEP) and immunofixation: detect and identify M-protein
• Serum free light chain assay
• 24-hour urine protein electrophoresis
• Bone marrow aspiration and biopsy with flow cytometry
• FISH/cytogenetics for high-risk chromosome changes such as del(17p), t(4;14) and t(14;16)
• Imaging: whole-body low-dose CT, PET-CT or whole-body MRI, which are more sensitive than plain X-rays for bone lesions

Treatment Options for Multiple Myeloma

Treatment is started when myeloma causes symptoms or organ damage, or when high-risk markers are present. Supportive care to protect bones and kidneys begins at the same time.

Induction Drug Therapy

Modern treatment uses combinations of drugs from different classes:

• Proteasome inhibitors: bortezomib, carfilzomib
• Immunomodulatory drugs: lenalidomide, pomalidomide, thalidomide
• Anti-CD38 monoclonal antibodies: daratumumab, isatuximab
• Steroids: dexamethasone

Common regimens include VRd (bortezomib, lenalidomide and dexamethasone) and quadruplet regimens adding daratumumab. Indian generic versions of bortezomib, lenalidomide and pomalidomide make long-term treatment far more affordable.

Autologous Stem Cell Transplant

For fit patients, usually up to around 70 years, high-dose melphalan chemotherapy followed by an autologous stem cell transplant (using the patient's own stem cells collected earlier) deepens the response and prolongs remission. Indian centres perform these transplants routinely with good outcomes and a hospital stay of about 3 weeks.

Myeloma with Kidney Failure or Older Age

Patients who arrive with kidney failure can still be treated effectively. Bortezomib and daratumumab do not need major dose changes for kidney function, and dialysis can be provided while the myeloma is brought under control. Older or frail patients receive gentler, well-tolerated combinations such as daratumumab with lenalidomide and dexamethasone, adjusted carefully by the haemato-oncologist to balance benefit and side effects.

Maintenance Therapy

After induction or transplant, low-dose lenalidomide (with or without other drugs) is usually continued to keep myeloma in remission for as long as possible.

Treatment of Relapsed Myeloma

Myeloma tends to return, but there are many effective options, including different drug combinations, bispecific antibodies such as teclistamab, and CAR-T cell therapy targeting BCMA, which is becoming available in India.

Supportive Care

• Bone-strengthening drugs (zoledronic acid or denosumab) to reduce fractures
• Radiotherapy for painful bone lesions or plasmacytomas
• Kyphoplasty/vertebroplasty for spinal fractures, and orthopaedic surgery for fractures
• Dialysis if kidney failure is severe; early myeloma treatment can help kidneys recover
• Vaccinations, antiviral and antibiotic prophylaxis to reduce infections

Cost of Multiple Myeloma Treatment in India

Indicative starting prices at JCI/NABH-accredited hospitals in Delhi/NCR are:

The final cost depends on the stage, the drug combination, kidney or bone complications, the need for transplant and the length of hospital stay. Contact Satyug Healthcare at +91-8860606766 / +91-9910655125 (WhatsApp) for a free medical opinion and cost estimate.

Living with Multiple Myeloma

International patients usually stay in India for 4 to 6 weeks to complete diagnosis and start induction therapy, after which many continue oral and injectable medicines at home. Those having a transplant return after about 4 to 6 cycles of induction and stay for about 6 to 8 weeks.

• Drink plenty of fluids (unless told otherwise) to protect the kidneys, and avoid painkillers such as ibuprofen and diclofenac.
• Stay active with gentle walking and physiotherapy, while avoiding heavy lifting.
• Dental check-up before bone-strengthening drugs to reduce the risk of jaw problems.
• Blood clot prevention: aspirin or blood thinners are given with lenalidomide or thalidomide.
• Regular monitoring of M-protein, light chains, kidney function and blood counts.

There is no known way to prevent myeloma, but people found to have MGUS should have regular check-ups so that any change is detected early.

Why Choose India for Multiple Myeloma Treatment?

• Experienced haemato-oncologists and high-volume autologous transplant programmes
• Affordable Indian generics of bortezomib, lenalidomide and pomalidomide, reducing long-term costs substantially
• Access to daratumumab, bispecific antibodies and CAR-T therapy
• Integrated care with nephrology, dialysis, spine surgery and radiation oncology under one roof
• Costs a fraction of those in the USA, Europe or the Gulf

Step-by-Step Process to Travel to India for Treatment

1. Share your reports - send your latest reports, scans/CD, angiography or echo films and passport copy to Satyug Healthcare on WhatsApp (+91-8860606766 / +91-9910655125) or email.
2. Free medical opinion & cost estimate - within 24-72 hours we share opinions and written cost estimates from 2-3 JCI/NABH-accredited hospitals and specialists.
3. Choose hospital & doctor - compare doctor experience, hospital, room category and total cost; we help you decide with no extra charge.
4. Visa Invitation Letter (VIL) - the hospital issues a VIL for the patient and up to two attendants; we arrange it within 24-48 hours.
5. Apply for Indian e-Medical Visa - apply online for the e-Medical Visa (patient) and e-Medical Attendant Visa (family) using the VIL; most approvals come in 3-5 working days.
6. Book flights & accommodation - we suggest flights and arrange a guest house, service apartment or hotel near the hospital to suit your budget.
7. Free airport pickup - our representative receives you at the airport and takes you to your hotel or directly to the hospital.
8. Hospital admission & treatment - a dedicated coordinator and language interpreter stay with you for registration, tests, doctor consultations, the procedure and billing.
9. Discharge & follow-up - you receive the discharge summary, prescriptions and fitness-to-fly certificate; follow-up checks are done before you fly.
10. Return home & tele-follow-up - we arrange airport drop and stay connected for online follow-up consultations with your doctor in India.

Frequently Asked Questions

Is multiple myeloma curable?

Myeloma is generally not considered curable, but it is highly treatable. With modern drugs and transplant, many patients live for many years with good quality of life, and some achieve long-lasting deep remissions.

Is a bone marrow transplant necessary for myeloma?

It is recommended for eligible fit patients because it prolongs remission. Patients who are older or unfit can still do very well with drug therapy alone.

Who is the donor in a myeloma transplant?

The patient is their own donor. Stem cells are collected from the patient's blood after induction therapy, frozen and given back after high-dose chemotherapy.

Can kidney damage from myeloma recover?

Yes, in many patients kidney function improves when myeloma is treated promptly with bortezomib-based therapy, good hydration and correction of calcium. Some patients need temporary dialysis.

Why do I have back pain with myeloma?

Myeloma cells weaken bones and can cause small fractures in the spine. Bone-strengthening drugs, radiotherapy, kyphoplasty and pain management can provide significant relief.

Can I take myeloma medicines in my home country?

Yes. After treatment starts in India, many oral drugs and injections can be continued locally, with blood tests sent to your Indian doctor and follow-up via video consultation.

Is MGUS dangerous?

MGUS itself causes no symptoms and most people with it never develop myeloma. Regular blood tests are advised to detect any progression early.

What reports should I send for an opinion?

Please send your blood tests (CBC, calcium, creatinine), SPEP, immunofixation, free light chain results, bone marrow report and any X-rays, MRI or PET-CT scans. Our team will arrange expert opinions within 48 hours.

Disclaimer: This article is for general information only and is not a substitute for a consultation with a qualified doctor.