Stage 1 Multiple Myeloma Treatment Options and Side Effect Management

It's important for patients to understand their diagnosis thoroughly to work with their oncology team. Here is an overview of stage 1 multiple myeloma to help guide a conversation with a specialist.

Understanding R-ISS Staging: What Defines Stage 1 Multiple Myeloma?

Multiple myeloma is a cancer of plasma cells, a type of white blood cell found in the bone marrow. Healthy plasma cells produce antibodies to fight infection. In multiple myeloma, cancerous plasma cells multiply uncontrollably, crowding out healthy blood cells and producing abnormal proteins, called M-proteins, that can cause organ damage.

The staging of multiple myeloma, often done using the Revised International Staging System (R-ISS), helps doctors predict the course of the disease and plan treatment.¹ The stages range from 1 to 3.

Stage 1 multiple myeloma is considered the slowest growing or least aggressive form. It is characterized by:

• Low levels of a protein called beta-2 microglobulin (M).
• High levels of albumin.
• The absence of myeloma-related organ damage (often summarized by the acronym CRAB: high Calcium, Renal failure, Anemia, and Bone lesions).
• Favorable or low-risk cytogenetics (gene changes).

Because stage 1 multiple myeloma is often discovered incidentally through routine blood tests and has not yet caused organ damage, it may be managed differently than higher stages.

Blood Tests and Biopsy: Detecting Myeloma Defining Events

The process of confirming a multiple myeloma diagnosis involves a series of blood, urine, and imaging tests. Key tests used for both diagnosis and staging include:

• Blood and urine tests: These look for M-proteins and can measure the level of light chains (Bence-Jones protein) produced by the myeloma cells. Blood tests also check for anemia and monitor kidney function (creatinine) and calcium levels. These results are key to determining if any CRAB features are present.
• Bone marrow biopsy and aspiration: A small sample of bone marrow (the soft tissue inside your bones) is removed to determine the percentage of abnormal plasma cells. A diagnosis of active multiple myeloma generally requires at least 10% clonal plasma cells. The sample also undergoes cytogenetic testing to check for specific gene changes.
• Imaging tests (Skeletal Survey, CT, MRI, PET): These scans are critical to check for bone lesions, which are "punched out" areas of bone damage caused by the myeloma cells. The absence of one or more of these lytic lesions or a single plasmacytoma is a feature of stage 1 disease.

Induction Therapy for Myeloma: First-Line Drug Combinations

A unique aspect of stage 1 multiple myeloma is that immediate treatment may not be required. If you have asymptomatic (no CRAB features) stage 1 disease, your doctor may recommend an approach called active surveillance or "watch-and-wait."

The goal of this process, called active surveillance, is to closely monitor the disease with regular blood and urine tests and periodic imaging to ensure it does not progress to a more symptomatic stage that requires treatment. You will have regular checkups with your oncologist, potentially every few months, but you will not be taking cancer-fighting drugs.

If your myeloma progresses or if the initial workup indicated active, symptomatic disease (even if staged as R-ISS I), treatment typically begins with a combination of drugs called induction therapy. This usually involves a triplet or even quadruplet regimen (three or four different classes of drugs) to achieve a deep and durable response.

Common drug classes include:

• Proteasome inhibitors (e.g., Velcade [bortezomib], Kyprolis [carfilzomib]): These block a cellular complex (the proteasome) that cancer cells need to function and survive.
• Immunomodulatory drugs (IMiDs) (e.g., Revlimid [lenalidomide]): These drugs alter the immune system to help it fight the cancer and also directly kill myeloma cells.
• Steroids (e.g., dexamethasone): These are effective anti-myeloma agents that also help manage treatment-related side effects.
• Monoclonal antibodies (e.g., Darzalex [daratumumab]): These targeted drugs bind to a specific protein on the surface of myeloma cells, marking them for destruction by the immune system.

For eligible patients, a high-dose chemotherapy with autologous stem cell transplant (ASCT) may be considered after induction therapy to further reduce the number of cancer cells and deepen the response. Following this, maintenance therapy (often with a single agent like Revlimid) is typically used long-term to keep the myeloma in remission.

Common Drug-Specific Side Effects: Lenalidomide, Bortezomib and Dexamethasone

It is important to discuss potential side effects with your oncologist. Managing these is a critical part of maintaining your quality of life.

Your care team will monitor you closely for these effects and can often adjust doses or provide supportive medications to help manage them.

Quality of Life with Multiple Myeloma: Tips for Patients and Caregivers

A multiple myeloma diagnosis is life-changing, but with modern treatments, many patients live fulfilling lives for years.

• Emotional support: It's normal to feel anxiety or sadness. Seek out support from family, friends, counselors, or myeloma-specific support groups. This is a journey you don't have to navigate alone.
• Infection prevention: Multiple myeloma and its treatments can weaken your immune system. Practice good hygiene, avoid sick contacts, and ensure you receive recommended vaccinations — like flu and pneumonia vaccines — as advised by your doctor.
• Bone health: Even in stage 1, plasma cells can affect bone health. Bone-strengthening medications (bisphosphonates like zoledronic acid) are often prescribed to reduce the risk of future fractures. Discuss safe exercise and activity with your doctor.
• Lifestyle: Maintaining a healthy lifestyle with a balanced diet and regular, moderate exercise — if cleared by your doctor — can help manage fatigue and improve overall well-being.

Next Steps: Empowering Your Conversation with Your Oncologist

A stage 1 multiple myeloma diagnosis indicates an early-stage, slowly progressive form of the disease. The standard of care often begins with active surveillance, allowing you to maintain your quality of life while closely monitoring the cancer. If treatment becomes necessary, there are highly effective combination therapies available.

Treatment for multiple myeloma is highly individualized. Use this information to ask your oncologist targeted questions about your specific staging results, the rationale for "watch-and-wait" versus immediate therapy, and a detailed plan for managing potential side effects.

Tamara Mobley, who was diagnosed with multiple myeloma at the age of 33, said in an interview with CUREthat she has learned a lot along the way about her cancer.²

“Before this diagnosis, I had never heard of multiple myeloma. Nobody around me had ever heard of multiple myeloma, and that's why I think it's super important that we have organizations and initiatives to bring forth information about myeloma and to bring awareness to it.”

Editor's note: Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

This article is for informational purposes only and is not a substitute for professional medical advice. Please contact your healthcare team with any questions or concerns.

References

1. “Beyond the Diagnosis: A Stage-by-Stage Guide to Multiple Myeloma Treatment.” CURE, September 18, 2025. https://www.curetoday.com/view/beyond-the-diagnosis-a-stage-by-stage-guide-to-multiple-myeloma-treatment
2. “The Importance of Awareness and Self-Advocacy in Multiple Myeloma.” CURE, September 29, 2025. https://www.google.com/search?client=safari&rls=en&q=The+Importance+of+Awareness+and+Self-Advocacy+in+Multiple+Myeloma.”+CURE&ie=UTF-8&oe=UTF-8

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