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Health condition · Clinically reviewed

Multiple myeloma, plasma cell cancer — modern immunotherapy and CAR-T.

A plasma cell cancer producing monoclonal protein and end-organ damage. Modern quadruplet induction, autologous stem cell transplant and CAR-T therapy have transformed outcomes.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced, not summarised

    Every claim is checked against NICE, BSH or a peer-reviewed source you can see at the end.

  • 03

    Updated for 2026

    Reflects current UK haemato-oncology practice — quadruplet induction, autologous SCT, bispecifics and CAR-T.

Key facts

Multiple myeloma at a glance.

The essentials, in plain English — what it is, how common it is, how it’s diagnosed in the UK today, and how treatment has changed.

  • What it is

    A plasma cell cancer that produces monoclonal protein and causes end-organ damage.

  • How common

    Around 6,000 new cases each year in the UK.

  • CRAB features

    hyperCalcaemia, Renal failure, Anaemia and Bone lesions define active myeloma.

  • Smouldering myeloma

    An asymptomatic precursor that can transition to active myeloma — monitored, not treated.

  • Autologous SCT

    Autologous stem cell transplant remains important in fit, eligible patients after induction.

  • Modern immunotherapy

    Bispecifics (teclistamab, talquetamab) and CAR-T (ide-cel, cilta-cel) have transformed outcomes.

Why this guide matters

Myeloma outcomes have transformed.

The pathway has changed. Quadruplet induction, autologous transplant, bispecifics and CAR-T have turned myeloma into a long-term, treatable disease for many.

  • Diagnosis is often incidental

    Many cases are picked up when routine bloods show anaemia, raised calcium or a paraprotein — with no dramatic symptoms.

  • CRAB features define active disease

    HyperCalcaemia, Renal failure, Anaemia and Bone lesions separate smouldering from active myeloma that needs treatment.

  • Modern immunotherapy is transformative

    Anti-CD38 antibodies, bispecifics and CAR-T have changed the outlook, particularly in relapsed and refractory disease.

How the diagnosis is made

From first bloods to a clear plan.

The stepwise pathway UK haemato-oncology teams follow — so you know what to expect and why each test matters.

  1. 01

    Screening

    FBC, U&E, calcium, LDH

    Baseline bloods pick up anaemia, renal impairment, hypercalcaemia and tumour bulk markers.

  2. 02

    Screening

    Serum + urine electrophoresis

    Electrophoresis with immunofixation identifies and types the monoclonal (paraprotein) band.

  3. 03

    Screening

    Serum free light chains

    Kappa and lambda free light chain assay is essential — especially in light-chain-only disease.

  4. 04

    Confirming

    Bone marrow biopsy

    A trephine and aspirate confirms the diagnosis when clonal plasma cells are 10% or more.

  5. 05

    Confirming

    Whole-body low-dose CT or MRI

    Modern imaging replaces the old skeletal survey — sensitive for lytic lesions and marrow disease.

  6. 06

    Planning

    Cytogenetics (FISH)

    FISH looks for high-risk changes — gain 1q, del 17p, t(4;14) — which shape treatment intensity.

  7. 07

    Planning

    Haemato-oncology MDT

    A specialist team combines all results into a personalised induction and transplant plan.

Typical timeline: 3–6 weeks from suspicious bloods to a treatment plan.

Symptoms

What multiple myeloma actually shows up as.

Symptoms are often non-specific — bone pain, anaemia, infections and kidney trouble. Here is what to watch for and when to act quickly.

  • Bone pain

    Persistent back, rib or pelvic pain — often the first sign, from lytic lesions in the skeleton.

  • Renal impairment

    Light chains can damage the kidneys — a rising creatinine may be the presenting feature.

  • Anaemia

    Marrow infiltration crowds out normal blood cells — tiredness and pallor are common.

  • Recurrent infections

    Suppressed normal immunoglobulin production leaves patients prone to bacterial and viral infections.

  • Hypercalcaemia

    Bone breakdown releases calcium — causing thirst, confusion, constipation and nausea.

  • Fatigue

    Anaemia, renal impairment and disease burden combine into profound, persistent tiredness.

  • Peripheral neuropathy

    Numbness or tingling in hands and feet — from the disease itself or from treatment.

  • Red flag

    Cord compression, hypercalcaemic crisis or hyperviscosity — call 999.

Treatment

How multiple myeloma is treated in the UK.

Treatment starts with quadruplet induction and, in eligible patients, autologous stem cell transplant — followed by maintenance and modern immunotherapy at relapse.

  • Quadruplet induction (Dara-VRD, Isa-VRD)

    Four-drug regimens combining an anti-CD38 antibody with bortezomib, lenalidomide and dexamethasone give the deepest first responses.

  • Autologous stem cell transplant

    High-dose melphalan with autologous stem cell rescue — still standard for eligible patients after induction.

  • Maintenance lenalidomide

    Ongoing lenalidomide after transplant prolongs remission and improves overall survival.

  • Second-line CD38 combinations

    Daratumumab- or isatuximab-based combinations at relapse — often paired with pomalidomide or carfilzomib.

  • Bispecific antibodies

    Teclistamab (BCMA) and talquetamab (GPRC5D) engage T-cells against myeloma in heavily pre-treated disease.

  • CAR-T (ide-cel, cilta-cel)

    BCMA-directed CAR-T cell therapies produce deep, durable responses in relapsed / refractory myeloma.

  • Bisphosphonate / denosumab

    Bone-modifying agents reduce fracture risk, bone pain and skeletal complications.

  • Radiotherapy for lytic lesions

    Short-course radiotherapy gives rapid pain relief for painful bone lesions and treats cord compression.

What this guide is based on

The sources behind every number on this page.

UK guidance, specialist society standards and patient-organisation resources, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or haemato-oncology team knows your history and can tell you which parts apply to you.

  • National Institute for Health and Care Excellence (NICE). Myeloma: diagnosis and management (NG35).

  • British Society for Haematology. Guidelines on the diagnosis and management of multiple myeloma.

  • Myeloma UK. Patient information and treatment guides.

  • International Myeloma Working Group (IMWG). Consensus criteria and response definitions.

Red flags

When multiple myeloma becomes an emergency.

Myeloma is usually managed as a chronic condition — but these situations need same-day or 999 action.

  • Spinal cord compression

    New back pain with leg weakness, numbness or bladder/bowel change — call 999 or attend A&E immediately.

  • Hypercalcaemic crisis

    Severe thirst, confusion, vomiting and dehydration — needs urgent bloods and IV fluids.

  • Hyperviscosity syndrome

    Headache, visual disturbance, mucosal bleeding and confusion from very high paraprotein — an emergency.

  • Renal failure

    Rapidly rising creatinine or oliguria — needs same-day haematology review and often plasma exchange.

  • Neutropenic sepsis

    Fever after chemotherapy in a myeloma patient — attend A&E within one hour for IV antibiotics.

  • CAR-T cytokine release syndrome

    Fever, hypotension and hypoxia in the days after CAR-T infusion — a recognised complication needing hospital care.

  • Osteonecrosis of the jaw

    Exposed bone, pain or non-healing sockets on bisphosphonates or denosumab — refer to oral surgery.

  • VTE on IMiDs

    Lenalidomide, thalidomide and pomalidomide raise clot risk — new leg swelling or breathlessness needs urgent review.

  • Palliative-stage crisis

    Uncontrolled pain, breathlessness or terminal bleeding — contact the specialist palliative care team urgently.

Living with it

A long-term journey, with structured support.

Four things that make the biggest difference day to day — monitoring, side effects, bone health and specialist follow-up.

A quiet reminder

Flag side effects early.

Neuropathy, infections and clots on IMiDs are all manageable when they’re picked up early — tell your team as soon as something changes.

  1. 01 Monitoring

    Paraprotein is a trend

    Your paraprotein and free light chain trend over months matters more than any single reading.

  2. 02 Side effects

    Neuropathy and infections

    Numbness, tingling and infection risk are common on treatment — flag them early so doses can be adjusted.

  3. 03 Bone health

    Bones on bisphosphonates

    Long-term bone-modifying agents protect the skeleton — dental review before starting reduces jaw complications.

  4. 04 Reviews

    Structured haematology follow-up

    Regular haemato-oncology review with bloods, and imaging when needed, keeps relapse detection on track.

Frequently asked

Everything we get asked about multiple myeloma.

Quick answers on CRAB features, smouldering myeloma, transplant, bispecifics and CAR-T.

  • What is multiple myeloma?

    A cancer of plasma cells in the bone marrow that produces a monoclonal protein (paraprotein) and causes end-organ damage — the CRAB features of hypercalcaemia, renal failure, anaemia and bone lesions. Around 6,000 new cases are diagnosed each year in the UK.

  • What are the CRAB features?

    CRAB stands for hyperCalcaemia, Renal failure, Anaemia and Bone lesions. Together with a clonal plasma cell population of 10% or more, they define active multiple myeloma that needs treatment.

  • What is smouldering myeloma?

    Smouldering myeloma is an asymptomatic precursor — plasma cells and paraprotein are raised, but there is no organ damage. It is monitored rather than treated, because not everyone progresses to active myeloma.

  • Is autologous stem cell transplant still used?

    Yes. In fit, eligible patients, high-dose melphalan followed by autologous stem cell transplant remains part of first-line treatment after quadruplet induction, and improves depth and duration of remission.

  • What are bispecifics and CAR-T?

    Bispecific antibodies (teclistamab, talquetamab) engage T-cells against myeloma. CAR-T therapies (ide-cel, cilta-cel) re-engineer a patient’s own T-cells to attack BCMA on myeloma cells. Both produce deep responses in relapsed and refractory disease.

  • When should I worry about symptoms?

    New back pain with leg weakness, numbness or bladder change needs 999 assessment to exclude cord compression. Severe thirst, confusion or vomiting can be hypercalcaemic crisis. Fever after chemotherapy is neutropenic sepsis until proven otherwise.

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