Care pathway for myeloma

Myeloma is a cancer associated with bone marrow and blood plasma cells. Typically, suspicion of myeloma arises when an abnormal antibody or a part of it, called the M component, is detected in the blood. Symptoms caused by myeloma may include fatigue, bone pain, or bone fractures. In addition to the M component, blood tests may reveal anemia, i.e. low hemoglobin value in the blood, other abnormal findings in blood tests, or renal failure.   

Sometimes an abnormal antibody (M component) is found by chance in a completely asymptomatic person in blood tests. In this case, it may be monoclonal gammopathy of undetermined significance (MGUS) or smoldering myeloma. Both are precursors of myeloma and often require follow-up for this reason. 

The initial examinations for myeloma may be performed at a health center, in occupational health care, or at a private clinic.

If the examinations suggest myeloma, the physician will make a referral to the HUS Comprehensive Cancer Center. 

When your referral arrives at HUS, we will direct it to an internal medicine outpatient clinic at the Jorvi, Peijas, Helsinki Laakso, or Malmi Hospital, or to a hematology outpatient clinic at the Comprehensive Cancer Center, Hyvinkää Hospital, or Porvoo Hospital, depending on your place of residence. A specialist will plan the necessary additional examinations based on your referral. If there is a strong suspicion of myeloma requiring treatment, we will refer you to the hematology outpatient clinic, where the treatment of myeloma has been centralized.

Monoclonal gammopathy (MGUS) and smoldering myeloma can be monitored in internal medicine outpatient clinics or primary health care. 

You will be informed of the time of the examinations and appointments by letter. You can also find this information in the Maisa portal, which enables electronic transactions with your treatment unit.

Although the suspicion of myeloma arises already on the basis of abnormalities in blood tests, changes detected in a bone marrow sample are needed to confirm the diagnosis. A bone marrow sample is taken from the rear part of the pelvic bone under local anesthesia and the sampling takes about 20–30 minutes. You will receive more detailed instructions on the procedure in your appointment letter. In addition to bone marrow samples, we take blood and urine tests and perform a computed tomography scan of your bones to detect any bone lesions.  

If you are suspected of having a myeloma precursor, it is not always necessary to take a bone marrow sample.

Results for some of the bone marrow sample tests are completed quickly, but some take 3–4 weeks to complete. For this reason, we will book you a physician’s appointment approximately one month after the bone marrow sample is taken, so that all the examination results would be available at the appointment. This allows us to confirm the diagnosis at the appointment and draw up a treatment plan with you. You may bring a loved one to the appointment if you wish.  

At the physician’s appointment, we will ask you about your other illnesses and symptoms related to your disease. Your physician will examine you by listening to your heart and breathing sounds and palpating your stomach. After the examinations, you will discuss the diagnosis and treatment plan for your hematological disease with your physician.  

After the physician’s appointment, you will meet the nurse at the outpatient clinic either on the same day or within a few weeks. The nurse will go through matters related to your blood disorder with you, and you will receive more detailed guidance, for example, on the medication you will be starting to take. 

In the treatment of myeloma, we follow the treatment recommendations issued by the Finnish Myeloma Group. Criteria for initiating myeloma treatment include elevated blood calcium levels, renal failure, anemia, or bone lesions (CRAB symptom criteria). Other findings may also support the initiation of treatment.

Our hematology unit is conducting various clinical drug trials, which we offer to suitable myeloma patients during the treatment selection phase. 

Autologous stem cell transplants, i.e. stem cell transplants performed with the patient’s own cells, can be performed up to the age of 70, if you do not have significant underlying diseases that increase the risks in transplantation. In exceptional cases, we perform allogeneic stem cell transplants with cells collected from healthy donors. 

We administer calcium and vitamin D supplements, anti-infection drugs, bone medicines, and certain vaccines to all myeloma patients. Some patients require radiation therapy of skeletal metastases.

There is no curative treatment for myeloma. With treatments, our aim is to keep your disease non-progressive, i.e. in remission, for as long as possible. 

We monitor the treatment response during the treatments with blood samples taken approximately every month. Follow-up takes place remotely by phone and at appointments. 

Good palliative care and psychosocial support are an integral part of cancer treatment. The Palliative Care Center provides help in the stressful life situation caused by the illness or cancer treatments. We help treat difficult symptoms and offer conversational support. 

A decision on palliative, i.e. symptomatic, treatment is made when the focus of your treatment shifts from slowing down the progression of cancer to managing the symptoms. In this case, treatment aims to alleviate symptoms and, as far as possible, to ensure a good and active life with the illness until death. Typically, at this stage, your care responsibility is transferred to the palliative care unit or to the palliative outpatient clinic or a hospital-at-home unit in your area.

The illness will be treated at HUS, and follow-up will not be terminated unless you transfer to palliative care.  

If we transfer to palliative, we will make a referral to a palliative outpatient clinic and/or hospital-at-home.