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

• tiredness
• bone pain
• 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 such cases, it may be

• a 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 medical clinic. 

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

When your referral arrives at HUS, we will refer you based on your place of residence

• to the internal medicine outpatient clinic at Jorvi, Peijas, Lohja, Raseborg, or Malmi Hospital, or
• to the hematology outpatient clinic at the Comprehensive Cancer Center, Hyvinkää Hospital, or Porvoo Hospital.

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 healthcare.

You will be informed of the time of the examinations and appointments by letter. You can also find this information in the Maisa Portal service, 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. We take a bone marrow sample from the rear of the pelvic bone under local anesthesia. 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 CT 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.

Read more about bone marrow sampling

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 family member to the appointment if you wish.

At the appointment, the physician 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 have a discussion about the diagnosis and treatment plan for the hematological disease with your physician.  

After the appointment, you will meet the nurse 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. The criteria for initiating treatment for myeloma are

• elevated blood calcium levels
• renal failure
• anemia or
• bone lesions.

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 for skeletal metastases.

A multiprofessional treatment team is in charge of the treatment of myeloma. You can reach your treatment team in the Maisa Portaland by phone. You will find the contact information for the unit treating you on the invitation letter.

• The Comprehensive Cancer Center helpline at 09 471 74900 is open Monday through Friday from 7:30 a.m. to 4:00 p.m.
• If your condition deteriorates suddenly or your fever rises above 38 degrees Celsius, contact the 24-hour emergency Medical Helpline at 116 117 (toll-free) or the nearest hospital with on-call services.
• In an emergency, always call 112.

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

We monitor the treatment efficacy with blood samples taken approximately every month. We will be in touch with you by phone, and will also meet with you at the outpatient clinic.

Bone disease associated with myeloma can sometimes cause pain. In addition, the illness itself and the treatments for it can cause fatigue. Staying active and maintaining muscle strength within the limits of one’s health is still important. If necessary, you can see a physiotherapist. You should not restrict your diet.

We will treat your condition at HUS and will not discontinue your follow-up care unless your treatment is switched to a symptomatic treatment plan.  

If we transfer to symptomatic treatment, we will make a referral to a palliative outpatient clinic and/or home health care.