What happens if I choose no treatment for Multiple Myeloma

What Happens Without Treatment for Multiple Myeloma

This is an important question, and I want to give you a clear, honest answer based on medical evidence.

The Natural Course of Untreated Myeloma

According to the NCCN Guidelines for Patients: Multiple Myeloma, multiple myeloma is a progressive disease. Without treatment, myeloma cells continue to multiply and crowd out healthy blood cells in your bone marrow, leading to serious complications:

What Typically Develops:

Blood-related problems:

• Severe anemia (low red blood cells) → extreme fatigue and weakness
• Low white blood cells → increased risk of serious infections
• Low platelets → increased bleeding and bruising

Organ damage:

• Kidney damage - Myeloma cells produce abnormal proteins (M proteins) that can accumulate and impair kidney function
• Bone damage - Myeloma cells break down bone, causing:
  • Severe bone pain
  • Fractures from minor injuries
  • High calcium levels in blood (which causes nausea, confusion, kidney problems)

Other complications:

• Thickened blood (hyperviscosity) → stroke risk, vision problems, shortness of breath
• Increased infections due to fewer healthy white blood cells

Important Context: "Smoldering" vs. "Active" Myeloma

The NCCN Guidelines note an important distinction: some patients have smoldering myeloma (early-stage disease with fewer symptoms). Your doctor may recommend monitoring rather than immediate treatment in these cases. However, this is different from choosing no treatment—it's called "watch and wait" and involves regular testing.

Why Treatment Matters

According to NCCN Guidelines, new treatments have resulted in more long-term survivors of myeloma now than ever before. For many people, treatment can:

• Keep myeloma under control for a significant time
• Reduce or stop symptoms
• Improve quality of life
• Extend survival

The guidelines emphasize: "For an increasing number of people, myeloma is a chronic medical problem they learn to live with rather than a disease that they die from."

Questions to Ask Your Doctor

If you're considering delaying or avoiding treatment, discuss these with your care team:

1. Do I have smoldering myeloma or active myeloma? (This determines whether monitoring or treatment is appropriate)
2. What are my specific test results, and what do they tell us about how quickly my disease might progress?
3. If I choose to monitor rather than treat now, how often will I need testing, and what symptoms should prompt immediate treatment?
4. What are the risks of waiting, given my specific situation?
5. What treatment options would be available to me if I develop symptoms later?

The Bottom Line

While it's your right to decline treatment, untreated myeloma typically progresses and causes serious complications. The good news is that modern myeloma treatments are increasingly effective at controlling the disease and maintaining quality of life. Most myeloma specialists recommend discussing your concerns about treatment (side effects, lifestyle impact, etc.) rather than avoiding treatment altogether—there are often options that balance disease control with your quality of life goals.

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.