What is Multiple Myeloma?

Multiple myeloma is a cancer that develops in plasma cells. These cells are typically found in the bone marrow and play a vital role in producing antibodies that help the body combat infections. In multiple myeloma, these plasma cells become cancerous and multiply abnormally, forming tumors inside the bone marrow.

As the disease progresses, it interferes with the production of healthy blood cells, weakens bones, and leads to complications such as kidney dysfunction, anemia, bone fractures, and a weakened immune system. It is considered a hematologic (blood-related) malignancy and falls under the broader category of plasma cell dyscrasias.

Unlike many cancers that form solid tumors, multiple myeloma affects the entire bone marrow system. It is typically a relapsing and remitting disease, which means patients may go through periods of remission followed by relapse, requiring ongoing monitoring and treatment adjustments.

Forms of Multiple Myeloma:

• Smoldering Multiple Myeloma (SMM): An early, asymptomatic stage that does not yet require treatment but must be closely observed.
• Active Multiple Myeloma: This stage exhibits symptoms and organ damage, necessitating immediate treatment.
• Light Chain Myeloma: A subtype where only parts of antibodies are produced, often affecting the kidneys more severely.
• Non-Secretory Myeloma: A rare form where malignant plasma cells do not release detectable antibodies in the blood or urine, making it harder to monitor.

What are the Signs and Symptoms of Multiple Myeloma?

The symptoms of multiple myeloma often develop slowly and may be mistaken for other common health conditions in the early stages. This is why many patients are diagnosed only after the disease has progressed. Understanding the typical signs can lead to earlier detection and better outcomes.

Common Signs and Symptoms:

• Bone pain: One of the most common symptoms, particularly in the back, hips, or ribs. It occurs because cancerous plasma cells weaken the bone structure.
• Frequent fractures: Weakened bones may break easily, sometimes from minor falls or even regular movement.
• Fatigue and weakness: Anemia is common in multiple myeloma due to the reduced production of healthy red blood cells, leading to chronic tiredness.
• Frequent infections: Multiple myeloma can compromise the immune system, making it more difficult for the body to fight off bacteria and viruses.
• Unexplained weight loss: Cancer-related metabolic changes and reduced appetite may result in weight loss.
• Excessive thirst and urination: This may be a sign of high blood calcium levels (hypercalcemia), a complication of bone destruction.
• Numbness or tingling in the limbs: Myeloma can affect the spinal cord or peripheral nerves, leading to neurological symptoms.
• Shortness of breath or paleness: These may be related to anemia or kidney dysfunction.
• Swelling in the legs: Often caused by kidney problems or low protein levels in the blood.

Symptoms of multiple myeloma can vary depending on the stage of the disease and the parts of the body affected. Some patients may not experience any symptoms initially, especially in smoldering myeloma, which is only detected through routine blood or urine tests.

What are the Treatment Options for Multiple Myeloma?

Multiple myeloma treatment has seen significant improvements in recent years, with various therapies now available to manage the disease, control symptoms, and extend survival. While there is currently no permanent cure, many patients live long and active lives with appropriate care. The choice of treatment depends on the symptoms, the patient's age, general health, the stage of the disease, and specific genetic markers found in the cancer cells.

Below are the main treatment options used in managing multiple myeloma:

• Chemotherapy: Often used to kill fast-growing myeloma cells and is typically given in cycles over a few weeks. Common chemotherapy drugs include cyclophosphamide, melphalan, and doxorubicin, which are either taken orally or given intravenously.
• Immunomodulatory drugs (IMiDs): Such as lenalidomide (Revlimid), thalidomide, and pomalidomide, work by enhancing the immune system's ability to fight cancer cells. These are often used in combination with other treatments and are effective in both first-line and maintenance therapy.
• Proteasome inhibitors: Including bortezomib (Velcade), carfilzomib, and ixazomib, block the enzymes cancer cells use to grow and divide. These drugs disrupt protein recycling in myeloma cells, leading to their death.
• Corticosteroids: Such as dexamethasone and prednisone, are commonly included in treatment regimens to reduce inflammation and suppress the growth of myeloma cells. Steroids also improve the effectiveness of chemotherapy and other drugs.
• Autologous stem cell transplant (ASCT): A standard treatment for eligible patients under 70 years old or those in good health. This procedure involves collecting the patient's own stem cells, giving high-dose chemotherapy to kill the cancer, and reinfusing the stem cells to restore healthy bone marrow function.
• Targeted therapies: Such as monoclonal antibodies (like daratumumab and elotuzumab), bind to specific markers on myeloma cells, enabling the immune system to identify and eliminate them. These drugs are often used in relapsed or refractory multiple myeloma.
• CAR T-cell therapy: An advanced option for patients who have relapsed after multiple treatments. It involves modifying a patient's T-cells in a laboratory so they can recognize and kill myeloma cells. FDA-approved CAR T therapies, such as idecabtagene vicleucel and ciltacabtagene autoleucel, are now available in specialized centers.
• Radiation therapy: May be used to treat plasmacytomas or relieve bone pain, especially when tumors press on nerves or cause fractures. While not used as primary therapy, it is very effective for symptom management.
• Supportive care measures: Crucial for enhancing comfort and minimizing complications. These include medications such as bisphosphonates to strengthen bones, antibiotics to prevent infections, antivirals, blood transfusions, and pain control medications.
• Triplet and quadruplet drug combinations: Commonly used to improve treatment response and extend remission. These regimens often combine a proteasome inhibitor, an immunomodulator, a corticosteroid, and sometimes a monoclonal antibody.

Modern multiple myeloma treatment is highly personalized, combining various approaches to deliver the best possible outcomes tailored to a patient's genetic profile, age, and response to therapy.

What is the Multiple Myeloma Treatment Protocol in India?

In India, the treatment of multiple myeloma follows globally accepted clinical guidelines, such as those from the National Comprehensive Cancer Network (NCCN) and the European Society of Medical Oncology (ESMO). However, treatment is also personalized to meet the patient's medical condition, age, financial considerations, and disease aggressiveness. The Indian protocol strikes a balance between clinical effectiveness and cost-efficiency, often combining standard regimens with high-quality, generic drugs.

Standard Treatment Protocol in India:

1. Initial evaluation: Includes confirming the diagnosis through blood tests (serum protein electrophoresis, immunofixation, and free light chain assay), a bone marrow biopsy, cytogenetic testing, and imaging scans such as PET-CT or MRI to assess bone involvement.
2. Risk Stratification: Performed using staging systems, such as the Revised International Staging System (R-ISS), cytogenetic analysis, and renal function tests. It helps doctors categorize patients as standard-risk or high-risk, which in turn influences the intensity of therapy.
3. Induction Therapy: Typically given to reduce the myeloma burden before a stem cell transplant. Standard triplet regimens include bortezomib, lenalidomide, and dexamethasone (VRd), or bortezomib, cyclophosphamide, and dexamethasone (VCd). These are administered in 3–4 cycles over several months.
4. Autologous Stem Cell Transplant (ASCT): Offered to eligible patients aged 65–70 years who have responded well to induction therapy. The patient's own stem cells are harvested, high-dose melphalan chemotherapy is administered to eliminate the remaining cancer cells, and the stem cells are then reinfused.
5. Consolidation Therapy: May be offered after transplant to deepen the response, especially in high-risk patients. It may involve repeating some of the induction drugs for 1–2 additional cycles.
6. Maintenance Therapy: Follows transplant or induction and helps prolong remission. The most commonly used drug is lenalidomide, which may be given for 1–2 years or longer, depending on the response and tolerance.
7. For transplant-ineligible patients: (Due to age or poor health), continuous chemotherapy using oral regimens like lenalidomide and dexamethasone (Rd) or bortezomib-based combinations is used.
8. Relapsed or Refractory Multiple Myeloma (RRMM): Treated with newer therapies, including monoclonal antibodies (daratumumab, elotuzumab), second-generation proteasome inhibitors (carfilzomib), and CAR T-cell therapy, in select centers. Salvage stem cell transplant is also considered in some cases.
9. Supportive care: Provided throughout the protocol, including antibiotics, antifungals, calcium and vitamin D supplements, bone-strengthening medications (such as zoledronic acid), and regular monitoring of kidney function and bone health.

India's myeloma treatment centers often feature multidisciplinary teams comprising hematologists, oncologists, transplant specialists, and experts in supportive care. Treatment plans are closely monitored with blood tests, imaging, and bone marrow evaluations to ensure the best possible outcomes with minimal complications.

What is the Cost of Multiple Myeloma Treatment in India?

The cost of treating multiple myeloma in India is lower compared to other developed countries without compromising the quality of care. India offers a range of advanced treatments, including chemotherapy, targeted therapy, autologous stem cell transplant, and immunotherapy.

Multiple Myeloma Treatment Costs in India:

• Standard treatment with chemotherapy and supportive care (non-transplant): ₹5,00,000 to ₹10,00,000 ($6,000 to $12,000)
• Treatment including autologous stem cell transplant: ₹15,00,000 to ₹25,00,000 ($17,000 to $30,000 USD)
• Relapsed/refractory patients needing advanced targeted or CAR T-cell therapies: ₹45,00,000 to ₹55,00,000 ($40,000 to $60,000)

Breakdown of Multiple Myeloma Treatment Costs in India (Estimated):

• Chemotherapy regimens: Generally cost between ₹3,00,000 and ₹6,00,000 ($3,600 to $5,500) for a full course of treatment for multiple myeloma. It includes drug costs, consultations, hospital visits, and supportive medications.
• Targeted therapy: Using drugs like lenalidomide or bortezomib typically costs between ₹1,00,000 and ₹2,50,000 ($1,200 to $3,000) per month, depending on the drug brand and dosage.
• Autologous stem cell transplant (ASCT): Commonly used in eligible patients, costs between ₹12,00,000 and ₹20,00,000 ($15,000 to $25,000). It includes pre-transplant evaluation, stem cell harvesting, high-dose chemotherapy, hospital stay, and post-transplant care.
• Immunotherapy: With monoclonal antibodies, such as daratumumab or elotuzumab, may cost ₹1,50,000 to ₹3,00,000 ($1,800 to $3,600) per dose, and multiple doses are typically required over several months.
• CAR T-cell therapy: The latest treatment option in India and can cost between ₹45,00,000 and ₹55,00,000 ($40,000 to $60,000), although its availability is limited to a few specialized centers.
• Supportive care expenses: Such as medications for bone health, antivirals, lab monitoring, and imaging tests, can add ₹50,000 to ₹2,00,000 ($600 to $2,400) to the treatment cost.

What are the Factors Influencing Multiple Myeloma Treatment in India?

The overall cost and approach to multiple myeloma treatment in India depend on several clinical and non-clinical factors. Understanding these variables helps patients and caregivers plan more effectively and avoid unexpected expenses during treatment.

• Stage and aggressiveness of the disease: Significantly influence the complexity and cost of treatment. Early-stage multiple myeloma may be treated with oral medications and outpatient regimens, while advanced or relapsed cases often require more intensive therapies, including stem cell transplant or monoclonal antibodies.
• Patient's overall health status: Including kidney function, bone damage, and the presence of infections, impacts treatment decisions. Patients with organ damage may need pre-treatment support (e.g., dialysis, fracture stabilization) before cancer therapy begins.
• Choice of hospital and city: Affects pricing, with larger metropolitan cities, such as Delhi, Mumbai, and Bangalore, generally having slightly higher costs due to their more extensive infrastructure and reputation.
• Use of branded versus generic medications: Can significantly impact the cost. India's availability of high-quality generic drugs enables patients to access effective therapies at considerably lower prices compared to Western brands.
• Treatment protocol followed: Such as whether a stem cell transplant is recommended or if CAR T-cell therapy is available—directly impacts both cost and duration. Some regimens are shorter but more expensive, while others are longer but affordable.
• Hospitalization duration, ICU care, and any complications: During treatment can also increase the overall cost of treatment. Some patients may require extended monitoring or special care for infections, bleeding, or adverse drug reactions.
• Treating doctor's experience and team expertise: May also affect consultation fees and clinical outcomes. Leading hematologists and transplant specialists in India typically offer personalized, multidisciplinary care.

Is Multiple Myeloma Treatment Cost-Effective in India?

Yes, multiple myeloma treatment in India is considered highly cost-effective, particularly when compared to countries such as the United States and the United Kingdom. Patients from around the world choose India not only for its affordability but also for the advanced medical care available in accredited hospitals staffed by experienced specialists.

The cost-effectiveness of treatment in India stems from a unique combination of high-quality care, access to modern therapies, and lower overall healthcare expenses.

• Affordable Access to Modern Therapies: India offers the same global-standard treatment protocols used in top cancer centers worldwide, including autologous stem cell transplants, targeted drugs like lenalidomide and bortezomib, and even CAR T-cell therapy in select institutions. These advanced treatments are available at a fraction of the price charged in Western countries without compromising safety or outcomes.
• Widespread Availability of Generic Drugs: India is one of the largest producers of generic and biosimilar medications. These alternatives are as effective as branded drugs but come at significantly lower prices. For patients with multiple myeloma who require prolonged or maintenance therapy, this substantially reduces the financial burden.
• Skilled Hematologists and Transplant Experts: Indian doctors are well-versed in treating hematologic cancers, such as multiple myeloma. Many hospitals offer comprehensive care through multidisciplinary teams, ensuring patients receive accurate diagnoses, personalized treatment plans, and continuous monitoring.
• Lower Infrastructure and Operating Costs: Healthcare delivery in India benefits from lower administrative and operational expenses. This efficiency enables hospitals to deliver high-quality services at lower costs, including diagnostic tests, hospital stays, imaging, and follow-up care.
• Personalized Care for International Patients: For medical tourists, India offers a range of value-added services, including visa assistance, travel coordination, airport pickup, accommodation support, and translation services, all at reasonable rates. This makes the entire treatment journey smooth and budget-friendly.

For most international patients, treatment for multiple myeloma in India costs 70–90% less than in the US or Europe yet delivers comparable results. The shorter wait times, access to world-class doctors, and transparency in pricing further enhance India's reputation for value-based care.

Whether you're opting for first-line therapy or more advanced options, such as transplant or immunotherapy, India ensures that the investment in your health yields strong outcomes without exhausting your savings.

What is the Success Rate of Multiple Myeloma Treatment in India?

The success rate of multiple myeloma treatment in India has improved remarkably over the past decade due to early diagnosis, advanced therapeutic options, and the availability of skilled hematologists and transplant experts. While multiple myeloma is not considered curable in most cases, it is highly treatable, and many patients live long, productive lives with proper care.

Doctors measure the success of myeloma treatment not only by survival rates but also by the quality of life, duration of remission, and control of symptoms. In India, access to internationally approved drugs, experienced specialists, and well-equipped transplant centers contributes to high standards of care and improved outcomes.

Key Success Metrics in India:

• Overall survival rates for multiple myeloma in India range from 5 to 10 years on average, depending on the stage at diagnosis, treatment protocol used, and patient-specific factors like age and comorbidities.
• Progression-free survival (the time a patient lives without disease worsening) has significantly increased with the use of triplet therapies (e.g., bortezomib, lenalidomide, dexamethasone) and maintenance therapy post-transplant.
• Autologous stem cell transplant (ASCT) success rates in India are comparable to international benchmarks, with complete remission achieved in up to 60–70% of eligible patients. Many patients also enjoy prolonged disease-free intervals.
• Patients treated in high-volume centers often experience better outcomes due to the availability of advanced diagnostic tools, effective infection control protocols, and thorough post-treatment monitoring.
• High-risk patients with genetic abnormalities (e.g., del (17p), t(4;14)) are also experiencing better outcomes with the use of monoclonal antibodies and next-generation therapies available in India.

Survival Statistics by Risk Group:

• Standard-risk patients can expect a 5-year survival rate of 70–80% with timely treatment and transplant.
• High-risk patients may have a lower 5-year survival rate (40–60%), but newer therapies are gradually improving these numbers.
• Smoldering multiple myeloma (SMM) patients may remain stable without needing treatment for years, but close monitoring is essential.

Patient Stories

Hearing from other multiple myeloma patients who have walked a similar path can be reassuring for those newly diagnosed with it. Below are real-life patient stories from individuals who chose India for their treatment, especially at our specialized institute, where Dr. Ganesh Jaishetwa and his team have guided hundreds of international patients toward recovery and improved quality of life.

Tewita – 61, Fiji

Tewita, a retired banker from Fiji, was diagnosed with multiple myeloma in 2022 after experiencing severe back pain and fatigue. Local treatment options were limited and costly, so his family researched alternatives and found our institute. Under Dr. Ganesh Jaishetwa's care, Tewita received chemotherapy followed by an autologous stem cell transplant.

"Within six months, I felt stronger than I had in years. The treatment was smooth, and the cost was just a fraction of what we were quoted in Fiji. I am in remission and doing great, thanks to the team at our institute."

Amina – 53, Oman

Amina had relapsed myeloma after her initial treatment failed in her home country. She was referred to our institute, where she underwent a combination of monoclonal antibody therapy and supportive care.

"The doctors explained every step clearly. I was worried, but the staff made me feel safe and supported. The therapy worked, and I returned home after three months with my disease under control."

Nazmeen – 67, Bangladesh

Nazmeen, a teacher, came to India with progressive multiple myeloma. After initial evaluation and financial counseling, she was deemed fit for a transplant. Our institute effectively managed her entire journey from diagnosis to recovery.

"I had heard about Indian hospitals but didn't expect this level of professionalism. Dr. Jaishetwa's team was amazing, and the cost of my treatment was less than one-third of what I had planned for. I'm back to teaching now and forever thankful."

Lubanzi – 58, South Africa

Lubanzi, a school administrator from Johannesburg, was diagnosed with multiple myeloma after months of unexplained bone pain and fatigue. Treatment in South Africa was available but unaffordable for her family. He chose to travel to India after hearing about the outcomes at our institute.

"When I arrived in India, I was nervous. But the moment I met Dr. Ganesh Jaishetwa's team, I felt hope again. They explained everything clearly and treated me with dignity. I underwent chemotherapy, followed by a successful stem cell transplant. I've been in remission for over a year now. I'm walking again, working again, and grateful beyond words."

Reza – 62, Iran

Reza had previously been treated for multiple myeloma in Tehran, but his disease returned after two years. With limited options for a second line of therapy in his country, his children searched online and found expert care in India. He flew to Delhi and was evaluated for advanced immunotherapy.

"The doctors at our institute reviewed all my reports and started me on a new treatment with targeted drugs and supportive therapy. Within three months, my condition stabilized, and I gained back my strength. The staff treated me like family, and everything—from medication to food—was well-managed. Choosing India saved my life and gave my family peace of mind."