Is Multiple Myeloma Hereditary? Family Risk Explained

Multiple myeloma is generally not considered an inherited cancer. There is no single “myeloma gene” that is directly passed down from parent to child in the way we see with some breast or colon cancers. However, family members of someone with multiple myeloma do have a slightly higher risk of developing the disease or its precursor conditions.

Understanding the difference between the genetic changes in your cancer cells and the genes you pass to your children is an important first step in understanding this risk.

Your Test Results: Acquired vs. Inherited Mutations

When you were diagnosed, your doctor likely performed tests (like a FISH test, which stands for fluorescence in situ hybridization) on your bone marrow to look for genetic mutations. It is natural to worry that these mutations could be passed to your children, but they cannot.

The genetic changes found in your myeloma cells are known as somatic mutations ^[1][2]. This means they are acquired alterations that occur only in your tumor cells over the course of your lifetime ^[1][3]. They are not germline mutations, which are the inherited genetic traits present in all the cells of your body and the only genes that can be passed down to your children ^[1][2].

Because these somatic mutations are restricted to your plasma cells, they are completely separate from the DNA you gave your children ^[1][3].

What is the Actual Risk to Family Members?

While multiple myeloma itself is not directly passed down, research shows there is a shared genetic predisposition ^[4][5]. First-degree relatives (children, siblings, and parents) of someone with multiple myeloma have an approximately 2 to 4 times higher risk of developing multiple myeloma compared to the general population ^[4].

They also have an increased risk of developing MGUS (monoclonal gammopathy of undetermined significance). MGUS is a benign precursor condition that typically causes no symptoms and requires no treatment—only monitoring ^[6]. While it sounds concerning, the risk of MGUS progressing to actual multiple myeloma is very low, at approximately 1% per year ^[7].

This elevated risk may sound frightening, but it is helpful to put it into perspective. The lifetime risk of developing multiple myeloma for an average person is less than 1%. Even with a 2 to 4 times higher risk, the absolute chance that your children will develop the disease remains very small ^[4].

Additionally, researchers have noted that African Americans have a higher baseline incidence of the disease (roughly double that of white Americans) ^[8][9]. However, even with this increased baseline, the absolute lifetime risk for an African American individual remains quite low, typically under 2% ^[8].

Do My Children Need Routine Screening?

Currently, there are no universally standardized clinical guidelines recommending routine screening for multiple myeloma or MGUS in the family members of myeloma patients ^[10][11]. Most major medical organizations do not advise that children of patients get regular blood tests solely to check for myeloma ^[10].

Why aren’t routine tests recommended? Because finding MGUS outside of a clinical trial often causes significant patient anxiety without offering any preventative interventions. There is no medication to “cure” MGUS or prevent it from progressing; the standard of care is simply to watch and wait. Therefore, routine screening outside of structured studies is generally discouraged ^[10].

However, large-scale research initiatives have been created to study the benefits of screening in high-risk groups ^[12][13]. Two major observational studies—the PROMISE study and the iStopMM study—are actively investigating how screening populations with a family history could improve early detection ^[10][13].

If your children or siblings are concerned about their risk and wish to be proactive, enrolling in a clinical screening study like PROMISE is the preferred route. The PROMISE study typically recruits individuals who are 30 years of age or older and who meet high-risk criteria (such as having a first-degree relative with myeloma or being of African descent) ^[14][15][16].

If your children (over age 30) decide they want to discuss this with their primary care doctor, a helpful script they can use is:
“My parent was diagnosed with multiple myeloma. I understand that routine screening isn’t standard, but because I am a first-degree relative, I am considered high-risk. Can we discuss whether a serum protein electrophoresis (SPEP) blood test makes sense for me, or if I should consider joining a screening registry like the PROMISE study?”