Multiple Myeloma: Symptoms, Risk Factors & Whole-Person Care

WHEN THE BODY LOSES ITS FITRAH

You may have spent years caring for everyone around you — your family, your work, your responsibilities and the people who depend on you. In the name of love and responsibility, it is easy to give away pieces of yourself quietly: your sleep, your time, your energy and sometimes even the attention your own health has been asking for. Cancer makes this truth especially profound. It may begin with abnormal cells and tissues, but its impact rarely stays there. It can change the rhythm of a family, disturb sleep, reshape emotions, challenge confidence and alter the way a person imagines tomorrow. The medical condition may be located in the body, but the experience belongs to the whole human being.

Yet illness does not diminish human worth. A person living with multiple myeloma remains worthy of tenderness, dignity, attention and care. We rarely notice it happening. Life simply becomes full. Until health changes — and suddenly ordinary things can feel precious again: waking with energy, moving without bone pain, sleeping comfortably, enjoying daily routines or making plans without wondering what the next test result may bring. The medical condition may be described in blood, bone marrow or laboratory reports, but the experience belongs to the whole human being. This leads us to a deeper question: What happens when the natural order that helps the body maintain balance begins to change?

At Ibnu Sina Wellness, this is where we begin looking beyond one diagnosis. We model the fundamentals of Ibnu Sina’s medical philosophy through a contemporary whole-person framework that considers the BODY-HEART-MIND-SOUL. [1] The body is not a collection of isolated parts. The human body functions as one connected living system, connected to the environment and way of life.

BUT WHY DOES CANCER OCCUR?

After a cancer diagnosis, one question can become difficult to escape: “Why did this happen?” Cancer is a complex group of diseases in which abnormal cells can grow beyond their usual boundaries and, in some cancers, invade surrounding tissues or spread to other parts of the body. Cancer develops through interactions between cellular changes and multiple biological, environmental and lifestyle influences. [2]

But cells do not live in isolation. Cancer is a complex group of diseases in which abnormal cells develop changes that disturb normal processes of growth, survival and regulation. Depending on the cancer, these cells may accumulate within tissues, invade neighbouring structures or spread to other parts of the body. [2] They exist within tissues containing blood vessels, immune cells, structural components, nutrients and chemical signals. The biological environment surrounding cells can influence how tissues function and how disease develops. And some cancers, including multiple myeloma, do not begin as one solid lump at all. They develop within a much wider biological system.

Inflammation is one example. It is normally part of the body’s protective response. But when inflammatory activity remains active over a prolonged period, it can contribute to tissue dysfunction and biological processes associated with long-term disease, including cancer. [4] This gives us a more useful way to think about cancer. Cancer is not simply a lump that suddenly appeared. It is a complex disease occurring within an equally complex human body. And therefore we ask: How do we understand the condition of the whole system rather than looking only at the place where the disease becomes visible?

WHAT MAKES MULTIPLE MYELOMA DIFFERENT?

Multiple myeloma is a haematological malignancy involving plasma cells — specialised immune cells normally responsible for producing antibodies. In multiple myeloma, abnormal plasma cells accumulate primarily within the bone marrow and usually produce a monoclonal immunoglobulin or part of an immunoglobulin. The disease is biologically complex and genetically heterogeneous, meaning that it does not behave identically in every person. [3] This makes multiple myeloma different from many cancers that begin as one solid tumour in one organ. The bone marrow is not merely an empty space inside bones. It is a highly active biological environment involved in producing blood cells and supporting immune functions.

When myeloma cells accumulate there, their effects can extend across several systems. Multiple myeloma may be associated with anaemia, kidney impairment, increased calcium levels and lytic bone disease. These features reflect the wider consequences of abnormal plasma-cell growth and the proteins these cells produce. [5] [7] Bone involvement can lead to pain, weakened areas of bone and fractures. Reduced healthy blood-cell production can contribute to anaemia and fatigue. Abnormal immunoglobulin production and disruption of normal immune function can influence susceptibility to infection. Kidney function may also be affected in some people with multiple myeloma. [3] [5] [7]

The disease itself is also heterogeneous. Modern molecular research shows that multiple myeloma develops through complex genetic and biological changes rather than one identical pathway in every patient. [5] Some patients also have biological or genetic features associated with higher-risk disease and different expected outcomes. Contemporary international recommendations therefore recognise that high-risk multiple myeloma requires attention to specific genomic and clinical characteristics rather than treating all cases as biologically equivalent. [13] Multiple myeloma also commonly develops through recognised precursor states.

Monoclonal gammopathy of undetermined significance, or MGUS, can precede multiple myeloma, while smouldering multiple myeloma represents another stage along the spectrum before symptomatic disease in some individuals. [3] [6] Risk is not explained by one factor alone. Age and biological background are important, and research continues to examine genetic, environmental, lifestyle and medical factors associated with multiple myeloma and its precursor conditions. [6] Importantly, having a risk factor does not mean that someone will inevitably develop multiple myeloma. Possible signs and symptoms also vary.

Some people experience persistent bone pain, particularly involving the back, ribs or other skeletal sites. Others may experience fatigue associated with anaemia, recurrent infections, kidney problems, weakness or complications arising from elevated calcium levels. Some people may initially have few symptoms, and the disease may first become apparent through abnormal blood or urine investigations. [7] These symptoms are not specific to multiple myeloma and can occur for many other reasons. Persistent, unexplained or worsening changes deserve appropriate medical assessment. Understanding these disease-specific features matters.

But the plasma cell still belongs to a living person whose bones, kidneys, blood, immune system, physical capacity, emotions, relationships, responsibilities and spiritual wellbeing continue alongside the diagnosis. The cancer matters. But so does the person living through everything around it.

WHAT DID IBNU SINA UNDERSTAND ABOUT HEALTH AND DISEASE?

Ibnu Sina — also known as Avicenna — wrote more than 450 books including Al-Qanun fi al-Tibb, or The Canon of Medicine. His medical writings reflected the knowledge and medical framework beyond his historical period, including the humoral theory — a model that explained health through the balance of bodily humours or fluids. [8] An important principle within Ibnu Sina’s medical reasoning remains deeply relevant to the philosophy of Ibnu Sina Wellness: do not understand one part of ailment without understanding the condition of the whole person. [1] At Ibnu Sina Wellness, we have taken inspiration from this whole-person orientation and developed it into a contemporary framework.

The disease may appear within plasma cells and bone marrow. But the person experiencing it is always more than those cells.

IBNU SINA WELLNESS — MODELING THE FUNDAMENTALS OF IBNU SINA MEDICINE

Ibnu Sina Wellness was established in 2015 in Kajang, Selangor, Malaysia. Since then, our work has focused on bringing whole-person principles into a structured wellness model. We have served people from Malaysia, Singapore, Indonesia and Brunei, including people living with complex and long-standing health challenges. Through that experience, one principle has remained central to our philosophy: We do not reduce a person to a diagnosis. We want to understand the whole human being.

THE BPS-S LENS VIEWS THE PERSON BEHIND THE DIAGNOSIS

This is where the Biopsychosocial-Spiritual, or BPS-S, framework becomes especially important. BPS-S recognises that human health and illness are experienced across interconnected biological, psychological, social and spiritual dimensions. These dimensions do not exist as separate compartments. They belong to one human life. [1] For someone living with multiple myeloma, the biological dimension may include bone disease, pain, anaemia, fatigue, kidney function, susceptibility to infection, mobility, sleep, nutrition and the effects of ongoing treatment.

The psychological dimension includes fear, uncertainty, thoughts, beliefs, coping, changes in confidence and the emotional weight of living with a disease that may require prolonged monitoring or therapy. The social dimension includes family, relationships, caregiving, work, finances, transport, appointments, support systems and the time required to live alongside ongoing healthcare. The spiritual dimension includes meaning, hope, purpose, relationship with Allah and the way a person understands illness within the wider journey of life.

Whole-person care therefore creates space to understand not only the biological condition, but also what the person is carrying emotionally, socially and spiritually. [9] Research in multiple myeloma has shown how financial burden and the amount of time required for healthcare can themselves be associated with quality of life. [10] This is especially important because multiple myeloma may involve years of treatment, monitoring, appointments and changing therapies. Illness therefore occupies not only biological space. It can occupy time. It can occupy finances. It can alter family routines, employment and plans.

These dimensions interact. Bone pain can limit movement. Fatigue may influence work and family roles. Long periods of treatment may affect finances and time. Uncertainty about relapse can shape thoughts about the future. A diagnosis tells us what disease is present. It does not tell us everything the person is carrying. To care for the person well, we must first learn to see the person as a whole.

AT IBNU SINA WELLNESS, WE DO NOT LOOK AT ONLY ONE DISEASE

When someone comes to us with multiple myeloma, we do not want to see only the words written on a medical report. We want to see:

THE WHOLE PERSON.

Within the Ibnu Sina Wellness functional framework, body functions are mapped across:

12 MAJOR BODY SYSTEMS

and

120 MICRO-SYSTEMS.

The 120 Micro-Systems are an Ibnu Sina Wellness functional framework. They give our practitioners and educators a more detailed way of asking: “Where is the body’s function giving us a signal?” Instead of seeing one disease in one biological compartment, we look at the interconnected network supporting the person.

THE 12 SYSTEMS ARE NOT 12 SEPARATE MACHINES

The human body is made up of systems with different responsibilities, but they do not function like twelve separate machines. The nervous system communicates and coordinates. The endocrine system regulates through hormones. The cardiovascular system circulates blood, oxygen and nutrients, while the respiratory system performs the essential exchange of gases. The digestive system processes and absorbs what we eat, the liver carries out vital metabolic and processing functions, and the urinary system regulates fluids while eliminating metabolic waste. [11]

The same interdependence continues throughout the body. The immune system protects and monitors, the lymphatic system supports immune function and fluid balance, the musculoskeletal system provides structure and movement, the integumentary system — the skin, hair, nails and associated structures — protects the body while interacting with the external environment, and the reproductive system carries reproductive and hormonal functions. [11] Multiple myeloma makes this interdependence particularly visible. The disease involves plasma cells within the bone marrow, yet its effects may appear through the skeleton, blood-cell production, immune function and kidneys. [3] [5] [7]

But none of these systems operates independently. Hormones travel through the circulation. The lungs and cardiovascular system work together to deliver oxygen. The kidneys regulate fluids and electrolytes. The nervous and endocrine systems coordinate countless processes throughout the body. [11] The body works through connection. And that is why understanding one part often requires us to look at the system surrounding it.

THE 120 MICRO-SYSTEMS AS CHECKPOINTS

This is where our 120 Micro-Systems become particularly important. Rather than beginning only with the question, “What disease do you have?”, we begin by looking more closely at the signals the body is giving us. Which system is signalling that something has changed? Which micro-system may be involved? What function is being affected? What may be disturbing that function? And what root-cause factors may need to be explored? This creates a pathway for deeper investigation: Symptom → System → Micro-System → Function → Imbalance → Root-Cause Factors → Restoration of Balance

The purpose is to move beyond naming the symptom and stopping there. A symptom can tell us where to begin looking, but it does not necessarily tell us the whole story. The symptom is not the end of the investigation. It is the beginning.

WHY THE MICRO-SYSTEM CANNOT BE SEPARATED FROM THE WHOLE PERSON

There is another principle that is essential: a micro-system does not exist separately from the life of the person experiencing the problem. A biological function may be under strain, while the same person may also be experiencing fear, anxiety, grief, anger, uncertainty, disturbed sleep, changes in relationships, loss of confidence, caregiving demands or spiritual distress. For someone living with multiple myeloma, the questions may include: Why am I so tired? Will this bone pain affect my independence? How will I manage repeated appointments? Can I continue working? How will my family cope? What happens if the disease returns?

These questions belong to the person experiencing the disease. So when we say “we look at the micro-system,” we are not looking only at biology. The BPS-S perspective helps us understand how these dimensions exist within the same life. What happens in the body is experienced by a person who also has emotions, thoughts, relationships, responsibilities and a spiritual life. [1] So when we say “we look at the micro-system,” we are not looking only at biology. We are also asking what is happening emotionally and mentally, what is happening within relationships and circumstances, and what is happening within the spiritual dimension of life. Because these are not separate human beings.

They are dimensions of one human life. And that is why understanding the micro-system must always lead us back to understanding the whole person.

THE MICRO-SYSTEM IS A BIOLOGICAL CHECKPOINT — BUT THE PERSON IS MORE THAN BIOLOGY

Imagine a city. You cannot understand its condition by looking at one building alone. Roads, water systems, electricity, communication networks, transportation, waste management, security and emergency services all depend upon smaller functions working together. The human body is far more complex. Every major system contains specialised functions, and those functions continuously interact with others. But the human being adds another layer: the person living inside that body has emotions, thoughts, relationships, memories, responsibilities, values and a spiritual life. [9] The physical condition is real. But so is the person experiencing it.

A biological checkpoint can help us understand what is happening within the body, but it can never describe the whole human being.

WHAT DOES “TOXIC BURDEN” MEAN AT IBNU SINA WELLNESS?

One of the concepts we investigate at Ibnu Sina Wellness is toxic burden. This can include harmful exposures associated with cancer risk, such as tobacco smoke, alcohol, air pollution, ultraviolet and ionising radiation, cancer-causing infections and particular occupational or environmental carcinogens. [2] [12] We also look at the wider metabolic and lifestyle environment surrounding the individual. Excess body weight, physical inactivity and patterns of nutrition are among the modifiable factors studied in relation to cancer risk, while chronic inflammation forms part of the wider biological environment relevant to disease. [4] [12]

Sleep and prolonged stress matter here for a different but equally human reason. They shape the way a person functions, copes and moves through illness, and therefore belong within the wider whole-person picture. [1] [10] This can include harmful exposures associated with cancer risk, such as tobacco smoke, alcohol, air pollution, ionising radiation, cancer-causing infections and particular occupational or environmental carcinogens. [2] [12] However, not every exposure is relevant to every cancer, and we should not assume that a general cancer risk factor caused one person’s multiple myeloma.

For multiple myeloma specifically, contemporary research examines a wider and more complex risk landscape, including demographic, genetic, medical, environmental and lifestyle factors as well as the precursor conditions from which the disease can develop. [6] MGUS and smouldering multiple myeloma are especially important in understanding the biological pathway towards symptomatic multiple myeloma in some individuals. [3] [6] This is different from saying that a particular lifestyle behaviour directly caused the disease.

We also look at the wider health environment surrounding the individual. Nutrition, movement, body composition, sleep and avoidance of established harmful exposures remain relevant to overall wellbeing even when they cannot be presented as direct explanations for a person’s multiple myeloma. Chronic inflammation forms part of the wider biological environment involved in many long-term diseases. [4] Sleep and prolonged stress matter for another reason. They affect how a person functions, copes and moves through illness. They should not be presented as proven direct causes of multiple myeloma. Toxic burden is therefore not one mysterious substance. And it is not a claim that one toxin explains multiple myeloma.

It is a wider way of considering avoidable harmful exposures and unnecessary burdens while respecting what disease-specific science actually shows. At Ibnu Sina Wellness, we bring these pieces together to understand the wider pattern of exposures, physiological demands and modifiable burdens surrounding the person. The body does not experience life as a list of separate risk factors. It experiences the pattern created by them over time. Toxic burden is therefore not one substance. It is the cumulative pattern of what the body has repeatedly been asked to process, tolerate and adapt to over time.

THE BIOLOGICAL BURDEN AND THE EMOTIONAL-MENTAL-SOUL BURDEN

A person may carry biological burdens while also carrying grief, fear, anger, betrayal, loneliness or unresolved emotional pain. The mind can carry its own burden too — constant worrying, overthinking, perfectionism, self-criticism, uncertainty or feeling that one must always remain strong. Daily life may add another layer through caregiving responsibilities, financial pressure, relationship conflict, work demands and long periods of uncertainty. There is also the spiritual dimension. A person may struggle with meaning, hope, spiritual connection, trust in Allah or the feeling that life has lost its direction. Spiritual distress has also been described among people living with cancer. [15]

Daily life may add another layer. Multiple myeloma can require repeated appointments, investigations and prolonged therapy. Research has highlighted both financial toxicity and time toxicity among people living with multiple myeloma, and their relationship with quality of life. [10] The person may therefore be carrying a diagnosis while also carrying financial concerns, time away from work, family responsibilities and uncertainty about what comes next. There is also the spiritual dimension. A person may struggle with meaning, hope, spiritual connection, trust in Allah or the feeling that life has lost its direction. Spiritual distress has been described among people living with cancer. [15]

These experiences should not be described as direct biological causes of multiple myeloma. They belong instead to the experience of living through illness. This is why the BPS-S perspective matters. The biology matters. But so do the heart, the mind, the life surrounding the person, and the soul.

OVERHAUL BODY™ — SUPPORTS THE WHOLE SYSTEM

This is where Overhaul Body™ fits into the Ibnu Sina Wellness philosophy. Overhaul Body™ is designed as a whole-person journey that looks beyond the tumour to the wider person and the interconnected systems supporting them. Ibnu Sina Wellness offers a new era in cancer healthcare — without chemotherapy, without surgery, without radiation, and without machine-based treatment. Within ISW, its Recovery Plan is structured around 15 integrated methods spanning herbal medicine, mind, natural lifestyle and spiritual care.

This reflects the wider Ibnu Sina Wellness whole-person philosophy, which brings together the body, heart, mind and soul and incorporates approaches such as herbal remedies, natural lifestyle practices, nutrition and spiritual care. [1] This wider supportive view also aligns with the field of integrative oncology, where supportive approaches may be considered alongside cancer-directed care. [17] Within the ISW framework, support begins by strengthening foundations such as nutrition, appropriate movement, bowel movement, sleep, rest and recovery, emotional wellbeing, mental wellbeing and spiritual wellbeing. Normal physiology itself depends on ongoing processes of regulation and repair.

Homeostasis describes the body’s continuous regulation of its internal environment. [11] Tissue repair involves coordinated interactions among cells, signalling molecules and the extracellular matrix as damaged tissue moves towards restoration. [16] These processes remind us of something important: The body is constantly working to regulate, communicate and repair. Our role is to support the person living within that body. And ultimately, the aim of Overhaul Body™ is to support the whole person. We support the body. We support the person. And we leave healing ultimately to Allah.

WHAT DOES “UNLOAD” MEAN?

When we say Overhaul Body™ aims to unload harmful burdens, we mean addressing factors that can reasonably be changed. This may include reducing avoidable harmful exposures, improving nutrition, supporting bowel movement and normal elimination, improving sleep, encouraging appropriate movement, creating space for rest and recovery and addressing emotional, mental and spiritual burdens. For someone living with multiple myeloma, the person’s medical condition, bone health, kidney function, blood counts, physical capacity and ongoing oncology care must remain part of the wider picture. [3] [7] Which systems are under strain? Which burdens may be modifiable?

Sometimes support begins not by adding more, but by asking: What can reasonably be reduced? Because our framework contains 120 Micro-Systems, we can then ask more focused questions: Which functions need attention? Which systems are under strain? Which burdens may be modifiable? What does this person need biologically, psychologically, socially and spiritually? Unloading, in this sense, is about making room for the body and the person to function with less unnecessary burden.

BUT WHAT ABOUT THE CANCER CELL?

Cancer cells involve complex biological changes. They may grow abnormally, escape normal growth controls, interact with surrounding tissue and, in some cancers, invade nearby tissue or spread to other parts of the body. [2] [3] Multiple myeloma cells are not biologically identical in every patient. The disease develops through complex molecular changes, and genetic heterogeneity helps explain why multiple myeloma can behave differently between individuals. [5]

The surrounding bone-marrow environment also forms part of the biological setting in which myeloma cells live and interact. Contemporary understanding of multiple myeloma therefore includes not only the malignant plasma cell, but also the wider disease biology surrounding it. [3] Even with major advances in therapy and substantial improvements in response and survival, relapse remains an important challenge in multiple myeloma, and achieving durable cure remains a central goal of ongoing research. [14] This biology matters. The cancer cell matters. This biology remains important within whole-person care.

Within the ISW framework, Overhaul Body™ focuses on supporting the person and the interconnected systems surrounding that biological challenge, while strengthening modifiable foundations across the wider health journey. [1] The cancer cell remains important. But it is not the whole story.

THE LAW OF FITRAH

At Ibnu Sina Wellness, we describe this wider natural order through Fitrah. Fitrah refers to the natural disposition and order created by Allah. Within the ISW BPS-S model, this provides a wider spiritual lens through which health, balance and the human being are understood. [1] At the biological level, the body demonstrates remarkable processes of regulation and repair. When tissues are injured, repair involves coordinated interactions among cells, signalling molecules and the extracellular matrix — the structural material surrounding cells — as the tissue works towards restoration. [16]

The body also continuously regulates temperature, blood glucose, fluid and electrolyte balance, acidity and many other internal conditions. Physiology describes this maintenance of internal stability as homeostasis — the body’s ability to maintain an internal environment compatible with normal function despite changing conditions. [11] When tissues are injured, repair involves coordinated interactions among cells, signalling molecules and the extracellular matrix — the structural material surrounding cells — as tissue moves towards restoration. [16] These are biological processes.

Within the ISW framework, Fitrah gives this natural order a wider meaning. It invites us to recognise that the human body is not merely a machine. It is a living system created with extraordinary organisation by the Almighty Creator. Our responsibility is to support that order as best we can.

THE WHOLE PERSON — NOT ONLY THE CANCER

This brings us to one of the most important principles at Ibnu Sina Wellness: We do not only look at the disease. We look at the body — the physical body and its systems. We look at the heart — emotional wellbeing and the experiences carried within us. We look at the mind — thoughts, perceptions, beliefs and patterns of thinking. And we look at the soul — meaning, purpose, relationship with Allah and spiritual wellbeing. At the same time, the BPS-S lens reminds us to understand the biological, psychological, social and spiritual dimensions together. [1]

Within the body, we look across the 12 body systems and the 120 Micro-Systems as functional checkpoints. This gives us a much richer question than simply asking: “What disease do you have?” We ask: What is your body telling us? Which system is giving the signal? Which functional micro-system may be involved? What is affecting its function? What biological burdens are present? What emotional and mental burdens are present? What is happening in the person’s relationships and circumstances? What is happening in the person’s life and soul? And ultimately: What do we need to understand about the whole you?

COME AND HEAL “ALL” PARTS OF YOU

If you are living with multiple myeloma and do not know what to do, if you have completed treatment and are now living with uncertainty about what comes next, or if you are experiencing persistent unexplained bone pain, unusual fatigue, repeated infections or other unexplained changes, perhaps what you need is a place where people see more than the diagnosis. Persistent or unexplained symptoms deserve appropriate medical assessment. Multiple myeloma cannot be diagnosed from symptoms alone; evaluation may involve blood tests, urine testing, bone-marrow assessment and imaging according to the clinical situation. [7] Come and speak with our professionals.

At Ibnu Sina Wellness, established in 2015 in Kajang, Selangor, we welcome you as a whole person. Our multidisciplinary team includes Hakeema, Hakeem, medical doctors, nutrition professionals, physiotherapists and counsellors, working within the broader whole-person philosophy of Ibnu Sina Wellness. And for someone living with multiple myeloma, we want to understand how bone health, energy, mobility, kidney health, immunity and the demands of ongoing care are affecting everyday life.

We want to understand your history, your body, your systems and your 120 functional Micro-Systems. We want to understand your nutrition, movement, bowel movement and sleep, as well as your emotional wellbeing, mental patterns, life circumstances and spiritual wellbeing. We want to understand the person behind the diagnosis. Because what you need now is not another person simply telling you what is wrong with you. We will sit with you to understand the whole you and ask: What has happened to you? What is your body telling us? Which systems need attention? Which burdens can we reduce? How can we support your 120 Micro-Systems? And how can we help you move towards greater balance and Fitrah?

For a consultation, kindly call Ibnu Sina Wellness at 03-604 30663. You may also join Ibnu Sina Wellness Official on TikTok LIVE for general guidance and transform your perspective on daily life issues. You deserve to be cared for as a whole human being. You deserve compassion, dignity and the opportunity to be heard. And you deserve support for the body, heart, mind and soul that have carried you this far. May Allah grant you wellbeing, strengthen your body, calm your heart, illuminate your mind, strengthen your soul and guide you towards what is best for you.

HAKEEMA ROZAINAH
Founder & CEO of Ibnu Sina Wellness
Registered Practitioner with Ministry of Health Malaysia (Act 775 Traditional and Complementary Medicine)
Pioneer of WHO’s Biopsychosocial- spiritual medicine in Malaysia
Specializing in Ibn Sina Medicine, with a focus on herbal therapy for cancer management

Understanding the Whole Person. Discovering the Root. Supporting the Systems. Caring for the 120 Micro-Systems. Returning Towards Fitrah.

REFERENCES

1. Hakeema Rozainah, & Prof. Dato Sri Dr. Abu Hassan Asaari. (2025). Biopsychosocial-Spiritual: A New Era in Healthcare. ISW Media Sdn. Bhd.
2. World Health Organization. (2023). Cancer fact sheets.
3. Malard, F., Neri, P., Bahlis, N. J., Terpos, E., Moukalled, N., Hungria, V. T. M., Manier, S., & Mohty, M. (2024). Multiple myeloma. Nature Reviews Disease Primers, 10(1), 45. doi:10.1038/s41572-024-00529-7. PMID: 38937492.
4. Furman, D., Campisi, J., Verdin, E., et al. (2019). Chronic inflammation in the etiology of disease across the life span. Nature Medicine, 25(12), 1822–1832. doi:10.1038/s41591-019-0675-0.
5. Maura, F., & Bergsagel, P. L. (2024). Molecular Pathogenesis of Multiple Myeloma: Clinical Implications. Hematology/Oncology Clinics of North America, 38(2), 267–279. doi:10.1016/j.hoc.2023.12.010. PMID: 38199896.
6. Ma, W., Zhao, L., & Zhou, W. (2025). Risk factors for multiple myeloma and its precursor diseases. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 50(4), 560–572. doi:10.11817/j.issn.1672-7347.2025.240594. PMID: 40785671.
7. Cowan, A. J., Green, D. J., Kwok, M., Lee, S., Coffey, D. G., Holmberg, L. A., Tuazon, S., Gopal, A. K., & Libby, E. N. (2022). Diagnosis and Management of Multiple Myeloma: A Review. JAMA, 327(5), 464–477. doi:10.1001/jama.2022.0003. PMID: 35103762.
8. Retsas, S. (2024). Perceptions of Cancer Through the Ages—From Hippocratic Oncology to Precision Cancer Medicine. Biomolecules, 14(11), 1383. doi:10.3390/biom14111383.
9. Lynch, J. M., van Driel, M., Meredith, P., Stange, K. C., Getz, L., Reeve, J., Miller, W. L., & Dowrick, C. (2022). The Craft of Generalism: Clinical skills and attitudes for whole person care. Journal of Evaluation in Clinical Practice, 28(6), 1187– 1194. doi:10.1111/jep.13624.
10. Banerjee, R., Cowan, A. J., Ortega, M., Missimer, C., Carpenter, P. A., Oshima, M. U., Salit, R. B., Vo, P. T., Lee, C. J., Mehta, R. S., Kuderer, N. M., Shankaran, V., Lee, S. J., & Su, C. T. (2024). Financial Toxicity, Time Toxicity, and Quality of Life in Multiple Myeloma. Clinical Lymphoma, Myeloma & Leukemia, 24(7), 446– 454.e3. doi:10.1016/j.clml.2024.02.013. PMID: 38521640.
11. Hall, J. E., & Hall, M. E. (2021). Guyton and Hall Textbook of Medical Physiology (14th ed.). Elsevier.
12. Islami, F., Marlow, E. C., Thomson, B., McCullough, M. L., Rumgay, H., Gapstur, S. M., Patel, A. V., Soerjomataram, I., & Jemal, A. (2024). Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019. CA: A Cancer Journal for Clinicians, 74(5), 405–432. doi:10.3322/caac.21858.
13. Avet-Loiseau, H., Davies, F. E., Samur, M. K., et al. (2025). International Myeloma Society/International Myeloma Working Group Consensus Recommendations on the Definition of High-Risk Multiple Myeloma. Journal of Clinical Oncology, 43(24), 2739–2751. doi:10.1200/JCO-24-01893. PMID: 40489728.
14. Rodriguez-Otero, P., Paiva, B., & San-Miguel, J. F. (2021). Roadmap to cure multiple myeloma. Cancer Treatment Reviews, 100, 102284. doi:10.1016/j.ctrv.2021.102284. PMID: 34597912.
15. Farahani, A. S., Kerdar, S. H., Ashrafizadeh, H., Büssing, A., Mehrnoush, N., Akbari, M. E., Karami, M., Tajalli, S., Mojen, L. K., & Rassouli, M. (2023). The predictors of spiritual dryness among Iranian cancer patients during the COVID-19 pandemic. Frontiers in Psychology, 13, 1024009. doi:10.3389/fpsyg.2022.1024009.
16. Krafts, K. P. (2010). Tissue repair: The hidden drama. Organogenesis, 6(4), 225– 233. doi:10.4161/org.6.4.12555.
17. Fuller-Shavel, N., & Krell, J. (2024). Integrative Oncology Approaches to Supporting Immune Checkpoint Inhibitor Treatment of Solid Tumours. Current Oncology Reports, 26(2), 164–174. doi:10.1007/s11912-023-01492-4.