Multiple myeloma is suspected when a patient with bone pain has tests that reveal bone lesions in the skull, spine, or ribs; anemia; renal failure; and high blood calcium levels that are accompanied by the presence of paraprotein in blood and urine. The diagnosis is made when bone marrow aspiration reveals an increased number of plasma cells. Further analysis of these cells may indicate the prognosis. Recent studies show that multiple myeloma is consistently preceded by precursor states called monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM). At this time, there is evidence that early treatment prevents progression to full-blown multiple myeloma; however, it is unknown if it leads to longer overall survival. Multiple myeloma is a treatable disease and many patients enjoy their lives for many years after diagnosis. Treatment options for multiple myeloma include drugs that affect the immune system (such as thalidomide and lenalidomide), proteasome inhibitors (such as bortezomib), chemotherapy (use of drugs that kill cancer cells), or radiation. Since the mid-1990s, high-dose treatment with the chemotherapy drug melphalan followed by an autologous stem cell transplant (using the patient's own stem cells) has been part of the therapy for newly diagnosed patients younger than 65 to 70 years without other serious diseases.