If you have multiple myeloma and aren't experiencing any symptoms, you may not need treatment. However, your doctor will regularly monitor your condition for signs the disease is progressing. If it is, you may need treatment.
If you're experiencing symptoms, treatment can help relieve pain, control complications of the disease, stabilize your condition and slow the progress of the disease.
Standard treatments for myeloma
Though there's no cure for multiple myeloma, with good treatment results you can usually return to near-normal activity. You may wish to consider approved clinical trials as an option.
Standard treatment options include:
- Bortezomib (Velcade). Bortezomib was the first approved drug in a new class of medications called proteasome inhibitors. It is administered intravenously. It causes cancer cells to die by blocking the action of proteasomes. It is approved for people with newly diagnosed and previously treated myeloma.
- Thalidomide (Thalomid). Thalidomide, a drug originally used as a sedative and to treat morning sickness during pregnancy in the 1950s, was removed from the market after it was found to cause severe birth defects. However, the drug received approval from the Food and Drug Administration (FDA) again in 1998, first as a treatment for skin lesions caused by leprosy. Today thalidomide is FDA approved for the treatment of newly diagnosed multiple myeloma. This drug is given orally.
- Lenalidomide (Revlimid). Lenalidomide is chemically similar to thalidomide, but because it appears to be more potent and cause fewer side effects, it is currently used more often than thalidomide. Lenalidomide is given orally. It is approved for people with previously treated myeloma, but is also often used in people with newly diagnosed disease.
- Chemotherapy. Chemotherapy involves using medicines — taken orally as a pill or given through an intravenous (IV) injection — to kill myeloma cells. Chemotherapy is often given in cycles over a period of months, followed by a rest period. Often chemotherapy is discontinued during what is called a plateau phase or remission, during which your M protein level remains stable. You may need chemotherapy again if your M protein level begins to rise. Common chemotherapy drugs used to treat myeloma are melphalan (Alkeran), cyclophosphamide (Cytoxan), vincristine, doxorubicin (Adriamycin) and liposomal doxorubicin (Doxil).
- Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, have been used for decades to treat multiple myeloma. They are typically given in pill form.
- Stem cell transplantation. This treatment involves using high-dose chemotherapy — usually high doses of melphalan — along with transfusion of previously collected immature blood cells (stem cells) to replace diseased or damaged marrow. The stem cells can come from you or from a donor, and they may be from either blood or bone marrow.
- Radiation therapy. This treatment uses high-energy penetrating waves to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells form a tumor (plasmacytoma) that's causing pain or destroying a bone.
Initial therapy for myeloma
The initial chemotherapy used to treat multiple myeloma depends on whether you're considered a candidate for stem cell transplantation and your individual risk profile. Factors such as the risk of your disease progressing, your age and your general health play a part in determining whether stem cell transplantation may be right for you.
If you're considered a candidate for stem cell transplantation, your initial therapy will likely exclude melphalan because this drug can have a toxic effect on stem cells, making it impossible to collect enough of them. Your first treatment will typically be lenalidomide or bortezomib combined with low-dose dexamethasone.
Your stem cells will likely be collected after you've undergone three to four months of treatment with these initial agents. You may undergo the stem cell transplant soon after your cells are collected or the transplant may be delayed until after a relapse, if it occurs. Your age and your personal preference are important factors in determining when to do the transplant.
After your stem cell transplantation, you'll likely start a new course of treatment with a drug combination that includes bortezomib and melphalan.
- If you're not considered a candidate for stem cell transplantation, your initial therapy is likely to be a combination of melphalan, prednisone and thalidomide — often called MPT — or melphalan, prednisone and bortezomib (Velcade) — often called MPV. If the side effects are intolerable, melphalan plus prednisone (MP) or lenalidomide plus low-dose dexamethasone are additional options. This type of therapy is typically given for about 12 to 18 months.
Treatments for relapsed or treatment-resistant multiple myeloma
Most people who are treated for multiple myeloma eventually experience a relapse of the disease. And in some cases, none of the currently available, first line therapies slow the cancer cells from multiplying. If you experience a relapse of multiple myeloma, your doctor may recommend repeating another course of the treatment that initially helped you. Another option is trying one or more of the other treatments typically used as first line therapy, either alone or in combination.
Research on a number of new treatment options is ongoing, and these drugs offer important options for those with multiple myeloma. Talk to your doctor about what clinical trials may be available to you.
Because multiple myeloma can cause a number of complications, you may also need treatment for those specific conditions. For example:
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- Back pain. Taking pain medication or wearing a back brace can help relieve the back pain you might experience with multiple myeloma.
- Kidney complications. People with severe kidney damage may need dialysis.
- Infections. Antibiotics may be necessary to help treat infections or to help reduce your risk of them.
- Bone loss. You may take medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), which bind to the surface of your bones and help prevent bone loss. Treatment with these drugs is associated with the risk of harm to the jawbone. If you're taking these medications, avoid dental procedures without consulting your doctor first.
- Anemia. If you have persistent anemia, your doctor may prescribe erythropoietin injections. Erythropoietin is a naturally occurring hormone made in the kidneys that stimulates the production of red blood cells. Research suggests that the use of erythropoietin may increase the risk of blood clots in some people with myeloma.
- Rajkumar SV, et al. Multiple myeloma and related disorders. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-443-06694-8..50114-7&isbn=978-0-443-06694-8&uniqId=265138448-3#4-u1.0-B978-0-443-06694-8..50114-7--cesec26. Accessed July 9, 2011.
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- Rajkumar SV. Clinical features, laboratory manifestations, and diagnosis of multiple myeloma. http://www.uptodate.com/home/index.html. Accessed July 9, 2011.
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- Rajkumar SV. Initial chemotherapy for patients with high risk multiple myeloma.http://www.uptodate.com/home/index.html. Accessed July 9, 2011.
- Thalidomide. National Cancer Insitute. http://www.cancer.gov/cancertopics/druginfo/thalidomide. Accessed July 9, 2011
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- Rajkumar SV. Treatment of the complications of multiple myeloma. http://www.uptodate.com/home/index.html. Accessed July 9, 2011.
- Multiple myeloma: Lifestyle changes to consider during and after treatment. American Cancer Society. http://www.cancer.org/Cancer/MultipleMyeloma/DetailedGuide/multiple-myeloma-after-lifestyle-changes. Accessed July 9, 2011.
- Multiple myeloma: How about your emotional health? American Cancer Society. http://www.cancer.org/Cancer/MultipleMyeloma/DetailedGuide/multiple-myeloma-after-emotional-health. Accessed July 9, 2011.
- Complementary and alternative methods for cancer management. American Cancer Society. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/complementary-and-alternative-methods-for-cancer-management. Accessed July 9, 2011.
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