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.
Immediate treatment may not be necessary
If you have multiple myeloma but aren't experiencing any symptoms (smoldering multiple myeloma), you may not need treatment. However, your doctor will regularly monitor your condition for signs the disease is progressing. This may involve periodic blood and urine tests.
If you develop signs and symptoms or your multiple myeloma shows signs of progression, you and your doctor may decide to begin treatment.
Treatments for myeloma
Though there's no cure for multiple myeloma, with good treatment results you can usually return to near-normal activity.
Standard treatment options include:
- Targeted therapy. Targeted drug treatment focuses on specific abnormalities within cancer cells that allow them to survive. Bortezomib (Velcade) and carfilzomib (Kyprolis) are targeted drugs that block the action of a substance in myeloma cells that breaks down proteins. This action causes myeloma cells to die. Both medications are administered through a vein in your arm.
- Biological therapy. Biological therapy drugs use your body's immune system to fight myeloma cells. The drugs thalidomide (Thalomid), lenalidomide (Revlimid) and pomalidomide (Pomalyst) enhance the immune system cells that identify and attack cancer cells. These medications are taken in pill form.
- Chemotherapy. Chemotherapy drugs kill fast-growing cells, including myeloma cells. Chemotherapy drugs can be given through a vein in your arm or taken in pill form. High doses of chemotherapy drugs are used before a stem cell transplant.
- Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, regulate the immune system to control inflammation in the body. They also are active against myeloma cells. Corticosteroids can be taken in pill form or administered through a vein in your arm.
Stem cell transplantation. A stem cell transplant is a procedure to replace your diseased bone marrow with healthy bone marrow.
Before a stem cell transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow.
- Radiation therapy. This treatment uses beams of energy, such as X-rays, 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.
How treatments are used
Which combination of treatments you're likely to receive will depend on whether you're considered a good candidate for stem cell transplant. This depends on the risk of your disease progressing, your age and your overall health.
If you're considered a candidate for stem cell transplant, your initial therapy will likely include a combination of treatments, such as targeted therapy, biological therapy, corticosteroids and, sometimes, chemotherapy.
Your stem cells will likely be collected after you've undergone a few months of treatment. 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. In some cases, doctors recommend two stem cell transplants for people with multiple myeloma.
After your stem cell transplant, you'll likely receive targeted therapy or biological therapy as a maintenance treatment to prevent a recurrence of myeloma.
If you're not considered a candidate for stem cell transplant, your initial therapy will likely include chemotherapy combined with corticosteroids, targeted therapy or biological therapy.
In select cases, doctors use a reduced-intensity stem cell transplant in older people who are in very good health but can't tolerate the strong chemotherapy doses used in a traditional stem cell transplant. A reduced-intensity or "mini" stem cell transplant uses lower doses of chemotherapy.
If your myeloma recurs or doesn't respond to treatment, 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 you may be eligible for a clinical trial in order to gain access to those experimental treatments. 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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- Bone pain. Pain medications, radiation therapy and surgery may help control bone pain.
- Kidney complications. People with severe kidney damage may need dialysis.
- Infections. Your doctor may recommend certain vaccines to prevent infections, such as the flu and pneumonia.
- Bone loss. Your doctor may recommend medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), to help prevent bone loss.
- Anemia. If you have persistent anemia, your doctor may recommend medications to increase your red blood cell count.
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- Palumbo A, et al. International Myeloma Working Group consensus statement for the management, treatment and supportive care of patients with myeloma not eligible for standard autologous stem-cell transplantation. Journal of Clinical Oncology. 2014;32:587.
- Kyprolis (prescribing information). South San Francisco, Calif.: Onyx Pharmaceuticals, Inc.; 2012. http://www.kyproslis.com. Accessed June 24, 2014.
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