Multiple Myeloma Treatment Options

A number of multiple myeloma treatments are available to keep myeloma cells under control. Your doctor may recommend a single therapy or a combination of methods that may include chemotherapy, targeted treatments, steroids, and bone marrow transplant. Other treatments, such as radiation, can help with pain and other symptoms. For example, a doctor may recommend radiation therapy alone or along with other treatments to treat painful bone disease.

The choice of treatment depends mainly on the stage of the disease and if you have symptoms. If you have smoldering myeloma and are without symptoms, you may not need cancer treatment right away. Your doctor may recommend active surveillance, which means he or she monitors your health closely so that you can begin treatment immediately if you develop symptoms. Your doctor will likely recommend induction therapy if you are experiencing symptoms. In some cases, your physician may recommend a bone marrow transplant.

The goal of treatment is to control multiple myeloma and its symptoms. In other words, therapy can keep the cancer in remission, but it only rarely cures the disease. Because standard treatment may not control myeloma, some patients prefer to take part in clinical trials in which researchers study new treatment methods.

If you have Stage I myeloma or smoldering myeloma, you may be able to delay treatment and practice active surveillance – your doctor can help you decide if active surveillance, sometimes known as “watchful waiting,” is a good idea. You will likely have to undergo regular checkups, perhaps as often as once every three months. If symptoms occur, you will contact your doctor and you may need to start treatment right away.

Waiting to start treatment until you have symptoms helps you avoid side effects, but it also carries some risks. You may not begin to experience symptoms until after the myeloma has worsened, so practicing watchful waiting may cause you to miss valuable treatment time.

If you are like many people with myeloma, you may feel uncomfortable living with untreated myeloma. In this case, you should discuss your feelings with your doctor. If you have smoldering myeloma, you can always choose active surveillance in the beginning and switch to treatment later – there are usually other approaches available.

Types of Treatments for Multiple Myeloma

Cancer doctors provide treatment for multiple myeloma in three phases: induction, consolidation, and maintenance. Each phase has a different objective and involves different courses of treatment.

Induction therapy

Induction therapy is the first type of multiple myeloma treatment given to many patients. The goal is to reduce the number of myeloma cells in your bone marrow and decrease the proteins that these cells produce. Induction therapy typically lasts for several months and is typically used before high doses of chemotherapy.

Induction therapy usually includes a combination of at least three drugs. Typically, it includes:

  1. Immunotherapy: Reduces the number of cancerous plasma cells in bone marrow and decreases the abnormal proteins produced by those cells. Doctors use a 3-drug regimen, known as VRD therapy, which includes:
  2. Targeted therapy: Uses drugs or other substances that attack and kill only cancer cells; the downside is that some myeloma cells may survive targeted therapy.
  3. Steroids: Some steroids, such as dexamethasone and prednisone, can kill myeloma cells and reduce damaging inflammation.

These treatments are available in oral form to be taken by mouth, or through an intravenous (IV) needle in a vein. Treatment for multiple myeloma typically takes place in an outpatient setting.

The combination of Velcade® (bortezomib), Revlimid® (lenalidomide), and low-dose dexamethasone (VRd) is the most commonly used induction therapy for fit, transplant-eligible patients, according to the International Myeloma Foundation.

Velcade (bortezomib) – interferes with the way cancer cells break down protein; protein builds up inside the cancer cell and eventually kills the cancer cell

Revlimid (lenalidomide) – activates your immune system to target and kill cancer cells like they would any other infection

Dexamethasone – a steroid drug that prevents inflammation and pain associated with myeloma; at high doses, the drug can even help kill myeloma cells

Bone Marrow Transplant

Cancer treatment can sometimes kill healthy cells, which makes it difficult to recover from treatment. To overcome this, you may benefit from a bone marrow transplant. Bone marrow contains special cells, known as hematopoietic cells, which produce all types of blood cells. Receiving very high doses of chemotherapy or other high-dose treatments can kill certain types of your blood cells; the bone marrow transplant replaces the destroyed cells with healthy ones. The procedure allows your body to recover from aggressive multiple myeloma treatment. Depending on the aggressiveness of your treatment, you may undergo two or more bone marrow transplants.

Autologous transplant

You might be able to provide your own bone marrow cells before you undergo high-dose treatment. In this procedure, known as an autologous transplant, your doctor removes bone marrow from your body before you have chemotherapy. Medical specialists will treat the bone marrow material to kill any myeloma cells there before freezing and storing the bone marrow. Then, after you receive high-dose chemotherapy, your healthcare team will thaw the stored cells and transplant them back into your body.

Using your own bone marrow cells has a number of advantages. You don’t need to find a suitable donor, for example, and a lower risk of rejection – your body is more likely to accept your own blood cells than accept bone marrow cells from another person. However, an autologous transplant is not always possible; your bone marrow may contain too many myeloma cells, for example. In this case, your doctor would recommend getting healthy bone marrow cells for transplant from someone else.

Allogeneic transplant

In transplants using a donor’s cells, known as an allogeneic transplant, the doctor removes healthy bone marrow cells from the patient’s relative or from an unrelated donor. In these cases, doctors use blood tests to ensure the donor’s cells match the patient’s cells. Researchers are still working to determine the safety and effectiveness of allogeneic bone marrow transplants in the treatment of multiple myeloma.

If you have an identical twin, you may be able to undergo a syngeneic bone marrow transplant.

Your doctor will collect bone marrow from you or the donor in a hospital operating room. The doctor uses a needle to collect bone marrow from either the hip or the sternum, often known as the breastbone. You or the donor will be under anesthesia and closely monitored throughout the donation procedure.

You will receive the healthy bone marrow cells intravenously through an IV needle. The transplanted cells will find their way to your bones through your bloodstream. In time, the transplanted bone marrow cells will begin to produce healthy blood cells.

You may need to stay in the hospital for several weeks or months after receiving your bone marrow transplant, as the large doses of chemotherapy you received will weaken your immune system and increase your risk for infections.

Consolidation therapy

Consolidation treatment is the next step in multiple myeloma treatment; it typically follows a stem cell transplant. It consists of a short course of treatment, typically two to four cycles. In many cases, consolidation treatment includes more cycles of induction therapy before the transplant. The goal of consolidation treatment is to consolidate, or strengthen, your body’s response to therapy.

Not all patients undergo consolidation treatment, but it can improve the patients’ chances of getting to a full recovery. Your oncologist will talk to you about whether this is needed.

Maintenance therapy

Maintenance therapy helps the body stay in remission, which means your tests no longer show signs of myeloma. Maintenance therapy with drugs like Revlimid (lenalidomide) and bortezomib can help you live longer. Talk to your doctor about the possible side effects of maintenance therapy.