Multiple Myeloma Treatment
In general, multiple myeloma treatment primarily helps people who already have signs of organ damage from multiple myeloma. These signs include anemia, high blood calcium, impaired kidney function, or bone lytic lesions.
The initial therapy to treat multiple myeloma is known as induction therapy, using various drugs (described below). In persons under the age of 70, this may be followed by autologous stem cell transplantation (SCT), In SCT, some of a person's stem cells are removed by a machine and are frozen and stored. The stem cells are taken from the person with multiple myeloma, usually after induction therapy. The procedure continues this way:
- The person with multiple myeloma undergoes high-dose chemotherapy. The strong chemotherapy destroys almost all the cells in the bone marrow -- both healthy cells and the plasma cells causing the disease.
- The harvested stem cells are then injected into the person's veins. They travel to the bone marrow, where they multiply and make new healthy blood cells.
- Some people undergo two stem cell transplantation procedures 6 months apart. This is known as tandem stem cell transplantation. Patterns of stem cell transplantation are undergoing clinical trial to determine which pattern is most effective.
- Allogeneic transplantation is usually reserved for patients with multiple myeloma who have progressed after autologous stem cell transplantation. However, there are clinical trials utilizing tandem autologous stem cell followed by reduced intensity allogeneic stem cell transplantation.
- After SCT, patients are usually take maintenance therapy for up to 2 years, usually with thalidomide or lenalidomide.
Stem cell transplantation doesn't cure multiple myeloma, but it leads to longer survival. However, SCT can cause serious complications, especially vulnerability to infections.
Chemotherapy refers to drugs that kill cancer cells. Chemotherapy alone is not as effective as stem cell transplantation for multiple myeloma treatment. However, chemotherapy is often a good option for people at higher risk for complications from stem cell transplantation.
To treat multiple myeloma, doctors generally use a combination of chemotherapy and other drugs, which may include:
Doctors can choose from multiple combinations of chemotherapy drugs. Corticosteroids (such as prednisone or dexamethasone) are often given with chemotherapy, to reduce side effects. Interferon is a hormone-like drug that can help keep multiple myeloma in remission after chemotherapy.
Bisphosphonates are drugs used to treat bone damage from multiple myeloma. With multiple myeloma, the bisphophonates primarily used are Aredia (pamidronate) and Zometa (zoledronic acid), which are given intravenously through a vein. A serious side effect of jaw bone death can occur with use of these medications, although it is rare.
Radiation therapy may also help treat multiple myeloma. A beam of radiation is directed from a machine to a bone or other part of the body affected by multiple myeloma. The high-energy rays kill multiple myeloma plasma cells, helping to reduce pain and stabilize the weakened bone. Multiple myeloma cells are highly sensitive to radiation.
People who aren't candidates for SCT, usually due to age, are given induction therapy followed by chemotherapy.
Multiple myeloma research is ongoing, including clinical trials to identify more effective chemotherapy drugs and combinations.