Chemotherapy for Multiple Myeloma

Chemotherapy is treatment with cancer-fighting drugs. Because these medicines go into your bloodstream and can reach all parts of your body, they’re a good choice to destroy myeloma cells. You might get chemotherapy as a shot in a vein or take it as pills.

Your doctor may use chemotherapy as your main treatment, or you may have it before you have a stem cell transplant.

You could also get it after a transplant to lessen the chance that cancer cells will come back. If you have an advanced stage, your doctor might use it to ease your pain and control your symptoms.

Often, combining two treatments works best.

The doctor will choose your treatment based on things like your:

Many people get chemotherapy in cycles. If the doctor decides this is right for you, you’ll get medicine for several days in a row. Then your body will recover for weeks before you have another treatment.

Your doctor will monitor your progress through blood tests, and he’ll adjust your medicine based on the results.

Traditional Drugs

Melphalan (Alkeran) and cyclophosphamide (Cytoxan) stick to a cancer cell’s DNA and prevent it from spreading. They’ve been around for many years and are often used to treat myeloma.

Both can be taken by IV, but in pill form, they may cause fewer side effects.

Make sure you take it on an empty stomach. This will make sure the right amount gets into your bloodstream.

Other chemotherapy drugs used to treat multiple myeloma include:

Another medicine, liposomal doxorubicin (Doxil), can be given by IV to patients with myeloma, but it’s not as common.

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Other Drugs Given With Chemotherapy

Some medicines help chemotherapy drugs work better. For instance:

  • Corticosteroids ( steroids ) like dexamethasone and prednisone help chemotherapy drugs kill more myeloma cells. Your doctor may give you a high dose of one before trying chemotherapy.
  • Immunomodulating agents (IMiDs) like lenalidomide (Revlimid), pomalidomide (Pomalyst), and thalidomide (Thalomid) help your immune system fight the cancer. They’re given in capsules. After chemotherapy, your doctor may still want you to take low doses of these to keep new tumors from growing.
  • Proteasome inhibitors trigger the death of myeloma cells by loading them up with defective proteins. Bortezomib (Velcade) is one that’s often used. It can be injected into a vein or under the skin. Other proteasome inhibitors include carfilzomib (Kyprolis), which you get in an IV, and ixazomib (Ninlaro), which is given in pill form.

One or several of these medicines likely will be added to your treatment. For instance, if a stem cell transplant isn’t right for you, your doctor may suggest a combination of bortezomib, lenalidomide, and dexamethasone (you may hear this combination called VRd or RVd.)

You can also ask your doctor about joining a clinical trial. This will allow you to try a new and possibly more effective drug that’s still being tested.

Induction Therapy

If your multiple myeloma is causing symptoms, you’ll probably start with this type of treatment. The goal is to lower the number of cancer cells, and the proteins they make, in your bone marrow. You’ll probably get this treatment for several months.

Induction therapy is usually a combination of treatments. Your doctor could pair chemotherapy with:

  • Targeted therapy: Drugs that attack specific cells in your immune system that help cancer cells grow
  • Corticosteroids: Medications that stop inflammation, especially around tumors, and can ease your pain

Chemotherapy Before a Stem Cell Transplant

A stem cell transplant is a common treatment for multiple myeloma. If you’re able to have one, you’ll get induction therapy followed by a high dose of a chemotherapy drug to kill as many cancer cells as possible. Or your doctor might give you a combination of some of the other medicines mentioned above.

You’ll then get a transplant of blood-making stem cells. These healthy cells replace the ones that have been damaged by the chemotherapy.

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Consolidation Therapy

You get therapy such as VRd (Velcade, Revlimid, dexamethasone) as a short-term treatment after a stem cell transplant to help the procedure work better and to keep your multiple myeloma at bay.

Side Effects

Chemotherapy drugs can also damage healthy cells and cause side effects. Some of the most common side effects are:

These often get better or go away once your treatment ends. Still, it’s important to tell your doctor about any side effects you’re having so she can help you manage them.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on October 07, 2018

Sources

SOURCES:

American Cancer Society: “Chemotherapy and other drugs for multiple myeloma,” “Stem cell transplant for multiple myeloma,” “Chemo Side Effects.”

Multiple Myeloma Research Foundation: “Multiple Myeloma Treatment” and Multiple Myeloma Drug Therapies,” “What to Expect: Targeted Therapies.”

Cancer Research UK: “Cyclophosphamide,” "Bendamustine (Levact).”

Macmillan Cancer Support: “Treatment to Control Myeloma.”

Canadian Cancer Society: “Chemotherapy for Multiple Myeloma,” “Consolidation therapy for multiple myeloma,” “Induction therapy for multiple myeloma.”

International Myeloma Foundation: “Understanding Dexamethasone and Other Steroids.”

Memorial Sloan Kettering Cancer Center: “Chemotherapy, Immune-Modifying Drugs and Proteasome Inhibitors.”

National Cancer Institute: “Chemotherapy.”

CancerCare.org: “Treatment Update: Multiple Myeloma.”

UpToDate: “Patient Information: Multiple Myeloma: Beyond the Basics.”

Blood Journal: “Lenalidomide, Bortezomib, and Dexamethasone (RVD) As Induction Therapy in Newly Diagnosed Multiple Myeloma (MM).”

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