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:
- Lab test results
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 they’ll adjust your medicine based on the results.
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:
- Bendamustine (Treanda)
- Doxorubicin (Adriamycin)
- Etoposide (Etopophos, Toposar)
- Vincristine (Oncovin)
Another medicine, liposomal doxorubicin (Doxil), can be given by IV to patients with myeloma, but it’s not as common.
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.
- Histone Deacetylase (HDAC) inhibitors interact with proteins that help control which genes are turned on inside of cells. Panobinostat (Farydak) is one that is used after certain other treatments are already given.
- Selective Inhibitors of Nuclear Export (SINE) helps suppress protein movement from the nucleus of the cancer cell. The drug selinexor (Xpovio) is currently the only one in this class and is used for treating patients with relapse refractory multiple myeloma (RRMM).
- Antibody Drug Conjugates is a new class of drugs designed to treat RRMM patients who have been already treated with at least four prior therapies including an anti-CD38 monoclonal antibody, a proteasome inhibitor and an immunomodulatory agent. The drug belantamab mafodotin-blmf (Blenrep) is currently the only drug classified as a BCMA (B-cell maturation antigen) inhibitor.It attacks the BCMA protein protecting the cancer cell and helps kill the cancer.
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.
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.
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.
Chemotherapy drugs can also damage healthy cells and cause side effects. Some of the most common side effects are:
- Mouth sores
- Hair loss
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 they can help you manage them.