Multiple myeloma isn’t curable, but there are plenty of treatments for it. This gives people with the disease and their doctors a lot of optimism, but also important decisions to make.

“It has perhaps the highest variety of available treatments,” says Parameswaran Hari, MD, professor of medicine at the Medical College of Wisconsin. “The number of weapons we have are increasing over time, so there are a lot of choices.”

Indeed, treatments for myeloma, a cancer of the bone marrow, range from standard-dose and high-dose chemotherapy to steroids, new drugs, and stem cell transplantation to so-called “watchful waiting.” Plus, there are clinical trials for patients at all stages of the disease.

With so many choices, how do you decide which course of action is good for you?

“You’re dealing with a treatable but still incurable disease, so you need the help, either remotely or in a face-to-face consultation, with someone who does this as their main thing,” Hari says. “Even if you have to travel a few hours to get that expertise, it’s well worth the effort.”

Not only will a myeloma center of expertise help you find the right treatment for you, says Hari, it will also “put you in the loop for receiving new drugs, using drugs in a more appropriate fashion, and finding out about drugs that are in the pipeline.”

The Multiple Myeloma Research Foundation’s web site has a link to help you find a treatment center in your area.

You and your medical team will choose your treatment based on answers to several questions, including:

How old are you? Myeloma is most common in people over age 60, and the average age at diagnosis is 70. So for many patients, there is the issue of a person’s ability to handle treatment, Hari says.

“The treatments have become less toxic and more tolerable, but people can become frail as they get older, so the doses have to be adjusted,” he says. “We keep myeloma treatments going on for a very long time. We don’t stop treatment once a patient goes into remission. If it’s more tolerable, that allows a patient to stay on that treatment for a longer period of time.”

A simple test (called a “geriatric assessment”) allows doctors to quickly decide whether a myeloma patient is fit. That helps doctors avoid overtreating those who can’t take it and undertreating those who can.

Are you healthy enough for a stem cell transplant? A stem cell transplant, in combination with high dose-chemo, “represents the best standard of care that we have,” says Sagar Lonial, MD, chief medical officer of the Winship Cancer Institute of Emory University.

But because the procedure is physically demanding, you need to be in good overall health to have it.High-dose chemotherapy kills myeloma cells, but it also destroys normal ones in the bone marrow. Stem cell transplantation replaces these cells.

Do you have any disease complications? Many myeloma drugs have risks, like nerve damage, damage to the heart, and blood clotting. If you’re prone to these kinds of risks, your doctor would not prescribe those drugs, Hari says.

Have you undergone myeloma treatment before? Since there’s no cure for multiple myeloma, there’s a high chance it will come back, Lonial says. And research shows that with each treatment, the length of time it works gets shorter.

So, Lonial says, how you treat a relapse depends on:

  • The side effects you had before and how they relate to your new treatment
  • What other conditions you have
  • How long your first treatment lasted

With multiple myeloma, your treatment options are many and varied. Make sure you and your team take time to discuss which are best for you.

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