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Chemotherapy for Multiple Myeloma

Medically Reviewed by Melinda Ratini, DO, MS on June 27, 2022

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. These days that’s less common though, since doctors now have newer types of drugs to treat multiple myeloma.

Or you may get chemo 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 your cancer is advanced, your doctor might use chemo to ease your pain and control your symptoms, too.

Doctors often combine two or more treatments to help you the most.

Your 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 track your progress through blood tests, and they’ll adjust your medicine based on the results.

Traditional Drugs

C yclophosphamide (Cytoxan) and melphalan (Alkeran) 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.

You can take both by IV. But they may cause fewer side effects in pill form.

Some other chemotherapy drugs for multiple myeloma are:

Other Drugs Given With Chemotherapy

Some medicines help chemotherapy drugs work better. That’s also true if your cancer comes back (called a relapse), or if your current treatment doesn’t help you enough or stops working (called “refractory” multiple myeloma).

Your doctor may combine chemo with drugs:

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 drugs (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.

Selective inhibitors of nuclear export (SINE) help suppress protein movement from the nucleus of the cancer cell. The drug selinexor (Xpovio) is the only one in this class and is used for treating people with relapsed or refractory multiple myeloma.

Antibody drug conjugates are a newer class of drugs. It can treat people with relapsed or refractory myeloma who’ve already tried at least four other therapies, including an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent. The drug belantamab mafodotin-blmf (Blenrep) is in this class of drugs. It attacks the BCMA protein protecting the cancer cell and helps kill the cancer.

Your doctor will likely add one or several of these medicines 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 drug that’s still being tested. It might work better for you.

It’s hard to say which specific combination of chemo and other drugs would work best for certain groups of people, like younger vs. older people. Each type of multiple myeloma drug isn’t necessarily limited to one group or another, says Krina K. Patel, MD, of MD Anderson Cancer Center in Houston, TX.

Induction Therapy

If your multiple myeloma is causing symptoms, you’ll probably start with this type of treatment. Your doctor might also call it frontline or first-line therapy.

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.

Consolidation Therapy

You may get therapy like Velcade, Revlimid, and dexamethasone (VRd) 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 for a Relapse

Most people with multiple myeloma see their symptoms go away or get better for a while after treatment. Then the symptoms come back or get worse. This usually happens several times over the course of someone’s treatment journey.

Each time your cancer relapses, your doctor can have you try different combinations of medications, including chemo drugs.

Many people with multiple myeloma try each type of drug that’s available at some point during their treatment journey.

But even if you’re eligible to try certain cutting-edge medications, you may have trouble getting them, Patel says. For instance, there are only so many openings for clinical trials that test newer drugs. Access to some newer drugs can be an issue, so chemotherapy is still very important, she says.

Side Effects

Chemotherapy drugs can also damage healthy cells and cause side effects. Some of the most common ones 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 they can help you manage them.

Show Sources

SOURCES:

Krina K. Patel, MD, associate professor, center medical director,  department of lymphoma/myeloma, division of cancer medicine, The University of Texas MD Anderson Cancer Center, Houston.

Up to Date: “Patient education: Multiple myeloma treatment (Beyond the Basics).”

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

Multiple Myeloma Research Foundation: “Multiple Myeloma Treatment,” 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,” “What Is Relapse in Myeloma?”

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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