Multiple Myeloma Treatment

If you have multiple myeloma, remember that you often have a lot of choices in how to treat it. You and your doctor will work together to create a cancer treatment plan that's right for you.

The goal of multiple myeloma treatment is to shrink your tumors, stop the cancer from spreading, keep your bones strong, and help you feel better and live longer. To do this, you might get medication, a stem cell transplant, radiation, a type of blood filtering called plasmapheresis, and surgery.

The treatment plan that you and your doctor choose will depend on:

  • Your age
  • How much your cancer has spread in your body, called the stage of your disease
  • Lab test results
  • Symptoms you have, like fatigue or pain
  • Your lifestyle and general health

Drugs That Treat Multiple Myeloma

Using medication to treat cancer is called chemotherapy. You might take just one medicine or a mix of them. Some come in pills, while others are shots into your vein or muscle.

Chemotherapy

These drugs kill cancer cells or keep them from spreading. They include:

  • Bendamustine (Treanda)
  • Cyclophosphamide (Cytoxan)
  • Doxorubicin (Adriamycin)
  • Etoposide (VP-16)
  • Liposomal doxorubicin (Doxil)
  • Melphalan (Alkeran, Evomela)
  • Vincristine (Oncovin)

Corticosteroids

Your doctor may also prescribe these. Sometimes you'll get them along with your chemotherapy so you have less nausea and vomiting during treatment. Commonly used steroids include:

  • Dexamethasone
  • Prednisone

Immunomodulators. These medications help your immune system fight cancer cells in your blood. Some activate certain immune cells, while others prevent cancer cells from putting out growth cells. They can even kill myeloma cells outright. They include:

  • Lenalidomide (Revlimid)
  • Pomalidomide (Pomalyst)
  • Thalidomide (Thalomid) 

They can cause birth defects if you take them while you're pregnant, so talk to your doctor about using birth control.

Monoclonal Antibodies

These man-made versions of your body's immune cells attack specific targets, like proteins on myeloma cells. Some are used in combination with other drugs:

  • Daratumumab (Darzalex)
  • Denosumab (Xgeva)
  • Elotuzumab (Empliciti)

Histone Deacetylase (HDAC) Inhibitors

These medications affect which genes are active or turned on inside cells. They do this by interacting with proteins in chromosomes called histones.

  • Panobinostat (Farydak)

Proteasome Inhibitors

These medications prevent cancer cells from growing. They do this by stopping enzymes in cells called proteasomes from attacking proteins that control cell growth. They include:

  • Bortezomib (Velcade)
  • Carfilzomib (Kyprolis)
  • Ixazomib (Ninlaro)

They can cause birth defects if you take them while you're pregnant, so talk to your doctor about using birth control.

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Procedures and Watchful Waiting

CAR T-Cell Therapy

This treatment is not approved for multiple myeloma yet, but it is being tested to see how safe it is and how well it works. CAR T stands for chimeric antigen receptor (CAR) T-cell therapy. Doctors take some of your blood and remove the T cells, which are considered workhorses of your immune system. They use a disarmed virus to program these cells to spot and kill cancer cells. The cells are returned to your body so they can multiply and get to work.

Plasmapheresis

This is a way to remove myeloma protein from the liquid part of your blood, called plasma. It won't get rid of your disease, but it may relieve your symptoms for a short time. You'll probably also get chemotherapy or treatment with another drug at the same time.

Radiation

Doctors use external beam radiation to kill cancer cells. It's kind of like getting an X-ray. And you might have side effects like:

  • Blistered or peeling skin
  • Fatigue
  • Nausea
  • Diarrhea
  • Low blood counts

Stem Cell Transplant

Myeloma damages your bone marrow where cells, called stem cells, make new blood. A stem cell transplant can help your body make new, healthy blood cells. You can get new stem cells from a healthy donor. In the standard treatment, your doctor collects some of your own stem cells from your blood and gives them back to you.

Before a transplant, you'll get high-dose chemotherapy to kill any cancer in your bone marrow. It could last for several days. You also may receive radiation therapy. Then the doctor will put stem cells back into your blood through an IV. (If you're using your own stem cells, the doctor will collect them from you before you start chemo.) You may not feel much pain, and you'll be awake while it's happening.

It can take up to 2 weeks after the transplant for your bone marrow to start making new blood cells. You may need to stay in the hospital during this time. You'll also have a higher risk of infection, so your doctor might give you antibiotics to keep you from getting sick.

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Using your own stem cells for a transplant can make myeloma go away for a while, sometimes several years, but it won't cure the disease.

Watchful Waiting

This is an option when you have:

  • Monoclonal gammopathy of undetermined significance (MGUS): This means your blood tests show a high amount of certain types of proteins that can be a precancerous form of multiple myeloma.
  • Smoldering myeloma: You're diagnosed with myeloma, but it isn't yet causing symptoms.

If you and your doctor decide on watchful waiting instead of treatment, you'll do just that -- keep a close watch on you to see if the disease has progressed.

Treating Complications

Doctors use a number of methods to treat the damage multiple myeloma causes throughout your body.

Bone damage or pain:

  • Bisphosphonates, drugs that help strengthen your bones
  • Surgery to help stabilize broken bones or vertebrae 
  • Radiation to ease bone pain

Kidney damage:

  • Fluids
  • Plasmapheresis, a treatment that removes extra myeloma protein from your blood
  • Dialysis
  • Avoid NSAID medications (such as ibuprofen and naproxen)

Anemia:

  • Dietary supplements like iron, folate, or vitamin B12
  • Growth hormones such as erythropoietin (EPO, Epogen, and Procrit) or colony-stimulating factors (CSFs)

Infections:

As a result of low white blood cell counts:

  • Vaccinations
  • Intravenous (IV) antibodies
  • Preventive herpes medications

As a result of taking proteasome inhibitors:

  • Colony-stimulating factors (Leukine, Neulasta, Neupogen)
  • Antibiotics or antifungals

Blood clots:

  • Blood thinners (aspirin, heparin)
  • Nondrug methods (for example, compression stockings)

Lifestyle Changes

To stay healthy during treatment and possibly lower the odds that your cancer will come back, you can make certain changes such as:

  • Quit smoking.
  • Eat a healthy diet.
  • Get regular physical activity.
  • Keep a healthy weight.

Will I Have Side Effects?

Side effects are possible, though not everyone has the same ones. The treatments may not affect you as much as another person. Some, like blood clots, may be serious but are rare.

The side effects that you might have from multiple myeloma treatment include:

  • Too few red blood cells (this is called anemia)
  • Bleeding problems
  • Blood clots
  • Bruising
  • Constipation
  • Diarrhea
  • Fatigue
  • Infections
  • Nausea
  • Nerve pain, tingling, or numbness
  • Vomiting

Talk to your doctor about how your treatment makes you feel. There may be ways to reduce your side effects, including lowering your drug dosage, changing medications, taking aspirin to fight blood clots, changing your diet to help with constipation or diarrhea, or giving you other medicines to ease nausea or fatigue.

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What Else Can I Do?

Stick with your multiple myeloma treatment plan. Your medications will work better against your cancer if you take them as prescribed. If you take pills at home, follow the instructions carefully.

Don't be afraid to talk to your doctor or nurse if you don't understand how to take your medicine. Don't stop taking it if you have side effects. Instead, call your doctor's office and talk about your options.

WebMD Medical Reference Reviewed by Neha Pathak, MD on May 08, 2019

Sources

SOURCES:

American Cancer Society: "Stem cell transplant for multiple myeloma."

FDA News Releases: "FDA approves Darzalex for patients with previously treated multiple myeloma," "FDA approves Empliciti, a new immune-stimulating therapy to treat multiple myeloma," "FDA approves Ninlaro, new oral medication to treat multiple myeloma."

Memorial Sloan Kettering Cancer Center.

Multiple Myeloma Research Foundation.

Patton, J. Journal of Oncology Practice, published online July 2008.

National Cancer Institute: “CAR T Cells: Engineering Patients' Immune Cells to Treat Their Cancers.”

Multiple Myeloma Research Foundation: “Radiation Therapy for Multiple Myeloma,” “Standard Treatments,” “Symptoms, Side effects and Complications.”

American Cancer Society: “Drug Therapy for Multiple Myeloma,” “Supportive Treatments for Patients With Multiple Myeloma.”

The Lancet Oncology: “Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomised, controlled, phase 3 study.”

NYU Langone Health / Pearlmutter Cancer Center: “Watchful Waiting for Multiple Myeloma.”

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