Multiple Myeloma

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Multiple Myeloma Treatment

Multiple myeloma treatment depends on several factors, including the stage of the disease and the overall health and age of the patient. The goal of treatment is to reduce symptoms and prolong survival (called palliative treatment). Treatment for multiple myeloma may involve radiation therapy, chemotherapy and other medications (e.g., targeted therapy, corticosteroids), stem cell transplantation, and additional treatments.

Patients with early stage multiple myeloma (i.e., smoldering myeloma) or slow-growing (indolent) myeloma usually do not require treatment. Instead, these patients are closely monitored and receive regular testing (called watchful waiting).

Radiation Therapy
Multiple myeloma treatment for patients with localized disease (i.e., myeloma that affects a small area) that causes bone pain often includes radiation therapy. This treatment, which also is called radiotherapy and external beam radiation, involves using high-energy x-rays to destroy cancer cells and shrink tumors.

Radiation therapy usually is administered once daily (e.g., 5 days per week) for several weeks. Treatment sessions usually last about 30 minutes. Radiation side effects include fatigue, skin changes (e.g., redness), and hair loss in the treatment area.

Chemotherapy
Chemotherapy involves using drugs to destroy cancer cells. Multiple myeloma treatment may include standard chemotherapy or high-dose chemotherapy. In many cases, a combination of chemotherapy drugs and other medications (e.g., corticosteroids [prednisone]) is used to treat multiple myeloma.

Chemotherapy is administered intravenously (i.e., through a vein; IV) or orally, usually in a cancer treatment center or hospital. Some patients with multiple myeloma receive chemotherapy prior to undergoing stem cell transplantation. This type of treatment is called induction therapy.

Chemotherapy drugs and other medications used to treat multiple myeloma include the following:

• Bortezomib (Velcade®)
• Dexamethasone (Decadron®)
• Doxorubicin (Adriamycin®)
• Lenalidomide (Revlimid®)
• Melphalan (Alkeran®)
• Thalidomide (Thalomid®)
• Vincristine (Vincasar®)

Chemotherapy is a systemic treatment, which means that it affects cells throughout the body. Common side effects of chemotherapy drugs used to treat multiple myeloma include the following:

• Birth defects (when used in women who are pregnant)
• Constipation
• Diarrhea
• Dizziness
• Drowsiness
• Hair loss
• Loss of appetite
• Low blood counts (may cause fatigue, weakness, infections, bruising, and abnormal bleeding)
• Mouth sores
• Nausea
• Numbness and tingling in the fingers and toes (peripheral neuropathy)

Stem Cell Transplantation
Stem cell transplantation (SCT) is often used to treat multiple myeloma in patients younger than 70 years of age who are otherwise healthy. Stem cells are the blood-forming cells in the bone marrow and lymphatic tissue from which all types of blood cells (e.g., red blood cells, white blood cells, platelets) and plasma cells arise. In stem cell transplantation, high-dose chemotherapy is used to destroy bone marrow cells (i.e., myeloma cells, normal blood cells) and healthy stem cells are then transplanted through a vein. The transplanted stem cells then begin to produce healthy blood cells.

There are two types of stem cell transplants: autologous stem cell transplant and allogeneic stem cell transplant. In an autologous stem cell transplant, blood-forming stem cells are removed from the patient (called leukapheresis) and frozen prior to chemotherapy. After chemotherapy, the stem cells are returned to the patient through an IV and begin making new healthy blood cells.

This type of stem cell transplant carries a lower risk for severe side effects than allogeneic stem cell transplant. In some cases, patients who have multiple myeloma receive more than one autologous stem cell transplant.

In an allogeneic stem cell transplant, the transplanted stem cells come from a relative or an unrelated donor and whose tissue closely matches the patient's. Although this type of transplant carries a higher risk than an allogeneic stem cell transplant, it may be more beneficial. Some studies have shown that donor stem cells may help destroy myeloma cells.

During this procedure, patients are at increased risk for serious infections. Multiple myeloma patients are often hospitalized for several weeks or months while undergoing stem cell transplantation.

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