Multiple Myeloma: Treatments

Specific treatment for myeloma is based on:

  • The patient’s age, overall health, and medical history
  • The extent of the disease
  • The patient’s tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • The patient’s opinion or preference

Treatment may include options such as medications to control pain, care of fractures, or any of the following:

Radiation therapy

Radiation therapy is given if myeloma weakens the vertebrae or backbones, resulting in risk that these bones collapse and start pressing on the nerves and spinal cord. Immediate treatment with radiation therapy may prevent paralysis.

Radiation Oncologists may use high-energy x-rays to destroy cancer cells and treat areas of bone damaged by myeloma. In External Beam Radiation Therapy, the energy source is aimed at the body by a machine. This treatment may be given over several weeks.

Chemotherapy

Chemotherapy drugs enter the blood stream with the purpose of destroying cancer cells. These drugs can be taken by mouth or given in a vein or a muscle.
Many different types of drugs are used to treat multiple myeloma and chemotherapy drugs are often used in combination to increase their effectiveness, since MM often spreads throughout the body.
The chemotherapy agents used to treat MM may include

  • Melphalan (Alkeran)
  • Cyclophosphamide (Cytoxan)
  • Etoposide (VP-16)
  • Liposomal doxorubicin (Doxil)
  • Bendamustine (Trenda)

Combinations of these drugs are more effective than any single drug.

Often chemotherapy agents are combined with other types of drugs like proteasome inhibitors, Immune-modifying drugs and corticosteroids.

Novel Drugs

Immune-Modifying Drugs

These drugs help the body’s immune system fight the cancerous myeloma cells. Our experts use the following approved drugs in this class:

  • Lenalidomide (Revlimid) is similar to thalidomide but with fewer side effects and appears to work better for patients with MM.
  • Pomalidomide (Pomalyst) is the newest immune –modifying drug approved for MM, is often used when other drugs are no longer effective.

Proteasome Inhibitors

Proteasomes break down proteins in the cells that are damaged or no longer needed. Proteasome inhibitors block this process and the result is cell death. Cancerous cells are more sensitive to this blockade than healthy cells, and are apt to die sooner, when subjected to these drugs.

  • Bortezomib (Velcade) is first generation proteasome- inhibitor approved for MM.
  • Carfilzomib (Kyprolis) is the second generation proteasome inhibitor approved for MM and can be effective when other drugs such as bortezomib no longer work.

Corticosteroids

Steroids such as prednisone and dexamethasone have been the cornerstone of treatment of MM for many years and are often given in combination with other therapies.

Stem Cell Transplantation (LINKS)

• Autologous Stem Cell Transplant

• Allogenic Stem Cell Transplant

Stem Cell Transplantation

A bone marrow transplant can also be referred to as a stem cell transplant and is a method of treating patients with specific types of cancers or bone marrow diseases.

There are two basic types of stem cell transplants. The types of transplants are named according to who donated the stem cells. If the person donating the stem cells is the patient, the transplant is called an autologous transplant or Auto for short ("auto" means self). If the stem cells are donated by someone other than the patient, the transplant is called an allogeneic transplant or Allo for short ("allo" means other).