Treatments for Multiple Myeloma
The need for multiple myeloma treatment depends on whether or not you are having symptoms. People without symptoms may not need myeloma treatment. Instead, their doctors may monitor the disease for signs that it is progressing. This is watchful waiting. However, people at high risk for disease progression may need to start treatment before symptoms develop. Once you and your doctor make the decision to start treatment for multiple myeloma, it typically goes in phases:
Induction therapy is the first phase of treatment. The goal is to quickly control the cancer and kill as many cancer cells as possible.
Consolidation therapy comes after induction therapy. The goal is to eliminate any remaining cancer cells.
Maintenance therapy is the third phase. The goal is to keep the disease in remission for as long as possible.
Here is a look at the possible multiple myeloma treatment options within each stage.
Chemotherapy—or chemo—uses powerful drugs to kill cancer cells, or stop or slow their growth. These drugs travel through the bloodstream to find cancer cells everywhere in the body. This makes chemo very useful for treating multiple myeloma. However, chemo is not selective—meaning it does not only kill cancer cells. Chemo drugs will kill any rapidly multiplying cell. This includes some types of normal cells, such as hair follicles and the lining of the digestive tract. Many of the side effects of chemo are the result of this action.
Multiple myeloma chemotherapy is usually part of all three phases of treatment. There are a variety of chemo drugs to treat multiple myeloma, including:
Cyclophosphamide (Cytoxan, Neosar)
Doxorubicin (Adriamycin, Doxil)
Etoposide (Toposar, VePesid)
You typically take more than one chemo drug in cycles that last for a few weeks. Doctors may also use corticosteroids in combination with chemo.
Unlike traditional chemotherapy, targeted therapy is selective. It works by using specific markers or characteristics unique to cancer cells. This often means fewer and less severe side effects. This therapy may also work when standard chemo does not.
The drugs in this group represent some of the newest treatments for multiple myeloma:
Histone deacetylase (HDAC) inhibitors target a specific enzyme. Panobinostat (Farydak) is in this class.
Monoclonal antibodies attack a target on myeloma cells. Elotuzumab (Empliciti) and daratumumab (Darzalex) are in this class.
Proteasome inhibitors target certain enzymes (proteasomes) and help control cell division. This class includes bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro).
They can be useful during induction therapy and maintenance therapy.
Immunotherapy—or biologic therapy—for multiple myeloma modulates the immune system to help fight cancer. These multiple myeloma drugs can boost the immune system to find and kill cancer cells better. Drugs in this class include:
Immunomodulators including lenalidomide (Revlimid), pomalidomide (Pomalyst), and thalidomide (Synovir, Thalomid)
Interferons, which are proteins that boost overall immune system function
Doctors use this kind of therapy for both induction and maintenance phases.
Consolidation therapy for multiple myeloma involves high-dose chemotherapy. This treatment destroys the bone marrow where the myeloma cells grow. However, it can lead to life-threatening complications because the bone marrow makes new blood cells—the red blood cells, white blood cells, and platelets necessary for good health. So it is necessary to restore the body’s ability to make new blood cells. A stem cell transplant accomplishes this goal.
Stem cells are the cells that form new blood cells. Stem cells are present in both the bone marrow and the bloodstream. In the past, doctors had to harvest bone marrow to find stem cells. However, new technology allows doctors to collect them directly from the bloodstream. There are two types of stem cell transplant:
Allogeneic, which uses stem cells from a donor
Autologous, which takes your own stem cells before high-dose chemo and freezes them for use afterwards. This is the standard type of transplant for people with multiple myeloma.
The goal of supportive treatment is to alleviate symptoms of multiple myeloma or its treatment. It does not treat the disease itself. Supportive treatments for multiple myeloma include:
Blood transfusions to correct anemia (low red blood cell count)
Bone-modifying drugs to treat weak, damaged or dissolved bone tissue. Doctors typically use bisphosphonate drugs, such as zoledronic acid (Zometa) and pamidronate (Aredia). However, the drug, denosumab (Xgeva), is an alternative for some people. It works differently, but is equally effective.
IVIG (intravenous immunoglobulin) gives antibodies through a vein to help fight or prevent infections. This may be necessary when blood tests show low levels of normal antibodies.
Plasmapheresis removes excessive amounts of M protein from the blood. This may be necessary when the blood becomes too thick with the protein—called hyperviscosity. This can interfere with adequate blood flow.
The treatment that is best for you depends on your symptoms and your overall health. Talk with your doctor about the goals, benefits, and side effects of multiple myeloma treatment. Being informed will help you make the best decision for you.