Last week, I recommended a newly diagnosed multiple myeloma patient should take some time, step back and gather information about the growing number of treatment options.

Let's assume you have followed my advice by getting your oncologist’s opinion, then asking why. Next, you have spoken with one or more patient counselors at the International Myeloma Foundation (IMF). You have searched The Myeloma Beacon archives for possible options. Hopefully you have even sought out a second opinion at a major cancer center which specializes in treating multiple myeloma patients.

What's the next step? How do you know which therapy option is right for you?

The answer isn't as complicated or overwhelming as it might seem. Last fall I attended a support group meeting in Stillwater, Minnesota. The guest speaker was Dr. Jim O'Connor, an orthopedic surgeon from Eau Claire, Wisconsin.

Dr. O'Connor is also a multiple myeloma patient. He was diagnosed with multiple myeloma five years ago. Before Dr. O'Connor was scheduled to speak, the group discussed a variety of therapy options. Dr. O'Connor listened for a number of minutes before volunteering the following words of wisdom: "When it comes to multiple myeloma therapy, there is no one right answer - only alternatives."

So true! He added that many of today's patients will end up using most of the available therapies at one time or another anyway. His advice: Make an informed decision and don't look back!

So unless you are considering traveling to Little Rock, Arkansas, to begin an aggressive Total Therapy regimen (doctors there are very specific about which order drugs are administered), the initial (induction) therapy you choose probably isn't that important. Just make sure you and your doctor have discussed if and when you will most likely get a stem cell transplant.

Why? Because certain novel therapy agents (chemotherapy drugs) are better to use pre-transplant than others. Some therapy choices can make it difficult to harvest stem cells now - or later.

Please address the timing of a possible stem cell transplant with your medical team. If you are considering a stem cell transplant as a therapy option, most transplant experts agree it is best to harvest your stem cells as early in the induction process as possible.

In the recent past, most newly diagnosed myeloma patients were immediately placed on one of the following novel therapy agents, along with dexamethasone ^[1] (Decadron): thalidomide ^[2] (Thalomid), Revlimid ^[3] (lenalidomide) or Velcade ^[4] (bortezomib). Today, these drugs are often used in combination. Sometimes additional anti-myeloma agents, such as Doxil ^[5] (pegylated liposomal doxorubicin) or Zolinza ^[6] (vorinostat) are added to the mix.

Regardless of which combination of chemotherapy agents your doctor recommends, never forget to ask why. What are the likely side effects? Why do you think this is the right combination for me?

Then, once you and your medical team decide to move forward, don't forget Dr. O'Connor's advice: "When it comes to multiple myeloma therapy, there is no one right answer - only alternatives." Take a deep breath, grit your teeth and move forward.

Good luck! Feel good and keep smiling! Pat