Currently, there are many treatments that slow down the progression of multiple myeloma, reduce tumors, and relieve pain and other symptoms. Clinical trials are also available at every stage of treatment.

Multiple myeloma treatments are tailored to patients’ age, general health, lifestyle, goals for treatment, response to any previous treatments, the disease’s stage, and whether the disease is active or inactive.

Smoldering multiple myeloma, also called inactive or asymptomatic multiple myeloma, is a stable form of myeloma where the affected person does not feel any symptoms. In this case, the person may not need treatment. Patients with smoldering multiple myeloma should see their doctors frequently, so that doctors can start treatment if the myeloma progresses to active or symptomatic multiple myeloma.

Patients with active or symptomatic multiple myeloma experience various symptoms, such as kidney problems, hypercalcemia (high levels of calcium in the bone), anemia, and bone damage. There are many treatment options for patients with active myeloma, including induction therapy, radiation therapy, high-dose chemotherapy with stem cell transplants, and maintenance therapy. Some of these options treat symptoms of myeloma, while others directly target the cancerous tumors. Course of treatment is determined on an individual basis and is generally based on a combination of the patient’s age, general health, and symptoms.

Induction Therapy

A patient’s first treatment regimen of chemotherapy drugs is called an induction therapy. The goal of induction therapy is to control the myeloma and reduce any tumors. There are many combinations of drugs that doctors can use to help fight multiple myeloma.

Induction therapies vary depending on whether the patient will receive a stem cell transplant afterward. For those who will not have stem cell transplants, three possible and well-established drug regimens are:

• Melphalan (Alkeran), prednisone, and thalidomide (Thalomid)
• Melphalan, prednisone, and Velcade (bortezomib)
• Revlimid (lenalidomide) and low-dose dexamethasone (Decadron)

However, any individual’s treatment might vary depending on the patient’s unique situation.

Before transplantation, patients routinely receive four rounds of chemotherapy. For these patients, common combinations of drugs used for induction therapy include some of the following: dexamethasone, Revlimid, thalidomide, and/or Velcade. Physicians avoid using melphalan because it interferes with collecting stem cells for the transplant.

Radiation Therapy

Radiation therapy uses high-energy X-rays to kill myeloma cells. Doctors use radiation therapy as a supplement to chemotherapy, to target specific areas that have painful myeloma tumors that are damaging the bone in that area. Unlike some other types of cancer, which deliver the treatment through radioactive “seeds” that are put into the body, myeloma patients receive radiation therapy externally from a machine.

High-Dose Chemotherapy with Stem Cell Transplants

In high-dose chemotherapy with stem cell transplants, doctors use an intense chemotherapy regimen to kill off myeloma cells. Since chemotherapy kills malignant tumor cells as well as healthy cells, patients receive a stem cell transplant to replace healthy bone marrow.

Commonly, the stem cells used in the transplant are the patient’s own. But sometimes, they come from a separate donor. When the stem cells are the patient’s own, the transplant is called an autologous stem cell transplant. A donor transplant is called an allogeneic stem cell transplant.

For autologous stem cell transplants, doctors will collect stem cells from their patients after their induction therapy, but before the high-dose chemotherapy begins. These stem cells usually come from the peripheral blood, or blood that is circulating through the body and are often taken out through the arm. In rare cases, doctors take stem cells directly from patients’ bone marrow. In either case, a doctor may take enough stem cells for two transplants, in case the patient needs a second transplant later.

After stem cell collection, patients undergo the high-dose chemotherapy, usually with high doses of melphalan.

Then, after receiving the high-dose chemotherapy, patients get an infusion of their own previously collected, healthy stem cells through a tube that goes into the chest. The stem cells will migrate through the blood stream into the damaged bone marrow to start producing cells again.

However, when a person receives an allogeneic stem cell transplant, the transplanted cells come from another, closely matched donor: often a healthy family member such as a brother or a sister. In this case, stem cells are not taken from the patient, but taken from the donor when the time for transplantation nears.

Currently, researchers are studying non-myeloablative transplants, sometimes called mini-transplants. Here, the preceding chemotherapy is a lower dose in order to conserve the bone marrow cells prior to treatment. A patient and his or her doctor can try a non-myeloablative transplant in a clinical trial.

Maintenance Therapy

Maintenance therapy is the treatment patients receive after their induction therapy, and after any possible stem cell transplants. The goal of maintenance therapy is to prevent a cancer relapse. Thalidomide is a standard maintenance therapy. Other options include interferons or steroids such as dexamethasone and prednisone.

If the Multiple Myeloma Returns

If the multiple myeloma comes back less than six months after the end of treatment, the patient’s doctor might try the induction therapy again. The doctor might even try another treatment of high-dose chemotherapy with another stem cell transplant.

If it has been more than six months since the first treatment ended, or if patients and their doctors decide to follow a different approach, they may try another drug regimen. Velcade is commonly included in relapse therapy. The time period after relapse is also a common time for patients to try clinical trials. For more information on current clinical trials, please see the National Institutes of Health’s ClinicalTrials.gov.

Supportive Care

Patients get supportive care to treat some of the serious symptoms of multiple myeloma and to relieve pain. Examples of supportive care include bisphosphonates for bone loss and bone pain, antibiotics for infections, radiation therapy for tumors in the bone and bone pain, and chemotherapy for pain.

Prognosis »