Multiple Myeloma Treatment

People with multiple myeloma have many treatment options. The options are watchful waiting, induction therapy, and bone marrow transplant. Sometimes a combination of methods is used.

Radiation therapy is used sometimes to treat painful bone disease. It may be used alone or along with other therapies. See the Supportive Care section to learn about ways to relieve pain.

The choice of treatment depends mainly on how advanced the disease is and whether you have symptoms. If you have multiple myeloma without symptoms (smoldering myeloma), you may not need cancer treatment right away. The doctor monitors your health closely (watchful waiting) so that treatment can start when you begin to have symptoms.

If you have symptoms, you will likely get induction therapy. 

When treatment for myeloma is needed, it can often control the disease and its symptoms. People may receive therapy to help keep the cancer in remission, but myeloma can seldom be cured. Because standard treatment may not control myeloma, you may want to talk to your doctor about taking part in a clinical trial. Clinical trials are research studies of new treatment methods.

Watchful Waiting

People with smoldering myeloma or Stage I myeloma may be able to put off having cancer treatment. By delaying treatment, you can avoid the side effects of treatment until you have symptoms.

If you and your doctor agree that watchful waiting is a good idea, you will have regular checkups (such as every 3 months). You will receive treatment if symptoms occur.

Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. In some cases, it may reduce the chance to control myeloma before it gets worse.

You may decide against watchful waiting if you don’t want to live with untreated myeloma. If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option in most cases.

Induction Therapy

Many different types of drugs are used to treat myeloma. People often receive a combination of drugs, and many different combinations are used to treat myeloma.

Each type of drug kills cancer cells in a different way:

• Chemotherapy: Chemotherapy kills fast-growing myeloma cells, but the drug can also harm normal cells that divide rapidly.
• Targeted therapy: Targeted therapies use drugs that block the growth of myeloma cells. The targeted therapy blocks the action of an abnormal protein that stimulates the growth of myeloma cells.
• Steroids: Some steroids have antitumor effects. It is thought that steroids can trigger the death of myeloma cells. Steroids may be used alone or with other drugs to treat myeloma.

You may receive the drugs by mouth or through a vein (IV). The treatment usually takes place in an outpatient part of the hospital, at your doctor’s office, or at home. Some people may need to stay in the hospital for treatment.

Bone Marrow Transplant

Many people with multiple myeloma may get a bone marrow transplant. A bone marrow transplant allows you to be treated with high doses of drugs. The high doses destroy both myeloma cells and normal blood cells in the bone marrow. After you receive high-dose treatment, you receive healthy cells through a vein. (It’s like getting a blood transfusion.) New blood cells develop from the transplanted cells. The new blood cells replace the ones that were destroyed by treatment.

Bone marrow transplants take place in the hospital. Some people with myeloma have two or more transplants.

Cells may come from you or from someone who donates their cells to you:

• From you: An autologous bone marrow transplant uses your own cells. Before you get the high-dose chemotherapy, your cells are removed. The cells may be treated to kill any myeloma cells present. Your cells are frozen and stored. After you receive high-dose chemotherapy, the stored cells are thawed and returned to you.
• From a family member or other donor: An allogeneic bone marrow transplant uses healthy cells from a donor. Your brother, sister, or parent may be the donor. Sometimes the cells come from a donor who isn’t related. Doctors use blood tests to be sure the donor’s cells match your cells. Allogeneic bone marrow transplants are under study for the treatment of multiple myeloma.
• From your identical twin: If you have an identical twin, a syngeneic bone marrow transplant uses cells from your healthy twin.

There are two ways to get cells for people with myeloma. They usually come from the blood (peripheral blood bone marrow transplant). Or they can come from the bone marrow (bone marrow transplant).

After a bone marrow transplant, you may stay in the hospital for several weeks or months. You’ll be at risk for infections because of the large doses of chemotherapy you received. In time, the transplanted cells will begin to produce healthy blood cells.