Myeloma - Treatment

Drug therapy is used as the primary method of treatment for myeloma. Drug therapy can cause a number of side effects, especially when chemotherapy is used. Chemotherapy drugs are highly potent and toxic enough to damage or kill myeloma cells. However, the drugs will also impact normal cells and cause side effects. Not all patients being treated experience side effects the same way.

If you have myeloma symptoms, your doctor will first determine if you are a candidate for stem cell transplantation. For transplant candidates, drug treatment starts with a mix of agents that don’t cause marrow damage.

Some patients do not want a stem cell transplant. Other patients— such as some older patients or patients with additional medical problems— find that potential transplant risks may outweigh the benefits. For patients who are not candidates for transplantation, treatment will most likely begin with a combination drug therapy. Often, two or three drugs are used simultaneously. As many as six drugs may be combined in some intense treatment regimens. You may be given drugs as pills to take orally, by injection, or through a catheter that is surgically placed in a vein in the upper chest area.

Drug therapy has led to long-term remission in some myeloma patients and a temporary remission or significant slowing of the disease in others. Longer periods of remission are becoming more common as new, more effective drugs become available. Some patients treated with these drugs may become functionally cured of their myeloma.

Treatment methods for people with myeloma have changed significantly over the past several years. Today, some of the drugs used in treating myeloma are taken by mouth. This is called “oral treatment” or “oral therapy.”

High dose chemotherapy with autologous stem cell transplantation is an important treatment option for many patients with myeloma. During this procedure, stem cells are collected from the patient and the patient is then treated with high doses of chemotherapy. Following the chemotherapy, the stem cells are returned through an IV into the patient’s bloodstream. This process rescues the bone marrow from the damaging effects of the high dose chemotherapy by giving it the ability to begin making new blood cells from the stem cells. Improved transplantation techniques have made this procedure relatively safe for many patients, including older patients.

This procedure is associated with good patient response rates. However, it is not appropriate for all patients with myeloma, and it is not a cure for myeloma. Patients should discuss the potential benefits and risks of this type of treatment with their doctors. Standard tests (such as blood and urine protein levels, marrow tests and imaging studies) used to monitor myeloma treatment are also used to measure the response to the stem cell transplant. Maintenance therapy may be necessary after an autologous transplant.

Allogeneic and reduced-intensity allogeneic transplants are also types of stem cell transplants that are used to treat some blood cancers. They are associated with increased side effects and higher rates of mortality than an autologous transplant. The primary difference between autologous and allogeneic transplant is that allogeneic transplants use cells collected from a suitable donor, often a sibling. Specific patients may have an allogeneic transplant or a reduced-intensity allogeneic transplant after first having an autologous transplant.

Discuss stem cell transplants with your doctor to determine if this is a treatment option for you.

Radiation therapy uses high-energy X-rays to kill malignant plasma (myeloma) cells. Radiation may be used to treat myeloma patients in select circumstances, and is the main treatment for plasmacytomas. Specific patients whose disease did not respond well to chemotherapy may also receive radiation therapy. Radiation therapy might not be a good option if the bone lesions causing pain or difficulty are widely dispersed throughout the body. New methods of delivering radiation therapy are currently being researched.

You may receive supportive care to prevent or treat the symptoms of the disease and side effects of therapy. It can be used for conditions such as:

• Treating Anemia: Chemotherapy can cause severe anemia in some patients. In these patients, the administration of an engineered form of the red cell growth factor, erythropoietin (EPO), can alleviate the anemia or decrease the need for blood transfusions.  Patients should discuss potential risks and benefits of this treatment with their doctor.
• Stabilizing Damaged Bones: Vertebroplasty and kyphoplasty are surgical procedures that can help alleviate the back pain that some myeloma patients may experience. In a vertebroplasty, a chemical cement solution is administered to the damaged or broken vertebrae through a catheter. Kyphoplasty involves gently inflating a balloon in the back area to create space before stabilizing the area with the chemical cement solution. These procedures relieve the compression of the bone(s) and can help to alleviate pain and decrease the amount of pain medication the patient needs. The use of bisphosphonates (a type of drug) can help decrease bone pain and the risk of bone fractures. These drugs can also help to prevent high levels of calcium in the blood which can result from bone destruction.
• Preventing Infections: Antibiotics and intravenous immunoglobulins can be administered in order to prevent infections that may develop when the immune system is suppressed.
• Maintaining Kidney Function: Drinking lots of water and other healthy fluids can flush the kidneys and help them filter impurities from the blood.

 Patients with early stage myeloma (such as smoldering myeloma or asymptomatic myeloma) may only need supportive care as treatment, since their disease causes few or no symptoms. In these cases,   supportive care may be given for prevention or treatment of the symptoms, but treatment won’t be given for the myeloma itself. Instead, your doctor will closely monitor the disease in an approach called watch and wait.