Multiple Myeloma Treatment Options

Treatment

Watchful Waiting
Induction Therapy
Stem Cell Transplant
People with multiple myeloma have many treatment options. The options are watchful waiting, induction therapy, and stem cell 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. Sometimes a stem cell transplant is part of the treatment plan.
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. See the Taking Part in Cancer Research section.

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.

You may want to ask your doctor these questions before choosing watchful waiting:

• If I choose watchful waiting, can I change my mind later on?
• Will the cancer be harder to treat later?
• How often will I have checkups?
• Between checkups, what problems should I tell you about?

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. A steroid 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.
The side effects depend mainly on which drugs are given and how much:

• Blood cells: When a drug used for myeloma treatment lowers the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop therapy for a while or reduce the dose of drug. There are also medicines that can help your body make new blood cells.
• Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may be somewhat different in color and texture.
• Cells that line the digestive tract: Chemotherapy and targeted therapy can cause poor appetite, nausea and vomiting, diarrhea, constipation, or mouth and lip sores. Ask your health care team about medicines and other ways to help you cope with these problems.

The drugs used for myeloma may also cause dizziness, drowsiness, numbness or tingling in hands or feet, and low blood pressure. Most of these problems go away when treatment ends. You may find it helpful to read the NCI booklet Chemotherapy and You. You may also want to read the NCI fact sheet Targeted Cancer Therapies.

You may want to ask your doctor these questions before having induction therapy:

• Which drugs will I get? What will the treatment do?
• When will treatment start? When will it end? How often will I have treatments?
• Where will I go for treatment? Will I have to stay in the hospital?
• Will I have side effects during treatment? What side effects should I tell you about? Can I prevent or treat any of these side effects?
• Will there be lasting side effects? How long will they last? What can I do about them?
• How often will I need checkups?

Stem Cell Transplant

Many people with multiple myeloma may get a stem cell transplant. A stem cell 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 stem cells through a vein. (It's like getting a blood transfusion.) New blood cells develop from the transplanted stem cells. The new blood cells replace the ones that were destroyed by treatment. Stem cell transplants take place in the hospital. Some people with myeloma have two or more transplants.
Stem cells may come from you or from someone who donates their stem cells to you:

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

There are two ways to get stem cells for people with myeloma. They usually come from the blood (peripheral blood stem cell transplant). Or they can come from the bone marrow (bone marrow transplant).
After a stem cell 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 stem cells will begin to produce healthy blood cells.
You may find it helpful to read the NCI fact sheet Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation.