Myeloma treatment options depend on a number of factors. These factors include the stage of the myeloma, your overall health with consideration to any other conditions such as heart or kidney disease, and the risk of complications from each treatment.
The goals of treatment for myeloma are to:
- Prolong your survival
- Achieve complete remission
- Slow your disease progress
- Prevent further organ damage
- Preserve your quality of life for as long as possible
- Address pain and other myeloma-related symptoms
The "Watch and Wait" Approach to Myeloma Treatment
In the case of indolent, smoldering or asymptomatic myeloma, the best treatment may be no treatment at all. Patients in this boat will have few, if any, signs of disease when they are diagnosed. Research has shown that earlier treatment in these patients does not improve outcomes, and may actually increase the risk of future complications.
For patients with smoldering myeloma, close monitoring of laboratory tests every few months and holding off on treatment until the disease progresses is the standard for care.
Drug Therapies for Myeloma
Chemotherapy is the use of medications to reduce the number of myeloma plasma cells and, in doing so, decrease the proteins they produce.
These medications may be taken by mouth or given intravenously. Depending on your individual situation, your doctor may order several (as many as six) different medications to be given in combination with each other to obtain the best treatment outcomes.
In between treatment cycles, or “rounds” of chemotherapy, your body is allowed to rest and recuperate before beginning therapy again. This will allow you to recover from any side effects.
Some common medications that may be given to treat myeloma include:
- Oncovin, Vincasar (Vincristine)
- Adriamycin (Doxorubicin)
- Decadron (Dexamethasone)
- Thalomid (Thalidomide)
- Velcade (Bortezomib)
- Revlimid (Lenalidomide)
- Alkeran (Melphalan)
- Prelone (Prednisone)
- Cytoxan (Cyclophosphamide)
- BCNU (Carmustine)
- VP-16, Vepesid (Etoposide)
- Platinol (Cisplatin)
- Trisenox (Arsenic Trioxide) -- in clinical trials for treatment of myeloma
You may also be given medications to help with complications of bone loss from your myeloma, such as fractures and high calcium levels in the blood. A group of drugs called bisphosphonates help to prevent existing bone lesions from getting worse, as well as new bone damage from occurring.
The two most common bisphosphonates are:
- Aredia (Pamidronate)
- Zometa (Zoledronic acid)
Radiation Therapy for Myeloma
If your myeloma is localized to one area of your body, radiation therapy may be used. This type of therapy can help relieve pain, and also treat symptoms of compression of the spinal cord, such as numbness, weakness and tingling. Radiation is not practical if there are large areas of disease, as it can make the poor cell production in your marrow even worse.
External beam radiation is the type of therapy that is used in myeloma. It is usually done as an outpatient. You will be asked to change into a hospital gown and lie still on a special treatment table. A machine will deliver energy rays to a very specific area where you are being affected by your myeloma.
The procedure is very similar to having an x-ray, which you may have had during your diagnosis stage. The procedure itself is painless, but may require you to lie still for a long period. Ask your doctor if you should plan to take a pain reliever before having your therapy.
Stem Cell or Marrow Transplantation for Myeloma
For some patients, stem cell transplant has been shown to reduce progression of the disease and prolong survival. In the case of myeloma, the most common type is the autologous transplant.
In an autologous transplant, you will be given a medication called Neupogen (Granulocyte-Colony Stimulating Factor, (G-CSF, Filgrastim) with or without chemotherapy. This medication, or combination of medications, will stimulate your bone marrow to increase the number of stem cells in your blood. This stage is called mobilization.
Once the stem cells are mobilized into your blood, they are collected, stored and frozen for your future use.
You will then receive high dose chemotherapy to destroy the myeloma cells in your bone marrow. This is called your conditioning regimen.
Unfortunately, this high dose chemotherapy also destroys the normal cells in your marrow as well. So, a couple of days after you receive this chemo, your stored stem cells are thawed and infused back into you. These stem cells will find their way back to the marrow, and start to produce new blood cells.
In some cases, a second autologous transplant will be done after recovery from the first, if the patient can tolerate it. This is called a tandem or double autologous transplant.
In an allogeneic transplant, the same principles apply but the stem cells are collected from a donor. This donor may be a relative, usually a brother or sister, or an unrelated donor, with the same tissue type as you.
Although stem cells transplants have shown some success in treating myeloma, they may not be considered for every patient. There is the potential for complications, and this risk is increased if you have other medical conditions such as heart or kidney disease. In addition, some cancer centers will not perform transplants in patients above a specific age, such as 70 or 75.
Research is ongoing for myeloma treatment options and many new therapies may be just as effective as stem cell transplant with less risk.
Following transplant, you may need to continue with maintenance therapy. Studies to determine a standard maintenance therapy regimen for myeloma patients are continuing. The goal of maintenance therapy is to keep your myeloma in a longer remission.
