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Treatment can be very effective at controlling symptoms| and stopping the development of myeloma.
Chemotherapy| is the use of anti-cancer (cytotoxic) drugs and is one of the main treatments used to control myeloma. Chemotherapy drugs stop cancer cells dividing and reproducing themselves. They circulate in the blood and can reach myeloma cells all over the body.
One or more chemotherapy drugs are given for a few days every 3-4 weeks, followed by a rest period during which you’ll have regular blood tests| to check the effect of the drugs. The dose of the drugs may be altered according to the results of your blood tests.
Chemotherapy may be given to you as an outpatient, but you may sometimes need to spend a few days in hospital.
Chemotherapy drugs used to treat myeloma include:
Some chemotherapy drugs for myeloma are given as tablets or capsules (orally), others by injection into a vein (intravenously). The drugs melphalan and cyclophosphamide are commonly used to treat myeloma and are usually given as tablets or capsules, but can also be given into a vein. They are most often given with steroid tablets. When given as tablets, these drugs can have fewer side effects. This makes them more suitable for people who aren’t able to have stronger treatments.
Biological therapies| are drugs which have an anti-cancer effect but work differently from chemotherapy. Each drug works in a different way but they all affect the way cancer cells grow or divide. The biological therapies used as part of initial treatment for myeloma are thalidomide| and bortezomib|.
Thalidomide is a drug that has been shown to be effective in treating myeloma. It’s thought that it stops cancers from developing new blood vessels. This reduces the cancer’s supply of oxygen and nutrients, and can stop the cancer growing or make it shrink. Thalidomide is taken daily, usually in the evening, as a tablet.
These can include:
Sometimes thalidomide can damage nerves, which can cause tingling in your hands and feet, known as peripheral neuropathy|. You may notice that you have difficulty fastening buttons or doing similar fiddly tasks. Your hands and feet may also become more sensitive to the cold. Tell your doctor if you notice any of these symptoms. They usually disappear slowly after treatment ends, although it can sometimes take months.
Thalidomide can cause birth defects, so it should not be given to pregnant women. People taking thalidomide who are sexually active should use a barrier form of contraception.
Your doctor and nurse will help you manage any side effects of thalidomide. Sometimes the side effects outweigh any benefits, and the dose of thalidomide will be reduced or stopped.
Bortezomib is a new type of anti-cancer drug called a proteasome inhibitor. Proteasomes are a group of enzymes found in all cells in the body. They have an important role in controlling cell function and growth. By interfering with the function of proteasomes, bortezomib may cause cancer cells to die and may stop the cancer from growing.
Some people may have bortezomib as a first treatment for myeloma when thalidomide or a bone marrow transplant isn’t suitable. It can also be given to people who previously had chemotherapy treatment, but whose myeloma has come back or continued to develop despite treatment, and who’ve already had, or are unsuitable for, a bone marrow transplant. You’ll be given bortezomib as an injection into a vein. You’ll usually have four doses over a three-week period and you may also be given a steroid.
Side effects of bortezomib include tiredness|, nausea|, diarrhoea|, numbness or tingling in the hands and feet (peripheral neuropathy)| and a tendency to bruise or bleed more easily, which is caused by a low platelet count.
Steroids| are drugs which can be used as part of your treatment to help destroy myeloma cells and make chemotherapy more effective. The two most commonly used steroids to treat myeloma are prednisolone and dexamethasone. They may be used on their own or in combination with other drugs. Steroids are usually taken as tablets, but liquid preparations or dissolving tablets can be given if you have difficulty swallowing.
Small doses of a steroid usually have few side effects. If you need larger doses for a longer period of time, some side effects may occur. Steroids can irritate the lining of the stomach and cause indigestion or heartburn. Taking your tablets with food or milk can help prevent this. If you get any stomach pains after taking steroids it’s important to let your doctor or nurse know as they can give you medicine to help with this.
Other side effects can include feeling irritable, an increased appetite, feeling more energetic and difficulty sleeping.
If you’re taking steroids for some time, you may have other temporary side effects including water retention, high blood pressure and a slightly greater risk of getting infections.
You may also develop an increased level of sugar in the blood. If this happens, your doctor will prescribe daily tablets or injections of insulin to bring your blood sugar level back to normal. You may need to do a simple daily test to check for sugar in your urine. Your nurses will show you how to do this.
It’s unusual for people with myeloma to have to take steroids for a long time but, if you do, you may notice that you put on weight, especially on your face, waist and shoulders. The side effects of steroids are temporary and will disappear as the dose is reduced.
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