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Chemotherapy| is often combined with biological therapy| and steroids| to treat myeloma.
Drug combinations that are commonly used include:
If you’re having your treatment by drip (infusion), your doctor may suggest you have a plastic tube, such as a central| or PICC line|, put into a vein in your chest or the crook of your arm.
The PICC line is threaded through the vein until the end is near your heart. The line can stay in place throughout your treatment. Your nurses will show you how to care for the line when you’re at home.
A tube with an injectable port just under the skin may sometimes be used. This is known as an implantable port|. The length of treatment will depend on the stage| of your myeloma and how well it responds to the drugs, but a course of treatment usually takes 4-6 months to complete.
Everyone reacts to chemotherapy in different ways. Not all drugs cause the same side effects and some people may have very few side effects. Your doctor will tell you about any problems your treatment may cause.
Chemotherapy can reduce the amount of white blood cells produced by the bone marrow, making you more prone to infection|. This effect can begin about seven days after treatment and your resistance to infection usually reaches its lowest point 10-4 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal before your next course of chemotherapy is due.
Contact your doctor or the hospital straight away if:
You’ll have a blood test before having more chemotherapy, to make sure your cells have recovered. Occasionally your treatment may need to be delayed if your blood count is still low.
Chemotherapy can also reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Chemotherapy tablets usually cause very mild feelings of sickness (nausea|). With some of the injected drugs this may be more of a problem, and these may even cause vomiting. There are now very effective anti-sickness drugs to prevent or greatly reduce these effects. If nausea occurs, it may begin a few hours after the treatment is given and last for up to a day. If it isn’t controlled, or continues, tell your doctor as they can prescribe other drugs which may be more effective.
Chemotherapy drugs can make your mouth sore|, so regular mouthwashes are important; the nurse will show you how to use these properly. If you don’t feel like eating at any time during your treatment, you could replace some meals with nutritious drinks| or a soft diet. It might help to speak to the hospital dietitian.
You may become anaemic while having chemotherapy. This may make you feel tired and breathless.
Hair loss| is more common with chemotherapy given into a vein than with chemotherapy tablets. If your hair falls out, it usually grows back within three months after treatment.
Chemotherapy affects people in different ways. Some are able to lead a fairly normal life during their treatment, while others find they become very tired| and have to take things more slowly. Just do as much as you feel like and try not to overdo it. For some people, the fatigue continues for some time after their treatment has ended.
Having cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. You may be given medicines to thin your blood and prevent blood clots. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you have any of these symptoms. Your doctor or nurse can give you more information.
High-dose treatment with a stem cell transplant may benefit some people with myeloma. If your doctor thinks that a transplant is necessary or possible for you, they’ll discuss it with you in more detail. Stem cell transplants are generally only carried out in specialist cancer treatment centres.
A stem cell transplant allows you to have much higher doses of chemotherapy than usual. Some people are also given radiotherapy. This can help to improve the chances of controlling your myeloma long term.
Stem cells are blood cells at the very earliest stage of development in the bone marrow. They are mainly collected (harvested) from the blood, but can also be collected from the bone marrow. In myeloma it’s more common to use your own stem cells, known as an autologous transplant|, than from a donor, which is known as an allogeneic transplant|.
The first stage of the treatment is called induction chemotherapy and it puts the myeloma into remission.
Once it’s in remission, your stem cells will be collected and stored until needed. You then have treatment using very high doses of chemotherapy which destroys your own bone marrow completely. Your own stem cells are then given back to you to ‘rescue’ you from the effects of the high-dose treatment and give you a source of healthy stem cells.
Other treatments involving the use of stem cells are being researched| in some hospitals. These include: allogeneic transplants from a donor; having a second transplant if myeloma recurs; mini-transplants, which involve less intense chemotherapy; and tandem transplants in which a second transplant is given straight after the first.
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If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.