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Once the doctors know the stage| of the myeloma they can plan the most appropriate treatment.
Treatment can be very effective at controlling symptoms| and stopping the development of the disease. The type of treatment you’re offered will depend upon a number of factors including your age, general health and how advanced your myeloma is. New drugs have improved the outlook for myeloma and you may be invited to enter a clinical trial|.
If the myeloma has been diagnosed| at an early stage| and is developing slowly (asymptomatic or smouldering myeloma), you may not require treatment straight away. You’ll see your doctor every few months and they will take blood samples and do other tests. This is known as active monitoring. Treatment will be started if the myeloma begins to get worse or if symptoms occur.
The main treatments used for myeloma are chemotherapy, biological therapies and steroids. These treatments are often given in combination. The aim of treatment initially is to treat the myeloma so that it goes into remission. Remission is when no abnormal myeloma cells can be detected in the blood or bone marrow, and normal bone marrow has developed again.
Chemotherapy| You may have treatment with a single chemotherapy drug or a combination of different drugs.
Biological therapies| This is another group of drugs commonly used to treat myeloma. They can be used on their own or in combination with chemotherapy.
Steroids| are usually given with chemotherapy and biological therapy to improve their effect.
Bisphosphonate drugs| may also be given with chemotherapy.
High-dose chemotherapy with stem cell support| This is intensive treatment to put the disease into a longer remission. It involves having high doses of chemotherapy followed by a stem cell transplant. This is an intensive treatment which isn’t suitable for everyone.
Maintenance therapy| When remission has been achieved by chemotherapy, this treatment is used to prolong the period that the disease is under control.
For a small group of people, treatment doesn’t put the myeloma into remission. This is called refractory myeloma.
In this case, your doctor may offer another type of treatment to control the disease. For most people, treatment will achieve a remission for a long period; however the myeloma usually comes back. This is called relapsed or recurrent myeloma. You may be offered further treatment at this time.
Radiotherapy| can be used to treat bone pain or as part of the preparation for a stem cell transplant.
Control of symptoms| This is important for everyone diagnosed with myeloma. Symptoms can include bone pain and fractures, anaemia, high levels of calcium in the blood called hypercalcaemia, and kidney problems.
If your tests show that you have myeloma, you’ll be looked after by a multidisciplinary team (MDT). This is a team of staff who specialise in treating myeloma and giving information and support. It normally includes:
Other staff will also be available to help you if necessary, such as:
The MDT will work together to plan the best treatment and support for you. When planning your treatment, they’ll consider a number of factors including your age, general health and the stage of your myeloma.
If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a relative or close friend with you.
They can remind you of questions you want to ask, and help you remember what the doctor said afterwards.
Your MDT uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion.
Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual for people to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People often feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor, or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. However, these can usually be controlled with medicines.
Treatment can be given for different reasons and the potential benefits will vary depending upon your individual situation. For people with early-stage myeloma who are suitable for intensive treatment, long-term control of the disease is often possible. For people with more advanced disease for whom intensive treatment isn’t suitable, treatment is usually only able to control the cancer, leading to a reduction of symptoms and a better quality of life.
Some treatments for myeloma involve far more side effects and risks than others. For some people, treatment will help to control the myeloma and the side effects of the treatment will be mild. However, for others, treatment will have no effect upon the cancer and they’ll get the side effects with little benefit.
Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to have it, you can still be given supportive (palliative) care with medicines to control any symptoms. It’s important to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting to have treatment, but it can help to let the staff know your concerns so they can give you the best advice.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.