Treatment for myeloma
Once the doctors know the stage of your myeloma, they can plan the most appropriate treatment.
The stage will also help your doctors predict how well you might respond to treatment.
Myeloma is rarely curable, but it is treatable. Treatment can be very effective at controlling symptoms and stopping the development of the disease. The type of treatment you’re offered will depend on a number of factors, including your general health and how advanced the myeloma is. New drugs have improved the outlook for people with myeloma and you may be invited to enter a clinical trial.
Myeloma without symptoms
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If the myeloma has been diagnosed at an early stage and is developing slowly (asymptomatic or smouldering myeloma), you may not need 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 (symptomatic or active myeloma).
The main treatments used for myeloma are chemotherapy, targeted therapies and steroids. Depending on your general health and how the myeloma is affecting you, you may be offered intensive chemotherapy followed by a stem cell transplant. Those who aren’t fit enough to tolerate the side effects of intensive treatment are often treated with a combination of chemotherapy, targeted therapies and steroids.
The aim of treatment initially is to get the myeloma under control, so it goes into remission. A complete remission is when no abnormal myeloma cells can be detected in the blood or bone marrow, and normal bone marrow has developed again.
A complete remission isn’t always possible for everyone treated for myeloma. However, treatment can still help reduce the amount of myeloma in the body (a partial response), or stop it from developing further (stable disease).
You will have tests and investigations throughout your treatment to monitor the amount of paraprotein and/or light chains in your blood and to check how well the myeloma is responding to treatment.
You may have treatment with a single chemotherapy drug or a combination of different drugs.
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 targeted therapy to improve their effect.
Bisphosphonate drugs may also be given with chemotherapy. They help to prevent bone damage, relieve pain and may help people to live longer.
High-dose chemotherapy with stem cell support
This intensive treatment can help improve the chances of controlling your myeloma in the long term. It involves having high doses of chemotherapy followed by a stem cell transplant. High-dose treatment isn’t suitable for everyone.
When remission has been achieved, maintenance therapies are used to prolong the time that the disease is under control.
For a small group of people, treatment doesn’t help control the myeloma. This is called refractory myeloma. In this case, your doctor may offer you another type of treatment to help control the disease. For most people, treatment will achieve a good response. However, the myeloma usually comes back.
This is called relapsed myeloma. You may be offered further treatment at this time.
Radiotherapy can be used to treat small areas of myeloma (localised disease) that are causing bone pain.
Surgery is sometimes needed to repair or strengthen bones damaged by the myeloma.
Controlling symptoms is important for everyone diagnosed with myeloma. Symptoms can include bone pain and fractures, anaemia, high levels of calcium in the blood and kidney problems.
Planning your treatment
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In most hospitals, a team of staff who specialise in treating myeloma will talk to you about the treatment they feel is best for your situation.
This multidisciplinary team (MDT) will include:
a haematologist – a doctor who specialises in treating blood disorders
an oncologist – a doctor who is a chemotherapy and radiotherapy specialist
a specialist nurse who gives information and support
a pathologist – a doctor who specialises in how disease affects the body
a radiologist – a doctor who specialises in x-rays and scans.
The team may also include other health professionals, such as a dietitian, physiotherapist, occupational therapist, psychologist or counsellor.
If two treatments are equally effective for the stage of myeloma you have, your doctors may offer you a choice. If you have to decide between treatments, make sure that you have enough information about the different options.
You might want to ask more about what is involved in each treatment, and about possible side effects, before you decide what is right for you.
Before you have any treatment, your doctor will explain its aims. They will 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:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
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 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.
There is so much to learn and so much to deal with. I can’t always take it all in at some appointments and that is where I rely on my wife to take notes.
People sometimes 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.
The benefits and disadvantages of treatment
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Many people are frightened by 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 on your individual situation.
For people with early-stage myeloma who are fit enough 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 myeloma for a period time. This should cause a reduction in symptoms and allow 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 on 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.
Your multidisciplinary team (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 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.
Dr David Plume talks about the possible benefits or disadvantages of getting a second opinion.