Treatment for myeloma

Planning your treatment

After your tests results, a team of specialists (MDT) meet to plan the best treatment for you. After the MDT meeting, you will usually see your specialist doctor and nurse. They will talk to you about your treatment plan.

Myeloma cannot usually be cured, but it is treatable. Treatment aims to reduce the number of myeloma cells to as few as possible.

Treatment can be very effective and is used to:

stop the myeloma developing further
control symptoms
improve your quality of life.

You and your doctor can decide together on the best treatment plan for you. Your doctor is an expert in the best treatments. But you know your preferences and what is important to you. You may need more than one meeting with your doctor or nurse to talk about your treatment plan.

We have more information about the benefits and disadvantages of treatments and choosing between treatments.

Types of treatment for myeloma

The type of treatment your doctor offers you depends on a number of things and your general health. Treatment may also depend on whether you have symptoms or not.

A combination of different treatments are usually used to treat myeloma.

Monitoring myeloma without symptoms (smouldering myeloma)

If you have smouldering or asymptomatic myeloma, you may not need treatment straight away. This is because there is no strong evidence that having treatment at this stage will help. Instead, doctors may suggest active monitoring. This means treatment is delayed until it is needed.

Your doctor will see you every few months to take blood samples and do some other tests. If tests show the myeloma is progressing or you develop symptoms, your doctor will talk to you about starting treatment.

Some people may be offered treatment for smouldering myeloma, but only as part of a clinical trials.

Treatment for active myeloma with symptoms

If you have active myeloma with symptoms or are at a high risk of developing symptoms, you will usually start treatment. You may have intensive treatment or less intensive treatment.

The aim of treatment is reduce the number of myeloma cells to as few as possible, to get the myeloma into remission. It is also used to manage symptoms. You will have tests during your treatment to check how well the myeloma is responding to treatment.

Less intensive treatments for myeloma

Less intensive treatments include:

Targeted therapies

Targeted therapies are drugs that interfere with the way myeloma cells grow. Some types of targeted therapy are also an immunotherapy. You may have targeted therapy drugs called thalidomide or bortezomib or lenalidomide. These are usually given with chemotherapy and steroids to treat myeloma.
Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You usually have 2 or more chemotherapy drugs. These may be given with other drugs, such as steroids and targeted therapies.
Steroids

Steroids are drugs that help destroy myeloma cells and make other treatments work better. The most common steroid drugs used to treat myeloma are prednisolone and dexamethasone.
Managing symptoms

Managing symptoms is an important part of treatment for myeloma. Myeloma can cause symptoms if it affects areas of the body such as the bones, kidneys, blood or nerves.

Usually, a combination of these treatments is used.

You may be asked to take part in a clinical trial. Cancer research trials are done to try to find new and better treatments for cancers, including myeloma.

Intensive treatment for melanoma

Some people might have intensive treatment for myeloma. It may be used to improve the chances of controlling the myeloma for a longer time.

Intensive treatment is divided into the following 2 stages:

Induction therapy – uses targeted therapies, chemotherapy and steroids to get rid of as many myeloma cells as possible.
Consolidation therapy – uses treatment with high-dose chemotherapy with stem cell transplant to get rid of remaining myeloma cells.

When a high-dose chemotherapy with stem cell transplant is used to treat myeloma, it is more common to use your own stem cells for the transplant rather than stem cells from another person (a donor). Stem cells are blood cells that are at the earliest stage of development. They are transplanted to help you recover from the side effects of treatment.

Using your own stem cells is called an autologous stem cell transplant.

These are the different stages of an autologous stem cell transplant:

Induction therapy

This is treatment with targeted therapies, chemotherapy and steroids. The aim of induction therapy is to get rid of as many myeloma cells as possible.
Collecting stem cells

After the induction treatment, your stem cells are collected (harvested) and stored. This is done before you have high dose treatment. They are usually collected from the blood, but they can also be collected from the bone marrow.
High dose treatment

High dose chemotherapy treatment aims to destroy any remaining myeloma cells and get the best response possible. But chemotherapy also affects healthy stem cells in your bone marrow and causes side effects.
Stem cell transplant

After the high dose treatment, the collected stem cells are given back to you through a drip (infusion). Your stem cells travel to your bone marrow and start making new healthy blood cells. This helps you to recover from the side effects of high dose treatment.

Stem cell transplants are only done in some specialist hospital units. You usually stay in hospital for a few weeks.

Intensive treatment is not suitable for everyone. It depends on how the myeloma is affecting you and your general health. If your doctor thinks this treatment is suitable for you, they will talk with you about this in more detail.

We have more information about high dose chemotherapy and stem cell transplants.

Your doctor may suggest continuing treatment until they get the best possible response for you. Or you may be given treatment for as long as it controls the myeloma. This is called continuous therapy or maintenance treatment. If the myeloma does not respond to the first treatment, your doctor will look at other treatments.

Some people who are in remission may also be offered continuous treatment. The aim is to keep the myeloma under control.

Controlling symptoms of myeloma

Myeloma can cause symptoms if it affects areas of the body such as the bones, kidneys, blood or nerves. Controlling symptoms is an important part of treatment for anyone diagnosed with myeloma .

You will see your doctor regularly for blood tests and x-rays, and to talk to you about how the myeloma is affecting you. Not everyone has symptoms, and some people may only have mild symptoms. Always tell your doctor and nurse about any problems you may have. There are different ways that symptoms can be managed.

This can include the following:

Treating bone pain and other bone problems - You may have painkillers, drugs called bisphosphonates, radiotherapy and sometimes surgery to treat pain and other bone problems.
Managing other symptoms of myeloma - You may be very tired or have difficulty fighting infections. Sometimes the kidneys are affected by myeloma. There are different ways of managing myeloma problems.

Always tell your doctor or nurse if you notice:

any new symptoms
that a symptom is getting worse
that a symptom is not getting better with treatment.

Treatment for relapsed myeloma

Treatment for myeloma is usually very effective and most people have a good response to treatment. After a time, myeloma usually comes back. This is called recurrent or relapsed myeloma. Doctors may then change your treatment or offer further treatment.

If treatment does not control the myeloma, or stops controlling it, the doctors will talk to you about treatments to manage symptoms.

The benefits and disadvantages of treatment

Some treatments for myeloma have more side effects and risks than others. For most people, treatment helps to control the myeloma and the side effects of the treatment are manageable. But for some people, treatment has little or no effect on the cancer and they get the side effects with little benefit.

If you have early-stage myeloma and are well enough for intensive treatment, it is often possible to control the cancer long-term.
If you have more advanced myeloma, treatment may be given to help control the cancer, reduce symptoms and improve your quality of life.

Choosing between treatments

Doctors sometimes ask you to choose between different treatments. You need to know as much as possible before you can make any treatment decisions. Your doctor or nurse can help you with your decision. You do not usually need to decide straight away. It can help to talk to your family or friends about your treatment options.

You could write a list of benefits and disadvantages for each treatment. When choosing a treatment, you may want to think about:

how long you need to have it for
how it may affect your everyday life
how much time you will need to spend in hospital
the different side effects and how they are likely to affect you.

If you choose not to have treatment, you can still have supportive care to help manage symptoms.

Related pages

About our information

References

Below is a sample of the sources used in our myeloma information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

National Institute for Health and Care Excellence (NICE). Myeloma: diagnosis and management. NICE guideline [NG35]. Published: 10 February 2016 Last updated: 25 October 2018. Available from: https://www.nice.org.uk/guidance/ng35/chapter/recommendations Accessed: 19/07/22

Jonathan Sive et al., on behalf of the British Society of Haematology. British Journal of Haematology. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Published: 21 March 2021 Available from: https://onlinelibrary.wiley.com/doi/10.1111/bjh.17410 Accessed: 19/07/22

M.A. Dimopoulos et al. Annals of oncology. European Society for Medical Oncology (ESMO). Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Volume 32, ISSUE 3, P309-322, March 01, 2021. Available from: https://www.annalsofoncology.org/article/S0923-7534(20)43169-2/fulltext Accessed: 19/07/22

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This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.

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