Treatment overview

Myeloma is rarely curable, but it is treatable. Treatment can be used to stop the myeloma developing further, to control symptoms and to improve quality of life.

If the myeloma is diagnosed at an early stage and is developing slowly (smouldering myeloma), you may not need treatment straight away. Your doctor will see you every few months (active monitoring).

If the myeloma begins to get worse or you develop symptoms (symptomatic or active myeloma), your doctor will talk to you about starting treatment. The aim of treatment is to get the myeloma under control (into remission) and to manage the symptoms.

The main treatments used to control myeloma are:

  • chemotherapy
  • targeted therapies
  • steroids
  • a combination of these.

If the myeloma goes into remission, some people may have maintenance treatment to keep the myeloma under control. This is usually only done as part of a clinical trial.

For most people, treatment will achieve a good response. However, the myeloma may come back. This is called relapsed myeloma. Doctors may then offer further treatment.

Treatment for myeloma

Once the doctors know the stage of the myeloma, they can plan the best treatment for you. Knowing the stage will also help your doctors predict how the myeloma might respond to treatment.

Myeloma is rarely curable, but it is treatable. Treatment can be used to stop the myeloma developing further, to control symptoms and to improve quality of life. The type of treatment you’re offered will depend on a number of factors, including your general health and how advanced the myeloma is.

Treatment overview for myeloma
Treatment overview for myeloma

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Myeloma without symptoms (smouldering myeloma)

If the myeloma is diagnosed at an early stage and is developing slowly, you may not need treatment straight away. Your doctor will see you every few months and take blood samples and do some other tests. This is called active monitoring. If the myeloma begins to get worse or you develop symptoms (symptomatic or active myeloma), your doctor will talk to you about starting treatment.

New research has shown that some people with smouldering myeloma are at higher risk of progressing to symptomatic myeloma in a short time. Your doctors will use tests and monitoring to spot early signs of this before CRAB symptoms develop. Treatment can then be started earlier.


Active or symptomatic myeloma

Treatment for active myeloma usually begins soon after diagnosis. The aim of treatment is to get the myeloma under control (into remission) and to manage the symptoms. A complete remission is when no myeloma cells can be detected in the blood or bone marrow, and normal bone marrow has developed again. The main treatments used to control the myeloma are:

The first treatments used are sometimes called induction therapy. Depending on your general health and how the myeloma is affecting you, you may be offered further treatment with high-dose treatment followed by a stem cell transplant. This is sometimes called consolidation therapy.


Response to treatment

For most people, treatment will achieve a good response. However, the myeloma usually comes back. This is called relapsed myeloma. Doctors may then offer further treatment.

A complete remission isn’t always possible for everyone treated for myeloma. But treatment can still reduce the myeloma in the body (a partial response), or stop it from developing further (stable disease). You will have tests and investigations during your treatment to check how well the myeloma is responding to treatment.

If the myeloma goes into remission, some people may have maintenance treatment to keep the myeloma under control. This is usually only done as part of a clinical trial.

For a small group of people, treatment doesn’t control the myeloma, or it stops controlling it. This is called refractory myeloma. If this happens, the doctors will talk to you about other treatments.


Maintenance treatment

Once myeloma is in remission, you may be offered maintenance treatment as part of a clinical trial to try to keep it under control for as long as possible. Your doctor will talk to you about this. Trials are taking place to find out whether the targeted therapy drugs thalidomide, bortezomib and lenalidomide help keep myeloma in remission.

You may find our Online Community helpful while you’re having treatment for myeloma. You can chat to people who know what you’re going through and also give support to others.


Treatment if myeloma comes back

If the myeloma comes back (relapses), there are usually other treatment options available. It may be possible to repeat the treatment you first had. This will depend on what the treatment was and how long your remission lasted. Or you may be offered a different treatment.

Treatments that may be used are bortezomib, lenalidomide and thalidomide. These drugs are usually given with steroids.

A second high-dose treatment with stem cell support may be offered to some people. Your doctor will talk to you about the different treatment options.


Symptom control

This is important for everyone diagnosed with myeloma. Symptoms can include bone pain and fractures, anaemia, high levels of calcium in the blood, kidney problems and more general symptoms such as tiredness. We have more information about controlling symptoms.


Clinical trials

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

Current research

A number of research trials are looking at the use of different targeted therapies, and how high-dose treatment with stem cell support is used. Your cancer specialist will be able to tell you more about these and other trials.

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