Treatment of myeloma

There are different treatments for myeloma. Your treatment will depend on things, including how myeloma is affecting you and your general health.

If the myeloma is not causing symptoms (smouldering myeloma) you do not usually need treatment straight away. You see your doctor regularly for blood tests. This is called active monitoring. If there are signs the myeloma is beginning to cause symptoms you can start treatment.

Treatment for myeloma that is causing symptoms aims to reduce the number of myeloma cells to as few as possible (called remission). You also have treatment to improve symptoms. People with myeloma are now living for longer with a better quality of life because of treatments.

A diagram showing the different treatment options for someone diagnosed with myeloma:

Treatment overview for myeloma

Your doctors do different tests find out how well treatment is working and if the myeloma is in remission. This can include measuring the paraprotein (immunoglobulin) level in your blood and urine. Your doctor may suggest continuing treatment until it gets the best remission possible for you.

You usually have a combination of the following treatments.

Targeted therapy and immunotherapy

Targeted therapy works by interfering with the way myeloma cells grow. Immunotherapy drugs help the immune system destroy myeloma cells. You may have targeted therapy and immunotherapy drugs called thalidomide or bortezomib. These are 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, such as cyclophosphamide and melphalan. You may have this treatment as an outpatient. Sometimes you may need to spend a few days in hospital.

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.

Intensive treatment

Some people have intensive treatment. But you need to be well enough to cope with it. Your doctor will talk this over with you. Intensive treatment is divided into 2 stages:

  • induction therapy – you have treatments with targeted therapies, chemotherapy and steroids to get rid of as many myeloma cells as possible.
  • consolidation therapy – you have a stem cell transplant which allows you to have very high doses of chemotherapy to get rid of remaining myeloma cells.

 

Stem cell transplant

This treatment may help to keep myeloma in remission for longer. You need to think about the benefits and risks before you decide. You will need to stay in hospital for a few weeks.

High-dose chemotherapy destroys the stem cells (early blood cells) in your bone marrow as well as the myeloma cells. Because of this, you have some of your own stem cells (early blood cells) taken before the high-dose treatment. This is called an autologous stem cell transplant.

 Afterwards they give you back your stem cells through a drip (infusion). The stem cells go to your bone marrow and start making new blood cells.

Occasionally in myeloma they take stem cells from a donor (allogeneic transplant). This is more complicated than using your own stem cells and recovery is longer.

After treatment some people have ongoing treatment (maintenance) with targeted therapy drugs to keep the myeloma under control.

Controlling symptoms and other complications

Treating the symptoms of myeloma and possible complications is an important part of treatment for myeloma. This can include:

  • Treating bone pain and other bone problems. Painkillers, drugs called bisphosphonates, radiotherapy and sometimes surgery can be used to treat pain and other bone problems.

  • Managing other symptoms and complications of myeloma. You may be very tired or have difficulty fighting infections. Sometimes the kidneys are affected by myeloma. There are different ways these problems can be managed.

Treatment if myeloma comes back

Myeloma nearly always comes back at some point after treatment. This is sometimes called relapsed myeloma. Your doctor will talk to you about other treatments you can have to control it. In between treatments there may be long periods where the cancer is controlled, and you are getting on with your life.

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