Cancer drug treatment for myeloma

Myeloma is usually treated with a combination of different cancer drugs. This often includes targeted therapy drugs and a steroid. You may also have these drugs with chemotherapy.

Drug combinations are often named after the initials of the drugs used. The following are some combinations used to treat myeloma:

• PVD – panobinostat, bortezomib (Velcade^®) and dexamethasone
• IRD – ixazomib, lenalidomide (Revlimid^®) and dexamethasone
• DVTD – daratumumab, bortezomib (Velcade^®), thalidomide and dexamethasone
• DVCD – daratumumab, bortezomib (Velcade^®), cyclophosphamide and dexamethasone
• DRD – daratumumab, lenalidomide (Revlimid^®) and dexamethasone
• KRD – carfilzomib (Kyprolis^®), lenalidomide (Revlimid^®) and dexamethasone
• SVD – selinexor, bortezomib (Velcade^®) and dexamethasone.

Your doctor and nurse will talk to you about the different treatment options. They will tell you:

• the aims of the treatment
• how it is given
• how often you have it (treatment cycle)
• how long your course will take
• any possible side effects.

During a course of treatment, you have regular blood tests to check the effect of the drugs. The dose of the drugs may be changed based on the results of your blood tests, or any side effects.

Cancer drugs can cause side effects. It is important to tell your cancer doctor or specialist nurse if you have any side effects while you are having treatment. They may change your treatment to control side effects or to help to prevent more serious problems.

Targeted therapies are drugs that affect the way myeloma cells grow. Some targeted therapy drugs affect the immune system and help it to destroy myeloma cells. These are called immunotherapy drugs.

The targeted therapies used for newly diagnosed myeloma are:

• thalidomide, lenalidomide or pomalidomide
• bortezomib
• daratumumab
• panobinostat
• ixazomib
• carfilzomib
• selinexor.

You usually have these drugs with chemotherapy drugs and steroids. Sometimes you have 2 targeted therapy drugs together.

If you are taking thalidomide, lenalidomide or pomalidomide, you will be given drugs called anti-coagulants to thin your blood. This is because these drugs can increase your risk of developing a blood clot. Anti-coagulants help to reduce this risk. These drugs can cause birth defects in developing babies. You must not become pregnant or make someone pregnant while taking these drugs.

If the myeloma comes back (relapsed myeloma) other targeted therapies may be used alone or in combination.

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

Chemotherapy drugs used to treat myeloma include:

• melphalan
• cyclophosphamide
• bendamustine.

Steroids are drugs that can help destroy myeloma cells.

The 2 most commonly used steroids for myeloma are:

• prednisolone
• dexamethasone.

Steroids may be used on their own or in combination with other drugs. You usually take them as tablets. If you have difficulty swallowing them, you can have steroids that are liquid or that dissolve.

Steroids are also used to treat a possible bone problem of myeloma, called spinal cord compression. This is when myeloma is in the bones of the spine and putting pressure on the spinal cord.

Sometimes, high dose chemotherapy with a stem cell transplant is used to treat myeloma. This is called intensive treatment. 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.

Intensive treatment may improve the chances of controlling the myeloma for a longer time.

If your doctor thinks this treatment is suitable for you, they will discuss it with you in more detail. Having this treatment will also depend on your general health. Stem cell transplants are only done in some specialist hospital units. You usually stay in hospital for a few weeks.

When this type of treatment 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). Using your own stem cells is called an autologous stem cell transplant.

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

1. Induction treatment – you have a few cycles of chemotherapy and targeted therapy treatments to try to get rid of as many myeloma cells as possible.
2. 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.
3. High dose chemotherapy treatment – this 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.
4. 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.

Anthony Nolan are a UK charity who provides information and support for people who need a stem cell transplant. They have a lot of detailed information you may find helpful.