Multiple Myeloma: Treatment Choices

There are many types of treatment for multiple myeloma. Which treatment may work best for you? It depends on a number of factors. These include where the cancer is, its stage, and how likely it is to grow and spread quickly. Factors also include whether or not you're having symptoms, your age and overall health, what side effects you’ll find acceptable, and your preferences.

Learning about your treatment choices

You may have questions and concerns about your treatment choices. You may also want to know how you’ll feel and function during and after treatment, as well as if you’ll have to change your normal activities.

Your healthcare providers are the best people to answer your questions. They can tell you what your treatment choices are, how well they’re expected to work, and what the risks and side effects are. Your healthcare provider may suggest a specific treatment. Or you may be offered more than one and have to decide which one you would like to get. It can be hard to make this decision. It’s important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare providers about how much time you can take to learn more about your choices. You may want to get a second opinion before deciding on your treatment plan. You may also want to involve your family and friends in this process.

Understanding the goals of treatment for multiple myeloma

At this time, treatments for multiple myeloma are not able to cure it, but they can often keep it under control for many years. Treatment can also improve your quality of life by helping to control the symptoms of the disease. The goals of treatment can be one or more of these things:

• Destroy multiple myeloma cells

• Stop or slow the growth or spread of myeloma cells

• Ease symptoms from the cancer. These may include bone pain or problems from having too much calcium in your blood.

Types of treatment for multiple myeloma

Many types of treatment and combinations of treatment can be used for multiple myeloma. Each treatment has its own goals. Here's an overview of each type of treatment:

Active surveillance

The goal of active surveillance is to watch the myeloma but not treat it right away. This may be done when the cancer is growing slowly and won't likely cause problems for a long time. (This is called smoldering myeloma.)

This approach is often a good choice for myeloma that's not causing any symptoms. Or it might be suggested if you don’t have damage to your kidneys or bones and you have little or no anemia (low red blood cell counts).

Active surveillance means you'll see your healthcare provider every few months for checkups. These may include blood and urine tests. You may also get imaging tests, like X-rays. If the cancer starts growing more quickly, you can start active treatment.

Chemotherapy and other medicines

This is the use of medicines that kill cancer cells. Different kinds of medicines can be used to treat myeloma. The goal is to control the cancer for as long as possible.

Immunotherapy

This treatment "turns on" the immune system so it fights the cancer. Or it uses manmade immune proteins called monoclonal antibodies to attack the cancer cells. Different types of immunotherapy can be used. An example of a type of immunotherapy used to treat multiple myeloma is called an immunomodulator.

Radiation therapy

The goal of this treatment is to ease symptoms like bone pain, most often if medicine treatment isn't working.

Radiation can also be used as the main treatment for a single collection of myeloma cells, called a plasmacytoma.

Stem cell transplant

Your healthcare provider will check if a stem cell transplant is an appropriate treatment choice for you. The goal of a stem cell transplant is to kill as many of the cancer cells as possible to help you live longer. You’ll get high doses of chemotherapy. The chemo kills almost all of the cells in your bone marrow, including the cancer cells. But it also kills normal bone marrow cells. This can lead to life-threatening side effects. To get around this, you get replacement blood-forming stem cells after treatment.

Most often, the stem cells are taken from your own blood or bone marrow (and frozen) before high-dose chemotherapy treatment. This is known as an autologous stem cell transplant. Less often, the stem cells might come from a donor, such as a close relative. This is called an allogeneic stem cell transplant. After treatment, the stem cells are put into your body in a process that's like getting a blood transfusion. Over time, these stem cells rebuild your bone marrow.

Supportive care

Your healthcare provider may suggest treatments that help ease your symptoms but don’t treat the cancer. These can sometimes be used along with other treatments. Or your healthcare provider may suggest supportive care if they believe that treatments are more likely to do you more harm than good.

Examples of supportive care include antibiotics to treat or help prevent infection and a blood thinner to help prevent blood clots. Talk to your healthcare provider about the goal of each treatment you get.

Targeted therapy

These medicines target certain genes and proteins that help myeloma cells grow and survive. They can slow the growth and spread of multiple myeloma with limited harm to healthy cells. Your cancer cells will be tested to see if they have the changes that these medicines target. If so, targeted therapy may be helpful. An example of a type of targeted therapy used for multiple myeloma is called a proteasome inhibitor.

Clinical trials for new treatments

Researchers are always looking for new ways to treat multiple myeloma. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials that might be right for you.

Talking with your healthcare provider

At first, thinking about cancer treatment choices may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Consider the benefits and possible side effects of each choice. Discuss your concerns with your healthcare provider before making a decision.