Chemotherapy for Multiple Myeloma

Chemotherapy involves giving medications, either intravenously (through a vein) or orally, that interrupt the process by which the body’s fast-dividing cells reproduce themselves. Since cancer cells divide more quickly than normal healthy cells, they are vulnerable to the chemotherapy drugs. Chemotherapy is intended to kill cancer cells throughout the entire body.

Chemotherapy may be given as initial treatment for multiple myeloma, or it may be used if the disease recurs (returns after initial treatment). The chemotherapy agent Alkeran^® (melphalan) is often used to treat multiple myeloma. Other drugs that may be used, either alone or in combinations, include:

Chemotherapy is often used in combination with other types of medications. These may include the corticosteroids dexamethasone or prednisone. These medications help to reduce inflammation in the body and suppress the immune system. They are similar to the steroid hormones that our bodies produce naturally.

Chemotherapy also may be used together with biologically targeted therapies, such as Thalomid^® (thalidomide), Velcade^® (bortezomib), or Revlimid^® (lenalidomide). These three medications have been shown to slow or stop the growth of myeloma cells. As targeted therapies, they home in on specific biological pathways that enable cancer cells to grow and thrive. For example, they might prevent the cells from creating the new blood vessels they need to grow and spread. Or they might stop certain key proteins from helping the cells to grow. Thalidomide and lenalidomide are pills taken by mouth. Bortezomib is given intravenously (through a vein).

If you have stage II or III multiple myeloma, you may have chemotherapy—likely in combination with other biologic therapies—as your main treatment. Your doctor may recommend following it up with stem cell transplantation. Stem cell transplantation would involve having additional chemotherapy at higher doses.