How Is Multiple Myeloma Treated?

This content has been reviewed and approved by

Kenneth C. Anderson, MD
Chief, Division of Hematologic Neoplasia

Dana-Farber Cancer Institute

Treatment for multiple myeloma depends on whether or not your disease is asymptomatic (not causing symptoms) or symptomatic (causing symptoms). Asymptomatic disease does not require treatment. For symptomatic multiple myeloma, there is no one “standard” therapy for treating the disease. There are many different treatment options available, and you and your doctor can work together to choose the one that is right for you. This decision typically is based on many factors, including:

• Your age, overall health, and medical history
• The stage and type of the disease
• How well you can tolerate certain medications and therapies
  
• Expectations for the course of the disease
• Your personal preferences

Treatment for Asymptomatic Multiple Myeloma

If your multiple myeloma is not causing symptoms, treatment generally is not recommended. Your doctor will want to monitor your health closely. If the disease eventually shows signs that it is progressing, then you can consider treatment. Some patients in this situation decide to take part in a clinical trial. This is a research study that is done to compare new treatment approaches to the current standard of practice.

If you have any signs of bone lesions, your doctor may prescribe bone-strengthening medications called bisphosphonates.

Treatment for Symptomatic Multiple Myeloma

If your multiple myeloma is causing symptoms (usually at stage II or III), then treatment is recommended. Your doctor may suggest one or more of the following treatments, used either alone or in combination:

• Surgery - Surgery is not used to treat multiple myeloma. However, it may be used to treat a solitary plasmacytoma—a single collection of myeloma cells on soft tissue. Doctors would perform surgery to remove the tumor. Surgery also may be used to repair damage to the bones in the spine. This results from the weakening of the bones that can occur in people with multiple myeloma.
• Radiation therapy - Radiation therapy uses high-energy rays to damage cancer cells and keep them from growing. Unlike chemotherapy and other anticancer medications, which travel throughout the body, radiation therapy is a local treatment. In other words, it focuses on the specific area of the body where cancer cells are known to be growing. Your doctor may choose this therapy if you have myeloma cells growing on just one bone or one organ in the body—a condition known as solitary plasmacytoma. It also may be used to relieve pain from the tumors that can grow on the bones or to shrink these tumors.
• Chemotherapy - 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. Examples of drugs that may be used include Alkeran^® (melphalan), vincristine, or Adriamycin^® (doxorubicin).
  
  Chemotherapy may be given in combination with another type of medication, corticosteroids, which help to reduce inflammation in the body and suppress the immune system. They are similar to the steroid hormones that our bodies produce naturally. Examples include dexamethasone and prednisone.
• Biologically targeted therapies - Medications such as Thalomid^® (thalidomide), Velcade^® (bortezomib), and Revlimid^® (lenalidomide) have been shown to slow or stop the growth of myeloma cells. As targeted therapies, they home in on specific biologic 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).
  
  Targeted therapies may be given in combination with another type of medication, corticosteroids, which help to reduce inflammation in the body and suppress the immune system. They are similar to the steroid hormones that our bodies produce naturally. Examples include dexamethasone and prednisone.
• Stem cell transplantation - This treatment is used to generate healthy new bone marrow throughout your entire body. First, you receive high doses of chemotherapy that destroy all of the existing bone marrow. Then, new stem cells are sent into your bloodstream and they make their way to the bones, where they generate new bone marrow. Stem cells are the cells that develop into all types of blood cells your body needs.
  
  In most cases, your doctor “harvests” the stem cells from your body’s bloodstream before you have high-dose chemotherapy. This is called an autologous stem cell transplant. In a small number of cases, they may come from a donor. This process is called an allogeneic stem cell transplant.
  
  People in good physical condition with adequate lung, kidney, and heart function are potential candidates for stem cell transplantation.

All of the above therapies have the goal of treating the disease. Although there is not yet a definite cure for multiple myeloma, one or more of these treatments often can keep the disease under control, often for years at a time. Researchers are still looking for new and better ways of treating multiple myeloma. For example, they are researching new combinations of existing drugs, as well as new ways for timing stem cell transplants. Therefore, you may wish to talk to your doctor about participating in a clinical trial. A clinical trial is a research study of new treatment approaches that involves patients.

Supportive Therapy

Your doctor may prescribe other therapies designed to treat the symptoms and complications of multiple myeloma, rather than the disease itself. This is called supportive therapy. Examples can include:

• Bisphosphonates - These medications can prevent the bone loss that results from bone lesions that often form with multiple myeloma. They also can reduce the risk of fractures and decrease pain. Examples include Zometa^® (zoledronic acid) and Aredia^® (pamidronate).
• Growth factors - These can be used to stimulate the production of red blood cells or white blood cells. This is important in multiple myeloma because the myeloma cells often crowd the bone marrow and prevent it from making enough blood cells. Procrit^® (erythropoietin) or a related product called Aranesp^® (darbepoetin alfa) can help the bone marrow produce more red blood cells. Neupogen^® (filgrastim), Neulasta^® (pegfilgrastim), and Leukine^® (sargramostim) stimulate the production of white blood cells.
• Antibiotics - Having fewer white blood cells puts you at risk for infection. You may need antibiotics to fight off infection.
• Intravenous immunoglobulin - This therapy involves receiving a mixture of antibodies (infection-fighting proteins) made from donated human plasma. This can help boost your immune system and fight infection at a time when you do not have enough healthy white blood cells.
• Orthopedic interventions - Damage to the bones can cause pain and fractures. Your doctor may prescribe physical therapy or splinting of the bones to prevent or treat fractures. If necessary, surgery may be done to repair fractures in the spine, such as kyphoplasty or vertebroplasty.
• Radiation therapy - This treatment uses targeted beams of radiation to destroy tumors. Low-dose radiation therapy may be used to target the myeloma cells that are collecting in certain bones and causing pain.
• Analgesics (pain medication) - These may be given to relieve pain.