Multiple Myeloma Treatment

Multiple myeloma occurs when plasma cells become cancerous and often form tumors in the bones. One tumor of cancerous plasma cells is called a plasmacytoma. If a person has a malignant growth of plasma cells in the bone marrow that produce a large amount of abnormal protein, it is called multiple myeloma.¹

Treatment for multiple myeloma is based on several factors, including:²

• Stage of the disease
• Whether certain antibodies are present
• Whether certain genetic mutations are present
• Whether the kidneys are damaged
• How the cancer responds to initial treatment
• The age and general health of the person with cancer

Types of treatment for multiple myeloma

Several different types of treatment may be used for multiple myeloma, including:²

• Chemotherapy
• Targeted therapy
• Immunotherapy
• Radiation therapy
• Watchful waiting
• Surgery
• Stem cell transplant

Chemotherapy

Chemotherapy is the use of drugs to stop cancer cells. Chemotherapy works by targeting fast-growing cells, such as cancer cells. However, there are other fast-growing cells in the body that can also be affected, such as those in the gastrointestinal tract and hair.²

Chemotherapy drugs may be used together with other drugs or alone. They may be taken by mouth or injected into a vein or muscle. Frontline treatment for multiple myeloma is usually a combination of two small molecule inhibitors (a proteasome inhibitor and an immunomodulator), with or without an antibody, and steroids²

Targeted therapy

Targeted therapies are cancer treatments that block or slow the spread of cancer. They do this by interfering with specific areas of cancer cells involved in the growth of cancer cells or by focusing on specific features that are unique to cancer cells.²

While chemotherapy drugs typically kill cancer cells, targeted therapy usually blocks the growth of cancer cells. Types of targeted therapy used to treat multiple myeloma include:^2,3

• Monoclonal antibodies – These antibodies are created in a lab to identify and block cancer growth or kill cancer cells. They may also be used to deliver chemotherapy drugs to cancer cells.
• Proteasome inhibitors  – These therapies block the action of proteasomes, which remove proteins inside cancer cells. By blocking the normal action of proteasomes, these treatments can increase proteins in cancer cells and cause them to die.
• Nuclear export inhibitors – This treatment works by impacting the XPO1 protein. This disrupts proteins in cancer cells, which can cause them to die.^2,3

Immunotherapy

Immunotherapy is a type of treatment that aims to boost the body's own immune system to fight cancer cells. Immunotherapies work in various ways, not all of which are completely understood.^2,3

Radiation therapy

Radiation therapy uses high-energy radiation. Radiation may be used to treat plasmacytoma or tumors in multiple myeloma that have not responded to chemotherapy.^2,4

Watchful waiting

In some cases, watchful waiting may be recommended if a person with multiple myeloma is not experiencing symptoms from their disease. During watchful waiting, you do not receive treatment for blood cancer. However, problems like infections are treated. Your health is closely monitored during watchful waiting, and your doctor will watch for any changes in your condition and the potential appearance of symptoms.²

Stem cell transplants

Stem cell transplants are another treatment option for some people with multiple myeloma. Stem cell transplants are used along with high doses of chemotherapy. The high dose of chemotherapy destroys cancer cells. However, it also damages healthy blood cells. The transplant of stem cells (immature cells that can become new blood cells) is given to restore the bone marrow.²

The stem cells may be gathered from the person before chemotherapy. This is called an autologous transplant. Or, they may be given by a donor, which is called an allogeneic transplant. Not everyone is a candidate for stem cell transplants since high doses of chemotherapy can be very taxing on a person’s body. Stem cell transplants may not be tolerated by older adults or those with other health problems.²

Clinical trials

Clinical trials are a type of research where new treatments are studied. Clinical trials are an important part of the scientific process to find and prove the safety and effectiveness of new treatments. They offer people a chance to receive the latest treatments and be closely monitored by doctors. You can learn more about clinical trials by talking to your doctor or visiting the ClinicalTrials.gov website. Your doctor can help you decide if a clinical trial may be right for you.^2,5