Like other types of cancer, multiple myeloma patients receive a personalized treatment plan to effectively manage this complex blood cancer. The treatment plan is created by the hematologist who diagnosed you. At WVCI, our hematologists are also cancer specialists called oncologists. They will help you carefully consider the next steps, weighing the benefits of each treatment option with the potential risks and side effects.
Treatments are categorized as:
The best treatment for you depends mainly on the stage of the disease and if you have symptoms. It’s common for multiple myeloma patients to receive more than one treatment.
It’s possible for some patients to delay the start of treatments if they have no active symptoms, also called smoldering myeloma. Your hematologic oncologist may recommend active surveillance, which means they monitor your health closely so you can begin treatment immediately if you develop symptoms.
If you are experiencing symptoms, a drug therapy or a stem cell transplant may be recommended. For most patients with multiple myeloma, drug therapy is the primary treatment. While a single drug may be used, it’s common to receive 3 - 4 drugs. This type of cancer typically responds better to the drug combination. However, treatment will depend on several factors, including the stage of cancer and whether a patient is eligible for a stem cell transplant.
This treatment type uses drugs to destroy or control cancer cells. These can be taken by mouth or through a vein or muscle to reach almost all areas of the body. Chemotherapy used to be the primary treatment for multiple myeloma. However, newer drugs have reduced the role of this treatment in some cases. Common chemotherapy drugs include cyclophosphamide, etoposide, doxorubicin, and melphalan. These are often combined with other drugs like corticosteroids and immunomodulators. If a stem cell transplant is planned, doctors usually avoid chemotherapy drugs that might damage bone marrow.
Artificial versions of antibodies, called monoclonal antibodies, use the immune system to help fight cancer by attacking specific proteins on the surface of myeloma cells.
Several monoclonal antibodies attach to proteins commonly found in multiple myeloma. Including:
Newer artificial antibodies, known as bispecific antibodies, are created to attach to two different targets. Once in the body, one part of the BiTEs attaches to the CD3 protein on immune cells called T cells, while another part attaches to a protein on myeloma cells. The two cells are brought together to help the immune system attack the myeloma cells.
These medicines are typically used after several other drugs have been tried, including teclistamab, elrenatamab, talquetamab.
Chimeric antigen receptor (CAR) T-cell therapy is a revolutionary immunotherapy that helps the body’s immune system detect and attack cancer cells. CAR T-cell therapy is also considered a type of cell-based gene therapy since it involves altering the genes inside of immune cells to help them attack the cancer. CAR T-cell therapies used to treat multiple myeloma include idecabtagene vicleucel and ciltacabtagene autoleucel. These CAR T-cell therapies target the BCMA protein found in myeloma cells.
There are several other drugs used to treat multiple myeloma or its symptoms in ways different from chemotherapy. Some drug therapies target specific parts of myeloma cells that make them different from healthy cells, while others help the immune system attack myeloma cells. There are also drugs available to help strengthen bones to reduce the risk of fractures, a common side effect for multiple myeloma patients. These drugs are often combined, sometimes with chemo.
They can be taken as pills or given by injection, and each has its side effects. Ask your oncologist, physician assistant, or nurse about the drugs you'll receive and what to expect.
Some corticosteroids or steroids, such as dexamethasone and prednisone, are important in treating multiple myeloma. They can be used alone or in combination with other drugs. Steroids also help reduce chemo-related nausea and vomiting.
Immunomodulatory drugs (IMiDs) help treat multiple myeloma by affecting the immune system. These drugs are taken as pills almost every day with breaks on specific days during the month. IMiDs can increase the risk of blood clots, so they are often paired with aspirin or blood thinners.
Thalidomide, lenalidomide, and pomalidomide are immunomodulatory drugs often used to treat multiple myeloma.
This drug therapy stops enzyme complexes, or proteasomes, in cells from breaking down proteins that control cell division, affecting tumor cells more than normal ones.
Common proteasome inhibitors include bortezomib, carfilzomib, and ixazomib.
The cell’s nucleus holds most of the cell’s DNA needed to make the proteins cells use to function and stay alive. The XPO1 protein helps carry other proteins from the nucleus to different cell parts. A nuclear export inhibitor blocks the XPO1 protein from transporting other proteins, causing the cancer cell to die. This category of drug is not an immunotherapy but is often used with immunotherapy.
This drug can be used with the steroid dexamethasone for patients with myeloma that is no longer responding to other treatments or in combination with bortezomib for patients whose myeloma has developed further with at least one other drug.
A common side effect of multiple myeloma is weakened bones, resulting in broken bones. There are drugs available to help bones stay strong or reduce pain in the weakened bone(s). In some cases, pain medications will be prescribed along with one of these medicines to help control or relieve pain. Commonly used drugs for treating bone problems for multiple myeloma patients are bisphosphonates, such as pamidronate and zoledronic acid, and the drug denosumab.
A stem cell transplant involves receiving high-dose chemotherapy to kill cancer cells in the bone marrow (where new blood cells, including myeloma cells, are made). After chemo, patients are infused with new, healthy, blood-forming stem cells to replace the ones killed. This treatment is not typically the first treatment recommendation unless myeloma was diagnosed at a late stage and other treatments are not effective.
Decades ago, this process was known as a bone marrow transplant (BMT) when taking the new stem cells from the bone marrow was standard practice. Today, stem cells are often collected from blood. This is called a peripheral blood stem cell transplant (PBSCT). Through this process, stem cells are likely to begin working quicker and are less likely to be contaminated with cancer cells
Based on who is donating the stem cells for the transplant, a stem cell transplant can be one of two types: autologous or allogeneic.
Autologous Stem Cell Transplant
We perform a specialized surgical process to remove your healthy stem cells during this procedure. It happens before chemotherapy; once that ends, we reintroduce the cells into your body.
This allows us to reduce the risk of rejection or complications to high-dose chemos in patients. However, we understand that if you are at an aggressive treatment stage, this procedure may not be suitable for you.
Many therapies are in the research process for multiple myeloma. The WVCI blood cancer specialists are pleased to offer patients access to these clinical trials through the Sarah Cannon Research Institute. These include the latest advances in multiple myeloma treatment and other types of blood cancers. Through comprehensive clinical trials, we offer access to new drug combinations and leading therapies to patients who qualify. Our goal is simple: to advance cancer treatment to bring you closer to a healthier and symptom-free life.
Multiple myeloma patients in the Willamette Valley or the Oregon Coast can access expert myeloma specialists and the latest multiple myeloma clinical trials without traveling long distances. WVCI offers personalized care and individualized treatment plans. We also provide second opinions on a treatment plan.
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