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Multiple myeloma

Multiple myeloma treatments

Multiple myeloma treatment generally depends on the stage of the cancer, whether you are a candidate for a stem cell transplant, and other factors, such as personal preferences and needs. Treatment for multiple myeloma may include:

Chemotherapy

Chemotherapy for multiple myeloma may consist of a single agent or a combination of drugs. Because each medication destroys tumor cells in different ways, giving several drugs together may make the cells more responsive to treatment. For patients with multiple myeloma, chemotherapy is typically given orally (by mouth, in pill form) or intravenously (by injection into the vein).

Many multiple myeloma patients receive chemotherapy in combination with other drugs or treatments to fight the disease and prevent recurrence. A typical multiple myeloma treatment plan may include:

  • Induction chemotherapy (a combination of drugs used to destroy as many myeloma cells as possible)
  • Consolidation chemotherapy (high doses of chemotherapy to destroy any remaining myeloma cells) followed by a single or tandem stem cell transplant
  • Maintenance therapy (a less intensive course of chemotherapy to reduce the risk of recurrence)

Throughout your treatment, we will conduct routine blood tests and other diagnostic evaluations to check for myeloma cells and make modifications to your treatment plan as needed.

Interventional radiology

Interventional radiology allows doctors to visualize tumors and perform real-time image-guided interventional procedures. We deliver treatment directly to tumors and perform image-guided bone marrow biopsies, lymph node biopsies, and vascular catheter and port placements. We may also provide palliative treatment and vascular access for stem cell transplantation.

Kyphoplasty is an example of a minimally invasive procedure used to relieve pain from compression fractures of the spinal vertebrae caused by multiple myeloma.

Radiation therapy

Radiation therapy for multiple myeloma may be used to treat a specific area where bone has been damaged and myeloma cells growing in the bone marrow are causing pain. Also, radiation therapy is sometimes given in preparation for a stem cell transplant to destroy as many myeloma cells as possible.

Stem cell transplantation

A stem cell transplant may be used to treat multiple myeloma by infusing bone marrow with healthy cells, which help stimulate new bone marrow growth and restore the immune system. Typically, patients with advanced-stage multiple myeloma who are under 70 years old and in otherwise good health are candidates for a stem cell transplant.

Before a stem cell transplant for multiple myeloma, you will undergo a conditioning regimen, which involves intensive treatment to destroy as many myeloma cells as possible. You may receive high doses of chemotherapy and, in some cases, radiation therapy. Once this preparative regimen is complete, you are ready to undergo the transplant.

Much like a blood transfusion, you will receive the stem cells intravenously. The procedure takes about an hour. After entering the bloodstream, the stem cells travel to the bone marrow and start to make new blood cells in a process known as engraftment.

In the months following the transplant, your care team will monitor your blood counts. You may need transfusions of red blood cells and platelets. Sometimes, the intensive treatments you receive before stem cell transplantation for multiple myeloma may cause side effects, like infection. In this case, your doctor may administer IV antibiotics.

If you had an allogeneic stem cell transplant (using donor cells), your doctor may prescribe certain drugs to reduce the risk of graft-versus-host disease, a condition in which the donated cells attack the patient’s tissues.

Targeted therapy

Targeted therapy drugs are designed to attach themselves to specific protein receptors in or on the surface of cancer cells. For patients with multiple myeloma, targeted therapy may be used alone or in combination with other treatments, such as chemotherapy or radiation therapy.

Monoclonal antibody therapy is a type of targeted therapy that may be used to treat multiple myeloma. These drugs are made of antibodies engineered in a laboratory. Once injected into the body, monoclonal antibodies may target specific proteins found on cancer cells, killing them or preventing them from growing.

Among the targeted therapy drugs that may be used to treat multiple myeloma are proteasome inhibitors. Proteasomes are enzymes inside cells that break down old proteins so they can be recycled into new proteins. This process is necessary to prevent a toxic build-up of proteins inside the cell. Proteasome inhibitors are designed to stop the proteasomes from recycling proteins inside cancer cells, causing a toxic protein overload that may kill the cell.

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