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Multiple myeloma

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Treatment of multiple myeloma

Treatment for multiple myeloma is given by cancer specialists (oncologists). Some specialize in surgery, some in radiation therapy and others in chemotherapy (drugs). These doctors work with the person with cancer to decide on a treatment plan.

Treatment plans are designed to meet the unique needs of each person with cancer. Treatment decisions for multiple myeloma are based on:

  • presence of symptoms
  • presence of disease-related complications
  • stage of the multiple myeloma
  • type of multiple myeloma
  • person's age
  • person's overall health

Response to treatment

A person's response to treatment will be evaluated. The International Myeloma Working Group categorizes the response into the following categories:

  • Complete response (CR) is defined by any one of the following:
    • Immunofixation (a specialized type of electrophoresis that identifies the type of M-protein or immunoglobulin light chain) does not find M-protein in the blood or urine.
    • An extramedullary plasmacytoma disappears.
    • Plasma cells make up 5% or less of the cells in the bone marrow.
  • Very good partial response (VGPR) is defined by either of the following:
    • Immunofixation finds M-protein in the blood or urine, but it is not found by standard electrophoresis.
    • M-protein in the blood has dropped by 90% or more. M-protein in the urine is less than 100 mg over 24 hours.
  • Partial response (PR) is defined as:
    • M-protein in the blood has dropped by 50% or more. M-protein in the urine has dropped by more than 90% over 24 hours or is less than 200 mg over 24 hours
      • If the blood and urine M-protein cannot be measured, PR is determined by a drop of 50% between the uninvolved and involved free light chain (Bence Jones protein) levels.
      • If neither M-protein nor free light chains can be measured, PR is determined by a drop of 50% or more of plasma cells in the bone marrow (if the baseline bone marrow plasma cell percentage was 30% or more).
    • An extramedullary plasmacytoma has shrunk by more than 50%.
  • Progressive disease (PD) is defined by one or more of the following:
    • M-protein in the blood or urine has risen by 25% or more, the bone marrow plasma cell percentage has risen by 25% or more (the absolute percentage must be 10% or more), or both.
    • The person develops new bone lesions or plasmacytomas.
    • The person develops hypercalcemia (high levels of calcium in the blood) related to multiple myeloma.
  • Stable disease (SD) means that the person does not meet the criteria for CR, VGPR, PR or PD.

Treatment options for multiple myeloma

  • chemotherapy
    • Chemotherapy for multiple myeloma is often given as a combination of chemotherapy drugs and may include a corticosteroidcorticosteroidAny steroid hormone that acts as an anti-inflammatory by reducing swelling and lowering the body’s immune response (the immune system’s reaction to the presence of foreign substances)..
    • New targeted chemotherapy drugs have recently been approved for the treatment of multiple myeloma:
      • bortezomib (Velcade)
      • thalidomide (Thalomid)
      • lenalidomide (Revlimid)
      • pomalidomide (Pomalyst)
      • carfilzomib (Kyprolis)
    • Chemotherapy is given in preparation for a stem cell transplant.
    • Chemotherapy is sometimes given following a stem cell transplant.
  •  stem cell transplant
    • Stem cell transplant may be considered as a first-line treatment in people with a good performance statusperformance statusThe measure of how well a person is able to perform ordinary tasks and carry out daily activities..
    • It may also be used in people whose cancer recurs (relapses) or is no longer responding to other therapies (refractory).
  • radiation therapy
    • Radiation therapy is used as a primary treatment for a solitary plasmacytoma of the bone or extramedullary plasmacytoma.
    • It may help to prevent a bone fracture or spinal cord compression.
    • It may be used to relieve pain from bone fractures or to control the symptoms of advanced multiple myeloma (palliative radiation therapy).
    • Radiation therapy may be given before a stem cell transplant to destroy myeloma cells and healthy bone marrow.
  • surgery
    • Surgery may help to support weakened and fractured bones.
    • It may be used for urgent treatment of spinal cord compression.
  • supportive therapy
    • Growth factorsGrowth factorsA substance that regulates the growth, division and survival of cells. may be given to stimulate white blood cell production.
    • Bisphosphonates can slow down bone destruction.
    • Antibiotics may be given to fight infections.
    • PlasmapheresisPlasmapheresisA procedure that uses a special machine (pheresis machine) to separate and collect plasma (the liquid part of blood) from withdrawn blood. The remaining blood cells are then mixed with saline, a plasma substitute or donor plasma and returned to the body. is a treatment used when the blood becomes too thick (viscous).
  • follow-up after treatment is finished
    • It is important to have regular follow-up visits.

Clinical trials

Clinical trials investigate better ways to prevent, detect and treat cancer. There are many clinical trials in Canada that are open to people with multiple myeloma. For more information, go to clinical trials.

See a list of questions to ask your doctor about treatment.

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