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Treatments for multiple myeloma
If you have multiple myeloma, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for multiple myeloma, your healthcare team will consider:
- your age and health status
- whether or not you have symptoms and which symptoms you have
- if you have complications of the disease, such as kidneys not working well
- whether or not you are eligible to have a stem cell transplant – this depends on age, performance status and if you have other health issues
- risk stratification based on chromosomal changes – you will be told if you are good (low) risk, intermediate risk or high risk
- the type of multiple myeloma
- the stage of multiple myeloma
- if you have had other treatments and how well you responded to them
- if you would be a good candidate for a clinical trial
Multiple myeloma can’t be cured. The goal of treatment is to reduce symptoms, slow the progression, or advancement, of the disease and put the disease into remission. Remission for multiple myeloma is when most or all signs and symptoms of the disease disappear.
You may be offered the following treatments for multiple myeloma.
During watchful waiting, the healthcare team watches for any signs and symptoms that mean the cancer is progressing from smouldering or indolent multiple myeloma to active multiple myeloma. During watchful waiting you will see your doctor and have tests every 3–6 months. You will begin treatment if there are signs that the disease is progressing to active multiple myeloma.
Targeted therapy uses drugs to target specific molecules (such as proteins) on the surface of cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. Targeted therapy is a main treatment for multiple myeloma. Targeted therapy drugs may be combined with chemotherapy drugs or supportive therapy drugs.
Chemotherapy may be given in combination with targeted therapy drugs or with supportive care drugs such as corticosteroids.
Stem cell transplant
A stem cell transplant is a main treatment for people with multiple myeloma. A stem cell transplant may also be used to treat people whose cancer comes back after their first treatment (called a relapse, or recurrence) or if other treatments are no longer working (called refractory treatment).
Radiation therapy may be used as the main treatment for a solitary plasmacytoma of the bone or extramedullary plasmacytoma. It may also be used to prevent bone fractures (breaks) and control symptoms of advanced multiple myeloma, like bone pain.
Surgery is sometimes used to treat spinal cord compression or to treat or prevent bone fractures. Surgery may also be used to treat an extramedullary plasmacytoma. If surgery is used, it is usually done after radiation therapy.
Supportive therapy helps to prevent or control multiple myeloma and other health problems caused by treatment. Supportive therapy for multiple myeloma includes:
- Corticosteroids, such as dexamethasone (Decadron, Dexasone) and prednisone, help to lessen some chemotherapy side effects like nausea and vomiting.
- Bisphosphonates help slow down bone destruction caused by myeloma cells.
- Colony-stimulating factors (CSFs) are drugs that help the body make new red blood cells and white blood cells.
- Drugs may be given to prevent infection.
- Plasmapheresis is a procedure that helps remove M-protein from the blood, which can cause blood to thicken (called hyperviscosity). An M-protein is an immunoglobulin that is found in high amounts in a person with multiple myeloma.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits after treatment has finished. These visits allow your healthcare team to monitor your progress (watch for changes) and response to treatment. Multiple myeloma often comes back or doesn’t completely go away. Follow-up is very important to see if the disease is starting to relapse. For most people, multiple myeloma treatment may stop for a while, but in most cases the disease comes back and you will need to have another treatment.
Some clinical trials in Canada are open to people with multiple myeloma. Clinical trials look at new and better ways to prevent, find and treat cancer. Find out more about clinical trials.
Response to treatment
You will have tests at some point after your treatment that will help tell the doctors how well the treatment worked. This is called response to treatment. The International Myeloma Working Group categorizes the response to treatment into the following categories.
Stringent complete response
A stringent complete response (sCR) is defined by the following:
- There is a complete response.
- There are no myeloma cells in the bone marrow.
A 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
A very good partial response (VGPR) is defined by either of the following:
- Immunofixation finds M-protein in the blood or urine, but M-protein isn’t found by standard electrophoresis.
- M-protein in the blood has dropped by 90% or more, and M-protein in urine is less than 100 mg (in urine collected over 24 hours).
A partial response (PR) is defined as:
- M-protein in the blood has dropped by 50% or more, and M-protein in the urine has dropped by more than 90% or is less than 200 mg (in urine collected over 24 hours).
- If the blood and urine M-protein can’t be measured, PR is defined 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 defined 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).
- If there was an extramedullary plasmacytoma found at the time of diagnosis, it 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 or both has risen by 25% or more, or the bone marrow plasma cell percentage has risen by 25% or more (the plasma cells making up 10% or more of all cells in the bone marrow) or both.
- You have new abnormal areas in the bone or plasmacytomas.
- You develop 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 any of the categories above.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
The measure of how well a person is able to perform ordinary tasks and carry out daily activities.
Examples of scales used to evaluate performance status include the Eastern Cooperative Oncology Group (ECOG), World Health Organization (WHO) and the Karnofsky performance status scale.
Any 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).
Corticosteroids are made by the adrenal gland. They can also be produced in the lab.
A substance that stimulates the bone marrow to produce white blood cells, red blood cells and platelets.
Colony-stimulating factors are found naturally in the body or can be made in the lab.
Also called CSF or hematopoietic growth factor.