Multiple Myeloma

Treatment Options

Options for Multiple Myeloma cancer treatment depend on how much the cancer has affected the general health of the person, kidney function, and various organ systems of the body. The goal of multiple myeloma cancer treatment is to control the disease for as long as possible, and to provide comfort for the person.

Many cancer patients want to learn all they can about their disease and their treatment choices so that they can take an active part in decisions about their care. They are likely to have many questions and concerns about their cancer treatment options. Most patients want to know how they will function during and after treatment and whether they will have to change their normal activities. The doctor is the best person to answer a patient's questions, such as what their cancer treatment choices are, how successful it is expected to be, and what the risks and side effects may be.

Types of Multiple Myeloma Cancer Treatment

Treatment for multiple myeloma is systemic. Systemic treatments destroy or control cancer cells throughout the entire body. Chemotherapy is a systemic cancer treatment, and is almost always used to treat people with multiple myeloma. Bone marrow transplants and stem cell transplants, also systemic treatments, may also be used to treat multiple myeloma. Sometimes, local treatments can also be used to relieve symptoms of the disease.

Local treatments, such as radiation therapy, control or kill the cancer cells in a certain area. Radiation is often given to people with multiple myeloma in order to control bone pain or to prevent fractures in bones weakened by the cancer.

Goals of Treatment

Different types of cancer treatments have different goals. Below is a list of various treatments and their goals.

• Chemotherapy. The goal of chemotherapy cancer treatments is to control the cancer for as long as possible. Multiple myeloma is very sensitive to chemotherapy and is used to treat most patients. Chemotherapy can be given intravenously (through a vein) or by mouth.
• Immunotherapy.This treatment stimulates the immune system to fight multiple myeloma. The 2 main drugs used are Thalomid^® (thalidomide) and Revlimid^® (lenalidomide). They help keep multiple myeloma cells from reproducing within bone marrow.
• Radiation therapy. The goal of radiation in treating multiple myeloma is to relieve bone pain or prevent or treat a fracture in the area of the bone weakened by the cancer. Radiation therapy may be used in combination with chemotherapy.
• Bone marrow transplants. The goal of this cancer treatment is to kill as many of the cancer cells as possible by treating the body with very high doses of chemotherapy and radiation. Normally, the body would not be able to handle such high doses. Therefore, after patients undergoes such a cancer treatment, they need to be "rescued" with healthy, new bone marrow. The new bone marrow can be the person's own bone marrow (called an autologous transplant) or can come from a donor (called an allogeneic transplant).
• Stem cell transplants. A newer form of therapy, called a peripheral stem cell transplant, is based on the same idea as a bone marrow transplant but uses cells that are collected from the donor's or the patient's own blood rather than from the bone marrow. The main difference is that while the bone marrow is collected from the hipbone, the stem cells are collected from the veins of the arm. These treatments are given in transplant centers that specialize in this form of treatment.
• Watchful waiting. The goal of watchful waiting is to monitor or check cancer that is growing very slowly and that is unlikely to do any harm for a long time, if ever, rather than immediately starting cancer treatment. Sometimes the treatments for multiple myeloma can cause more harm than living with it. Your doctor may recommend watchful waiting if you don't have damage to your kidneys or bones and you have little or no anemia. You'll likely see your doctor about every 3 months for checkups. At that time, you'll have blood and urine tests and perhaps X-rays. These tests check to make sure the cancer is not starting to actively attack your body. If it is, you'll start active cancer treatment.

Research is ongoing in the field of multiple myeloma. New medicines and treatments are tested in clinical trials. Before beginning any cancer treatment, a person should ask the doctor if there are any clinical trials they should consider. Patients are often overwhelmed with the information they receive from their doctor. It is important that they take the time to gather as much information as possible.

Chemotherapy for Multiple Myeloma

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy as a treatment for multiple myeloma usually includes a combination of drugs. The drugs may be given by mouth or by injection. Either way, chemotherapy is a systemic therapy because the drugs travel through the body in the bloodstream.

A patient will be treated for a period of time with chemotherapy, and then will have a period of rest. This is called a cycle of treatment. Usually, the periods of rest last three to four weeks. This cycle will continue throughout the treatment.

Most patients have chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Depending on which drugs are given and the person's general health, the patient may have to stay in the hospital during treatment.

A newer combination of these 3 drugs is often the cancer treatment regimen of choice today.

• Oncovin^® (vincristine)
• Decadron^® (dexamethasone)
• Doxil^® (doxorubicin)

Here's another popular drug combination,

• Oncovin^® (vincristine)
• Adriamycin^® (dexamethasone)
• Decadron^® (doxorubicin)

These 2 drugs have been combined to treat multiple myeloma since the 1960s. These drugs are usually given together and are taken in pill form.

• Alkeran^®, L-phenylalanine mustard, L-PAM, L-sarcolysin (melphalan)
• Apo-Prednisone, Deltasone, Orasone (prednisone)

The names of these drugs are usually abbreviated to their first letters. For example, MP is used when melphalan and prednisone are given in combination.

Sometimes a chemotherapy drug is combined with an immunotherapy drug to kill the cancer cells and keep the cancer from growing in the bone marrow.One such combination is the chemotherapy drug Velcade (bortezomib) and the immunotherapy drug Thalomid^7reg; (thalidomide). It has recently been shown that this combination can work when other cancer treatments stop working. Velcade is also being tested in people newly diagnosed with multiple myeloma.

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