Multiple Myeloma: Treatment Choices
There are various types of treatment for multiple myeloma. Which may work best for you? It depends on a number of factors. These include the location and stage of your cancer, and how likely it is to grow and spread quickly. Factors also include whether or not you are having symptoms, your age and overall health, and what side effects you’ll find acceptable.
Learning about your treatment options
You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function during and after treatment, and if you’ll have to change your normal activities.
Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may suggest a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It’s important to take the time you need to make the best decision.
Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may require a second opinion. In addition, you may want to involve your family and friends in this process.
Understanding the goals of treatment for multiple myeloma
At this time, treatments for multiple myeloma are not able to cure it, but they can often keep it well under control for many years. Treatment can also improve your quality of life by helping to control the symptoms of the disease. The goals of treatment can include one or more of these things:
Destroy multiple myeloma cells
Stop or slow the growth or spread of myeloma cells
Ease symptoms from the cancer. These may include bone pain or problems from having too much calcium in your blood.
Types of treatment for multiple myeloma
Several types of treatment can be used for multiple myeloma. Different combinations of treatment may be used, depending on a number of factors. Each treatment has its own goals. Here is an overview of each type of treatment:
The goal of active surveillance is to watch myeloma. This may be done when the cancer is likely to grow slowly and is unlikely do any harm for a long time, rather than starting treatment right away. This approach is often a good option for myeloma that is not causing any symptoms. This is called smoldering myeloma. Your healthcare provider may recommend this approach if you don't have symptoms. Or he or she may suggest it if you don’t have damage to your kidneys or bones and if you have little or no anemia. You'll likely see your healthcare provider every few months for checkups. These will likely include blood and urine tests. You may also have imaging tests, such as X-rays. If your cancer is growing more quickly, your healthcare provider might suggest that you start active treatment.
Chemotherapy and other medicines
This is the use of medicines that kill cancer cells. Several different kinds of medicines can be used to treat this cancer. The goal of this treatment is to control the cancer for as long as possible.
This treatment stimulates the immune system to fight cancer. Or it uses manmade immune proteins (monoclonal antibodies) to attack the cancer cells. Different types of immunotherapy can be used. The goal is to keep the cancer under control for as long as possible.
The goal of this treatment is to ease symptoms such as bone pain, especially if medicine treatment is not working. Radiation can also be used to treat a single collection of myeloma cells. This is called a plasmacytoma.
Stem cell transplant
The goal of a stem cell transplant is to kill as many of the cancer cells as possible to help you live longer. You’ll receive high doses of chemotherapy and radiation. These treatments kill almost all of the cells in your bone marrow, including the cancer cells. But they also kill the normal bone marrow cells. This can lead to life-threatening side effects. To get around this, you get new blood-forming stem cells after treatment. Most often these stem cells are taken from your own bone marrow (and frozen) before treatment. This is known as an autologous stem cell transplant. Less often, the stem cells might come from a donor, such as a close relative. This is known as an allogeneic stem cell transplant. After treatment, the stem cells are put into your body in a process similar to a blood transfusion. These stem cells then rebuild your bone marrow.
Your healthcare provider may suggest treatments that help ease your symptoms, but don’t treat the cancer directly. These can sometimes be used along with other treatments. Or your healthcare provider may suggest supportive care if he or she believes that treatments are more likely to do you more harm than good.
Clinical trials for new treatments
Researchers are always looking for new ways to treat multiple myeloma. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.
Talking with your healthcare provider
At first, thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Consider the benefits and possible side effects of each option. Discuss your concerns with your healthcare provider before making a decision.
March 21, 2017
Overview of the Management of Multiple Myeloma. UpToDate.
Alteri, Rick, MD,Gersten, Todd, MD