HEALTH INSIGHTS

Multiple Myeloma: Immunotherapy

March 21, 2017

Multiple Myeloma: Immunotherapy

What is immunotherapy?

Immunotherapy is a type of treatment that affects your body’s immune system. It’s used to treat cancer. Immunotherapy medicines can work in a number of different ways.

What immunotherapy medicines are used to treat multiple myeloma?

Two main types of immunotherapy medicines can be used to treat multiple myeloma. 

Immunomodulating medicines (IMiDs)

Medicines in this group include:

  • Thalidomide

  • Lenalidomide

  • Pomalidomide

These medicines can have a number of different effects on your immune system. They can also affect cancer cells directly, and get in the way of the growth of new blood vessels that tumors need to grow. These medicines can be very helpful in treating multiple myeloma. However, it isn’t known exactly how they work.

Monoclonal antibodies

These medicines are man-made versions of immune system proteins. They can be made to attach to a specific target on cancer cells. This can cause your body's immune system to attack them. These medicines include:

  • Daratumumab. This medicine targets a protein on myeloma cells called CD38.

  • Elotuzumab. This medicine targets a protein on myeloma cells called SLAMF7.

When might immunotherapy be used to treat multiple myeloma?

Immunomodulating medicines (either lenalidomide or thalidomide) are often part of the first treatment of multiple myeloma. In most cases, they’re used with one or two other medicines.

If the initial treatment is no longer working, your healthcare provider may give you pomalidomide or one of the monoclonal antibodies. 

How is immunotherapy given for multiple myeloma?

Before treatment starts, your healthcare provider will talk about your treatment options with you. He or she will explain what you might expect. 

The immunomodulating medicines are taken as pills. You may take them once a day for several weeks at a time, followed by a break. 

You’ll receive monoclonal antibodies as an intravenous (IV) infusion into a vein. You’ll receive it once a week to start. Then you may wait longer between treatments. You’ll likely receive these medicines in an outpatient setting. That means that you’ll get it at a hospital, clinic, or healthcare provider's office. Then you can go home after your treatment. Less often, you may need to stay in the hospital during treatment. Your healthcare provider will watch you for reactions during your treatments. Since each of your treatments may last for a while, you may want to take along something that’s comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

What are common side effects of immunotherapy?

Side effects of immunotherapy tend to be different from those of chemotherapy or other treatments. But they can still be serious in some people. Ask your healthcare provider for more details about side effects. Tell your healthcare provider about any changes or side effects you have. He or she can suggest things to make you feel better. In most cases, you’ll stop having side effects within a few weeks after your treatment ends.

Some of the more common side effects from immunomodulating medicines include:

  • Tiredness

  • Drowsiness

  • Constipation

  • Nerve damage. This can cause burning, tingling, or decreased sensations in your hands or feet.

  • Blood clots in your legs or lungs

  • Low white blood cell counts. This can increase your risk of infection.

  • Low blood platelet counts. This can increase your risk of bleeding.

These medicines can cause severe birth defects or even death to an unborn baby. For this reason, women need to take pregnancy tests regularly during treatment. Women who take these medicines must also sign a consent form.

Monoclonal antibodies can have different side effects.

Side effects of daratumumab include:

  • Serious reactions during the infusion. These might include wheezing, trouble breathing, tightness in your throat, dizziness, rash, and nausea.

  • Tiredness

  • Nausea

  • Fever

  • Cough

  • Low blood cell counts. This increases the risks of infections and bleeding.

Side effects of elotuzumab include:

  • Serious reactions during the infusion. These might include wheezing, trouble breathing, tightness in your throat, dizziness, rash, and nausea.

  • Tiredness

  • Loss of appetite

  • Diarrhea or constipation

  • Fever

  • Nerve damage. This can cause burning, tingling, or decreased sensation in your hands or feet. 

  • Respiratory infections

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.

Updated:  

March 21, 2017

Sources:  

Selection of Initial Chemotherapy for Symptomatic Multiple Myeloma. UpToDate., Treatment of Relapsed or Refractory Multiple Myeloma. UpToDate.

Reviewed By:  

Alteri, Rick, MD,Gersten, Todd, MD