How is multiple myeloma treated?
Understanding Multiple Myeloma Treatment
Multiple myeloma, a cancer of plasma cells in the bone marrow, has no cure, but many treatment options help manage and control the disease and increase survival rates.
Treatment plans will differ for every patient’s disease stage, health, and long-term goals. Healthcare teams work with the patient to develop treatment options ensuring the best life quality.
Having a supportive community, like the one you can find at My Cancer Haven, is a vital part of treating multiple myeloma.
Proteasome Inhibitors in Multiple Myeloma Treatment
Proteasome inhibitors affect tumor cells by stopping enzyme complexes in cells from breaking down proteins, inducing cell death. Mechanism of action and role in disrupting cancer cell function.
The commonly used proteasome inhibitors are:
- Bortezomib (Velcade). This is one of the initial drugs given for multiple myeloma treatment. It’s administered under the skin and can cause nerve damage, decreased platelet and white blood cell count, fatigue, and nausea.
- Carfilzomib (Kyprolis). A newer drug that is usually given to patients who have not responded to other treatment drugs. It’s administered intravenously and can cause cardiovascular problems, and affect the blood counts.
- Ixazomib (Ninlaro). This is an oral drug that is taken along with other treatments. It may cause nerve damage, nausea, or lowered blood platelet count.
These drugs are administered at all stages of multiple myeloma and can help prolong remission.
Immunomodulatory Drugs (IMiDs) for Multiple Myeloma
Immunomodulatory drugs activate cells in the immune system and prevent myeloma cell growth. These drugs are administered orally and can increase the risk of blood clots.
The three drugs used to treat multiple myeloma are:
- Lenalidomide (Revlimid). Usually combined with a steroid, this drug can lead to a low white blood count and a risk of blood clots. Lenalidomide may be given to patients in remission after stem cell transplants.
- Thalidomide (Thalomid). This is the oldest iMiD and used less than the other two drugs. Thalidomide may cause serious blood clots, drowsiness, fatigue, and painful nerve damage.
- Pomalidomide (Pomalyst). More potent than the other immunomodulatory drugs, pomalidomide is used for patients who have relapsed or are high-risk. This drug also carries the risk of blood clots as well as anemia and low white blood clots.
Chemotherapy for Multiple Myeloma
There are several treatment options, including drug therapy. Chemotherapy is a drug used to kill and inhibit the growth of cancer cells.
With the advancement of other treatments, chemotherapy is used in combination with other drugs like corticosteroids or immunomodulation, or used in advance of a stem cell transplant.
There are several different chemotherapy drugs, which may be administered orally, intravenously, or through injections.
These drugs kill cancer cells as well as normal cells causing side effects, such as:
- Hair loss
- Reduced appetite
- Nausea and vomiting
- Increased risk of infection
- Fatigue
These side effects subside after chemotherapy is completed.
Read more about Multiple Myeloma.
Immunotherapy Options for Multiple Myeloma
Immunotherapy is another multiple myeloma treatment option that enhances the body's immune response to target and destroy cancer cells. Immunotherapy is a targeted treatment that has fewer side effects than chemotherapy.
Some of the options for immunotherapy are:
- Monoclonal antibodies. These are man-made antibodies that are designed to attack specific proteins on the surface of myeloma cells.
- Bispecific antibodies:These are man-made antibodies that are designed to direct the patient’s immune system to attack specific proteins on the surface of myeloma cells
- CAR T-cell therapy: collects a patient’s immune cells (T-cells) and modifies them to identify and attack myeloma cells. Then the enhanced cells are infused back into the blood.
Stem Cell Transplantation in Multiple Myeloma Treatment
These transplants help rebuild bone marrow and restore blood cell production.
Before the transplant, patients are given high-dose chemotherapy to kill or reduce the cells in the bone marrow.
Then the cells are replaced. There are two different types of transplants:
Autologous Stem Cell Transplantation (ASCT)
An autologous stem cell transplant removes the patient’s stem cells from the blood or bone marrow and stores them until the transplant.
After the chemotherapy, the autologous stem cells are infused back into the blood.
This treatment option is considered standard and can temporarily remove myeloma cells completely.
Allogeneic Stem Cell Transplantation
Allogeneic stem cell transplants use stem cells from a donor, which is usually a matched sibling.
A graft-versus-myeloma effect may occur, meaning the donor cells destroy the myeloma cells. In an ASCT, the cancer cells are killed during the chemotherapy, but usually return and the new cells do not kill them.
An allogeneic stem cell transplant is considered risky and usually only done as part of clinical trials.
One of the main complications is graft-versus-host disease (GVHD), occurring when the donor’s cells attack the patient’s tissue. This can be life-threatening.
Considerations and Precautions in Stem Cell Transplantation
Multiple myeloma is a complex and individual disease, so your healthcare team will help determine if you are an eligible transplant candidate. They’ll evaluate several factors,
including:
- The stage of the disease and its aggressiveness
- Age
- General health
- Organ function
- Reaction to initial treatment
ASCT can improve the rate and length of remission, which is known as progression-free survival (PFS). The transplant can also increase the minimal residual disease negativity (MRD-) status, meaning no indication of the disease after treatment.
Performing an ASCT early can improve the quality of life and decrease treatment costs.
Some of the risks include:
- Side effects of high-dose chemotherapy
- Low blood counts requiring transfusions and growth factors
- A weakened immune system leading to serious complications from infections
Recovery from a transplant can take 3 to 6 months so having support afterward is essential. You must also undergo a pre-transplant assessment to consider the length and intensity of the process and what aspects of your life it may affect, such as how long you can take off work.
Radiation Therapy as a Treatment Modality
Radiation is another offered treatment that uses high-energy rays to kill cancer cells and shrink tumors. Often, radiation therapy is used to treat damaged bone as it can relieve pain and reduce localized tumors.
Radiation is often used in conjunction with chemotherapy and other drug treatments.
Palliative Care and Supportive Treatments
Multiple myeloma treatment plans also include additional treatments to help relieve symptoms, manage pain, and improve quality of life.
These treatments can include:
- Bone damage drugs or surgeries
- Dialysis for kidney damage
- Supplements for anema
- Blood thinners
- Physical therapy
Engaging in mental health care, through therapy or support groups, is also essential for patients and their care community.
Clinical Trials and Experimental Treatments
If you’ve exhausted the standard drug and transplant treatment options, joining a clinical trial to access novel therapies and drugs is always an option.
Becoming a trial participant allows you to contribute to medical advancements in multiple myeloma treatment and care.
Accessing Novel Therapies through Clinical Trials
Participating in a clinical trial is a complex decision, requiring full consideration of the benefits and risks. You will also need to ensure your eligibility, as some clinical trials require certain levels of progression of multiple myeloma or certain identifying factors like age.
Some of the risks are unknown side effects, costs, or travel.
Some of the benefits are increasing your treatment options, helping others who also suffer, and feeling more in control of your myeloma.
Online you can find questions to ask to ensure you’re being completely informed. Advocation for yourself is important if you choose to participate in a clinical trial.
Exploring Investigational Drugs for Multiple Myeloma
Researchers, pharmaceutical companies, and healthcare providers are always developing new drugs and treatments. Many of these are in the preclinical and clinical phases.
When clinical trials for these drugs are available, you should thoroughly research the drugs and assess their safety, efficacy, and potential side effects.
This can be done through conversations with the researchers leading the trials and your healthcare team.
Learn more about multiple myeloma.
Contributing to Advancements in Multiple Myeloma Treatment
Clinical trials are essential in shaping future treatment standards. They provide healthcare professionals with a deeper understanding of multiple myeloma and help adapt treatment plans for all patients.
Experimental drugs, therapies, and treatments allow for accelerated progress in multiple myeloma care.
Treating Multiple Myeloma
Every patient with multiple myeloma will need an individualized treatment plan, specific to their own needs and the characteristics of their disease. What works for one patient won’t always work for another.
Educating yourself, approaching treatment through a multidisciplinary approach, and collaborating with many healthcare professionals will provide optimal results.
Join a supportive community by contacting My Cancer Haven, and ensure you’re knowledgeable about multiple myeloma.
