An Exploration of Multiple Myeloma Treatments

Treatment for the blood cancer multiple myeloma typically involves a combination of therapies. And while the main goals of treatment are to control the disease, alleviate symptoms, and improve quality of life, it’s important to tailor the approach to each patient's specific condition and overall health.  

With that in mind, here’s a brief overview of the primary treatment options for multiple myeloma. 

Chemotherapy 
Chemotherapy drugs are used to kill myeloma cells throughout the body. Common chemotherapy medications for multiple myeloma include melphalan and cyclophosphamide. These drugs are usually taken orally and are generally well-tolerated with mild side effects, such as nausea, fatigue, and increased risk of infections. 

Corticosteroids 
Steroid medications, like dexamethasone and prednisolone, are often used in combination with chemotherapy to enhance their effectiveness and help destroy myeloma cells. They are taken orally and may cause side effects, like mood changes, increased appetite, and sleep disturbances.  

Immunomodulatory Drugs 
Thalidomide is a commonly used immunomodulatory drug that helps kill myeloma cells. It’s taken as a daily tablet, usually in the evening due to its sedative effects. Side effects may include constipation, nerve damage, and an increased risk of blood clots.  

Lenalidomide and pomalidomide are other immunomodulatory drugs used in multiple myeloma treatment, especially for relapses. 

Proteasome Inhibitors 
Bortezomib is a proteasome inhibitor that kills myeloma cells by causing protein buildup inside them. It’s administered via injection, typically under the skin. Side effects may include nerve damage, fatigue, and an increased risk of shingles. 

Targeted Therapy 
Newer targeted therapies are being developed and used in multiple myeloma treatment. These drugs specifically target certain proteins or genetic mutations in cancer cells that could potentially offer more effective treatment with fewer side effects. 

Stem Cell Transplant 
For eligible patients—typically those under 65 years of age or who are in good overall health—high-dose chemotherapy followed by a stem cell transplant may be recommended.  

This intensive treatment aims to destroy a larger number of myeloma cells and achieve a longer period of remission. The stem cells are usually collected from the patient before treatment, known as autologous transplantation, but may occasionally come from a donor. 

Radiation Therapy 
Radiation therapy may be used to target specific areas of bone damage caused by myeloma cells, which could help to relieve pain and strengthen weakened bones. 

Supportive Care 
In addition to these primary treatments, supportive care, such as pain management medications, bone-strengthening drugs to prevent fractures, blood transfusions or medications to treat anemia, dialysis for patients with severe kidney damage, and vaccines to prevent infections can be crucial in managing patients with multiple myeloma. 

Clinical Trials
Patients who don't respond well to standard treatments may be eligible for clinical trials that are testing new therapies or treatment combinations.  

Treatment for multiple myeloma is often cyclical, with periods of active treatment followed by maintenance therapy or observation. The specific treatment plan depends on various factors, such as the patient's age, overall health, and the stage of the disease. For some patients with early-stage or asymptomatic myeloma, immediate treatment may not be necessary, and a "watchful waiting" approach may be adopted.  

It's important to note, however, that while multiple myeloma treatments can often control the disease and improve quality of life, the condition is generally considered incurable. Therefore, additional treatment is typically needed if the cancer returns.  

But the good news is that the treatment landscape for multiple myeloma continues to evolve, with ongoing research into new therapies and treatment combinations aimed at improving outcomes for patients with this complex disease. 

References
Burton-Bethke A. What are myeloma treatment options? - healthtree for multiple myeloma. HealthTree. April 2, 2024. Accessed July 10, 2024.  

Multiple myeloma. Mayo Clinic. September 2, 2023. Accessed July 10, 2024. https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/diagnosis-treatment/drc-20353383. https://healthtree.org/myeloma/community/articles/multiple-myeloma-treatment-options.  

Multiple myeloma. NHS inform. July 3, 2024. Accessed July 10, 2024. https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/multiple-myeloma/.  

Professional CC medical. Smoldering multiple myeloma: Symptoms, treatment & prognosis. Cleveland Clinic. Accessed July 10, 2024. https://my.clevelandclinic.org/health/diseases/23911-smoldering-multiple-myeloma.  

Treating multiple myeloma: Ways to Treat Multiple myeloma. Ways to Treat Multiple Myeloma | American Cancer Society. Accessed July 10, 2024. https://www.cancer.org/cancer/types/multiple-myeloma/treating.html.