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After the diagnosis, the most important decision is whether treatment is needed straight away. Early-stage myeloma, also called asymptomatic or smouldering myeloma, does not need to be treated, as early treatment has not been shown to be of any benefit. People with smouldering myeloma will need regular checkups, and treatment will be started if problems occur.
The main forms of treatment for multiple myeloma are a combination of chemotherapy, other medications and radiotherapy (x-ray treatment).
Chemotherapy
- Chemotherapy uses drugs to kill or slow the growth of leukaemia cells.
- It is usually given by injection into a vein (intravenously), under the skin (subcutaneously) or as tablets.
- The most commonly used chemotherapy drugs for multiple myeloma are melphalan and cyclophosphamide. Other drugs are adriamycin, bis-chloronitrosourea (BCNU) and vincristine.
- A hospital stay is sometimes necessary but it is usually short.
Side effects
Some chemotherapy drugs can cause side effects such as:
- feeling sick (nausea)
- mouth sores
- tiredness
- drops in blood counts
- thinning or loss of hair from your body and head.
The side effects are temporary and there are ways to prevent or reduce them. Tell your doctor or nurse of any side effects you experience. They may change the kind of treatment you are having. Don’t use aspirin or any other painkiller or medicine unless the doctor says you can. These can affect how chemotherapy works in your body, and may sometimes worsen side effects.
More information
Contact your doctor or hospital urgently if any of these problems occur:
- fever over 38 °C
- chills or constant shivering
- sweating, especially at night
- burning feeling when urinating
- severe cough or sore throat
- vomiting that lasts more than 24 hours or if you just feel very unwell
- unusual bruising or bleeding, such as nose bleeds, blood in your urine, or black bowel motions
- tenderness, redness or swelling around the place where the injection goes in.
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Thalidomide and related drugs
- Thalidomide is an old drug with new uses: it is now known to have anti-cancer effects, particularly for multiple myeloma.
- It is thought to work by blocking the blood supply to the cancer and by altering the body's immune response to cancer.
- New types of thalidomide-like drugs that cause fewer side effects are being developed.
Side effects
- Common side effects are drowsiness, rash and constipation.
- With new varieties of drugs, venous thrombosis (blood clots in veins) and low blood counts can occur.
- Prolonged use can cause neuropathy, leading to pain, numbness, tingling, swelling and muscle weakness.
Corticoid steroids
- Drugs that are similar to a hormone produced by the body's adrenal glands.
- Are commonly used to relieve swelling and inflammation.
- Have been shown to act against myeloma cells.
- Include prednisone, prednisolone or dexamethasone.
Side effects
- Common side effects include hyperactivity, sleep disturbance, mood change, increased appetite, fluid retention and weight gain.
- If used for a prolonged period, corticoid steroids may cause the onset of diabetes and contribute to osteoporosis (thinning of the bones).
Interferon alfa
- Used to treat certain cancers and viral infections.
- It is given as an injection under the skin several times a week.
- It may be used after chemotherapy or a bone marrow transplant to prolong control of the disease.
Side effects
- Lethargy, weight loss, a flu-like feeling and low blood counts.
Bisphosphonates
- A new class of drugs that are useful in myeloma
- Prevent and reduce complications of bone disease.
- Prevent a dangerous rise in blood calcium levels.
- Improve well-being and may prolong control of the disease.
- Can be taken as tablets or injections.
Side effects
- A common side effect is stomach upset.
- An uncommon but severe side effect is osteonecrosis of the jaw (ONJ), which causes intense pain. Tell your dentist if you are on bisphosphonates, as dental procedures should be avoided during treatment. Inform your doctor if you have mouth ulcers, infections or jaw problems.
Bortezomib
- Bortezomib (Velcade) belongs to a class of drugs that interfere with the function of myeloma cells, causing them to die.
- The drug is available for people who have had initial treatment but the myeloma is still progressing.
Side effects
- Common side effects include fatigue, diarrhoea, low blood counts and neuropathy.
Radiotherapy
- A painless procedure using x-rays to kill myeloma cells or injure them so they cannot multiply.
- It is used to help relieve some symptoms such as bone pain.
- Your radiation oncologist and haematologist will discuss the type of radiotherapy and the number of treatments you need.
- You will probably have treatment for a few days each week for several weeks.
Side effects
The most common side effect of radiotherapy are tiredness and dry or itchy skin. These are usually temporary.
More information
Plasma exchange
- Sometimes needed if the level of abnormal protein in the blood is very high, is interfering with blood circulation by making the blood thicker (hyperviscosity), or is damaging the body.
- Involves the separation and removal of plasma (which contains the abnormal protein) from the blood.
- A needle is placed into a vein in each arm. Blood is slowly removed from one arm and then passed through a separating machine. The healthy portion of the blood, plus new replacement plasma, is then put back in via the other arm.
- Usually takes a few hours.
Bone marrow or stem cell transplant
- A transplant of stem cells is an increasingly common treatment option for some myeloma patients.
- It enables you to receive high doses of chemotherapy to kill the myeloma cells.
- The goal of a transplant is to extend your life and improve your quality of life.
- It is not suitable for everyone because of the risks associated with the high-dose chemotherapy given before the transplant (e.g. infection or excessive bleeding).
Transplant process
- This is a general overview of the transplant process but it may be different for individual cases.
- The doctor will use stem cells from another person (allogeneic transplant) or your own stem cells (autologous transplant). If your stem cells are used, you will be given granulocyte-colony stimulating factor (G-CSF), a drug to help the stem cells multiply quickly and be released into the blood.
- When there are enough stem cells, they are collected from a vein with a needle or small tube. Stem cells are collected from the peripheral blood or the bone marrow.
- The collected stem cells are separated from the other blood cells by pumping the blood through a cell-separating device called an apheresis machine. The cells are processed so they can be frozen (cryopreserved). These stem cells can be stored for years.
- You will have a rest period at home for around a month before the next stage of treatment.
- In the week before the transplant, you will receive high-dose chemotherapy to kill the myeloma cells. It will also kill off your own blood-forming cells in the bone marrow.
- A day or so after chemotherapy, the stem cells are thawed and returned to you through an injection or intravenous drip.
- After the transplant, your blood counts will be low, you will be more at risk if infections and you may experience side effects from the chemotherapy.
Side effects
- You may have side effects from the chemotherapy or from the transplant itself.
- Side effects from chemotherapy include fatigue, nausea, mouth sores, tiredness, low blood counts or loss of hair.
- Side effects from the transplantation include nausea and abdominal cramps.
- When your blood counts have risen and your general health improves, you will be able to return home.
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