The treatment you have for myeloma depends on individual factors, such as the type and stage of the cancer, your symptoms and your general health. As myeloma is not curable, the aim is to control the myeloma and then keep it under control for as long as possible.
Learn more about:
- Treatment options
- Combining drug therapies
- Making treatment decisions
- Chemotherapy
- Immunomodulators
- Monoclonal antibodies
- Steroids
- Stem cell transplant
- Supportive treatment
Treatment options
| Active monitoring | People who have been diagnosed with either monoclonal gammopathy of undetermined significance (MGUS) or smouldering myeloma don’t usually need treatment straightaway. You will need check-ups every 3–12 months, depending on your level of risk. Your doctor will start treatment if you develop symptoms or other significant signs of myeloma. It is estimated that about 5% of people aged 70 years and over have MGUS, however most will never develop active myeloma. In most cases of smouldering myeloma, having treatment as soon as you are diagnosed does not offer any benefit. A small number of people with high-risk smouldering myeloma may benefit from early treatment. Talk to your doctor about what would be best for you. |
| Treatment to control active or symptomatic myeloma | This is often called induction, first-line or upfront treatment. It includes a combination of different drugs. A stem cell transplant may be suggested for some people. Active treatment may be followed by periods of stable disease (plateau phase or remission) when no maintenance therapy or treatment is needed. |
| Treatment for the symptoms and side effects of myeloma | These help issues such as bone disease, pain, kidney damage, hypercalcaemia, frequent infections and fatigue. |
| Treatment to prevent the disease returning | This is called maintenance or consolidation therapy. It uses a longer, lower-dose course of an immunomodulator such as lenalidomide, steroids or other drugs. These are often used after a stem cell transplant and sometimes after other first-line treatment. |
| Treatment when the disease comes back | You may be offered a different type of chemotherapy, a stem cell transplant, steroids or other drugs to regain control of the disease. Clinical trial treatments may also be available, so ask your doctor if they would benefit you. |
Combining drug therapies
Most people with myeloma will be treated with a combination of two, three or more different drugs.
The combinations may include therapies called immunomodulators, proteasome inhibitors, monoclonal antibodies or immunotherapy, as well as traditional chemotherapy drugs and steroids.
Combinations of drugs are used because each type of drug works differently to kill myeloma cells, and the combined effect helps treat as much of the disease as possible.
The choice of a particular drug combination will depend on things like the type of myeloma you have, your age and your kidney function. Your haematologist will select the most suitable combination and discuss this with you.
To learn more about the different drug combinations for myeloma, visit Myeloma Australia or eviq.org.au.
New drug therapies
New drug therapies are being developed all the time, including antibody drug conjugates, BCL2 inhibitors, and selective inhibitors of nuclear exports (SINE). At the time of publication (August 2024), the Pharmaceutical Benefits.
Scheme (PBS) only covers the cost of some newer drugs for myeloma (e.g. the SINE drug Selinexor). If your doctor thinks there is a promising treatment for you, ask about clinical trials or compassionate access schemes that may help with costs.
→ READ MORE: Making treatment decisions for myeloma
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Dr Ian Bilmon, Haematologist, Westmead Hospital and The Sydney Adventist Hospital (Clinical review); Martin Boling, Consumer; Catherine Bowley, Specialist Myeloma Nurse, Myeloma Australia; Dr Samuel Dickson, Radiation Oncologist, Calvary Mater Newcastle; Rachelle Frith, Clinical Nurse Consultant, Haematology, Prince of Wales Hospital; Dr Wojt Janowski, Haematologist, Calvary Mater Newcastle; Yvonne King, 13 11 20 Consultant, Cancer Council NSW. We would like to thank all the health professionals, consumers and editorial teams who have worked on current and past editions of this title.
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