Treatment for myeloma
If tests show that you have myeloma, your doctor will plan your treatment with you. It will all depend on your age, general health, the severity of the myeloma, and your personal preferences. The aim of treatment is to slow down and control the myeloma and to relieve the symptoms and complications it causes. With treatment, the bone marrow can recover and no longer make abnormal plasma cells. When this happens, the myeloma in said to be in remission.
If myeloma returns, it is called a relapse. In reality, most patients experience a number of remissions and relapses. As a result, you may receive a number of different types of treatment over time. In general, there are a number of ways to manage myeloma:
- Active monitoring
- Biological therapy
- High-dose therapy and stem cell transplant
- Maintenance therapy
- Treatment of symptoms
- Treatment of relapsed myeloma
When first diagnosed with myeloma, you may have few if any signs of active disease. In this case, your doctor may decide to watch and wait to see if the myeloma develops further. There is little or no benefit from treatment at this stage.
This is the use of drugs to control myeloma. It is the main treatment for myeloma. Some drugs used are:
Steroids are drugs that are also given with chemotherapy to treat myeloma. These are powerful drugs made naturally in the body. They can also be given to help with some of the side-effects that you might experience, for example feeling sick. Some steroids commonly given are dexamethasone and prednisone.
They are usually given in tablet form but can also be given into your vein.
Steroids do have side-effects like weight gain and raised blood sugar levels. Your doctor will give you more details about these side-effects beforehand. See the booklet called Understanding Chemotherapy.
This therapy uses the body´s immune system to treat cancer. The most common drugs used in myeloma are:
High-dose therapy with stem cell transplant
Your doctor may consider you suitable for high-dose therapy and stem cell transplant. This may be early on in your treatment or later. Often after this treatment, your response or remission gets better and lasts longer. This is because stem cell transplants allow higher doses of chemotherapy to be given to treat myeloma.
High-dose treatment will kill the bone marrow that makes the blood cells needed for your health. These cells include red blood cells, white blood cells and platelets. These cells can be replaced by giving you a stem cell transplant. If the cells are taken from you, it called an autologous transplant. If it is taken from someone else (a donor), it is called an allogeneic transplant. These stem cells can be taken from your bone marrow or from your bloodstream.
For more information see our booklets and factsheets:
- Understanding Myeloma
- Understanding Stem Cell Collection
- Understanding Autologous Stem Cell Transplants
- Total Body Irradiation
This is a treatment given after chemotherapy or a transplant. The aim is to prevent or delay the myeloma from reoccurring. The drugs used in maintenance therapy are usually biological therapies and sometimes steroids.
Treatment of symptoms
There are many symptoms of myeloma but you are likely to experience only some of these.
- Bone symptoms like bone pain are treated with painkillers and bone-strengthening drugs like bisphosphonates or monoclonal antibodies. Bone-strengthening drugs can also slow down damage to the bones due to myeloma. For more information, please see our bone health and cancer section.
- Blood symptoms include fatigue, anaemia, infections and bruising. Treatment may include blood transfusions, platelet transfusions, erythropoietin, plasmapheresis to thin the blood, antibiotics, and growth factors to boost your white cells.
- Kidney symptoms include kidney damage and hypercalcaemia. You will need to drink 3 litres of fluid each day and avoid certain drugs that can affect your kidneys. Hypercalcaemia is treated with fluids and medication, for example bisphosphonates. For kidney damage, you may need dialysis.
Treatment of relapsed myeloma
This will depend on your age, your general health and your previous response to treatment. Remember if myeloma recurs, it can be treated again. You may be given chemotherapy, steroids, biological therapy or any combination of these.
Advanced myeloma means that your myeloma has spread from the area where it started. It is usually not possible to cure advanced myeloma. But treatment can be given to control it and improve your quality of life. This can be done for quite a long time. Treatments can involve surgery, chemotherapy, radiotherapy and biological therapy.
Supportive therapy such as painkillers and bisphosphonates can be given to reduce bone pain For more information see our booklet on Cancer pain relief. Also, blood transfusions, antibiotics, drugs for anaemia, and growth factors may be needed to improve your symptoms.
You may also be seen by the palliative care team at this time. This team are there to help with any symptoms you have and to support you and your family throughout your treatment. For more information see our booklet A Time to Care; Caring for Someone Seriously ill at Home.
The type of side-effects you get will depend on the type of treatment, the dose, the duration and your own general health. Your doctor or nurse will discuss any possible side-effects with you before your treatment. Some treatments may cause symptoms such as nausea, vomiting, diarrhoea, constipation, loss of appetite and hair loss. A lot of treatments cause fatigue. Treatment with biological therapies can lead to numbness or tingling in your hands and feet peripheral neuropathy (pdf 391KB).
Myeloma can lead to kidney damage or kidney failure. You will be advised to drink plenty of fluids and to avoid certain drugs. For a small number of patients, kidney damage may be permanent and will need ongoing treatment called dialysis.
For more about coping with side-effects, see our Understanding myeloma booklet, and also the booklets Understanding Chemotherapy, Understanding Radiotherapy, Coping with Fatigue, Diet and Cancer and Understanding Cancer and Complementary Therapies, which are all available to download under the "Important cancer information booklets" list on the right hand side of this page. You can also learn more about side effects here.
If a treatment looks like it might be helpful, it is given to patients in research studies called clinical trials. Trials may be taking place at the hospital you are attending. If you are interested in taking part, talk to your doctor. He or she can tell you if the trial would suit you or not.
For further information please see the cancer and clinicial trial section.