Supportive Treatments for Patients with Multiple Myeloma

Supportive treatment is aimed at preventing or relieving symptoms instead of trying to cure the cancer. The main purpose of this type of treatment is to improve the comfort and quality of life for someone diagnosed with cancer no matter what the cancer stage or the goal of treatment might be. You might also hear supportive care referred to as palliative care, symptom management, or comfort care.

Intravenous immunoglobulin (IVIG)

Patients with multiple myeloma often have low levels of the normal antibodies (immunoglobulins) needed to fight infection. This can lead to problems with lung and/or sinus infections that keep coming back. The level of antibodies in the patient’s blood can be tested, and if it’s low, antibodies from donors can be given into a vein (IV) to raise the levels and help prevent infections. The antibodies given are called IVIG or intravenous immunoglobulin. IVIG is often given once a month at first, but may be able to be given less often based on blood tests of antibody levels.

Treatment for low blood cell counts

Some patients develop low red blood cell counts (anemia) from multiple myeloma or its treatment. They might feel tired, lightheaded, or short of breath while walking. Anemia that’s causing symptoms can be treated with blood transfusions. These are often given on an outpatient basis.

Epoetin (Procrit) and darbepoetin (Aranesp) are drugs that can help improve low red blood cell counts and reduce the need for blood transfusions in some patients who are getting chemotherapy. But these drugs are used much less often because they have been linked to poorer survival in some patients with lymphoid cancers, such as multiple myeloma.

Plasmapheresis

Plasmapheresis can be used to remove myeloma protein from the blood. It’s helpful when certain myeloma proteins build up, thicken the blood, and interfere with circulation (called hyperviscosity).

Most often, this procedure is done through a large catheter (tube) placed in a vein in the neck, under the collarbone, or in the groin. This catheter is hooked up to a machine, and blood flows into the machine. The machine separates the blood cells from the blood plasma (liquid part of the blood), and then returns the blood cells to the patient, along with either salt solution or donor plasma. The plasma that’s removed, which contains the abnormal antibody protein made by the myeloma cells, is discarded.

Although plasmapheresis lowers the abnormal protein level and can relieve symptoms for a time, it does not kill the myeloma cells. That means that without further treatment, the protein will just build up again. For this reason, plasmapheresis is often followed by chemotherapy or some other type of drug treatment to kill the cells that make the protein.