Multiple Myeloma

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Treating Multiple Myeloma TOPICS

Treatment options for multiple myeloma by stage

Solitary plasmacytomas

These are often treated with radiation therapy. If the plasma cell tumor is not in a bone, it may be removed with surgery. Chemotherapy (chemo) is only used if multiple myeloma develops.

Early myeloma

Early myeloma includes smoldering myeloma and stage I disease. Patients with early myeloma can do well for years without treatment. Starting treatment early does not seem to help them live longer. These patients are often watched closely without starting chemo or other treatments for myeloma. They may be started on a bisphosphonate if they have bone disease.

Advanced myeloma

Patients whose myeloma is stage II or higher are often given drug therapy. The drugs chosen depend on the patient's health (including their kidney function) and whether or not a transplant is planned. (These drugs are discussed in more detail in the section, "Chemotherapy and other drugs for multiple myeloma.")

Often, a combination containing bortezomib (Velcade), thalidomide or lenalidomide (Revlimid), and dexamethasone is used. Bortezomib may be a good option, especially for patients with kidney problems.

Other combinations may be considered, including vincristine, doxorubicin (Adriamycin), and dexamethasone (VAD). If the patient is not expected to have a transplant, chemotherapy with melphalan and prednisone (MP) may be used, and can be combined with thalidomide.

Bisphosphonate treatment is often started along with chemo. If the areas of damaged bone continue to cause symptoms, radiation therapy may be used.

A stem cell transplant may be part of treatment. Options for stem cell transplant were discussed in the section, “Stem cell transplant for multiple myeloma.”

Some patients are given additional cycles of treatment after transplant. This is called consolidation treatment and increases the chance of a complete response (where signs and symptoms of the disease go away).

Some patients (even some who didn’t have a stem cell transplant) may be given long-term treatment with thalidomide or bortezomib. This is known as maintenance treatment, and helps delay the return of the myeloma, but it can cause serious side effects.

Many drug combinations can be useful in treating myeloma. If a drug stops working (or the myeloma comes back), others can be tried.

Last Medical Review: 01/15/2013
Last Revised: 02/12/2013