- How is multiple myeloma treated?
- Chemotherapy and other drugs for multiple myeloma
- Bisphosphonates for multiple myeloma
- Radiation therapy for multiple myeloma
- Surgery for multiple myeloma
- Biologic therapy for multiple myeloma
- Stem cell transplant for multiple myeloma
- Plasmapheresis for multiple myeloma
- Clinical trials for multiple myeloma
- Complementary and alternative therapies for multiple myeloma
- Treatment options for multiple myeloma by stage
- More treatment information for multiple myeloma
Chemotherapy and other drugs for multiple myeloma
Chemotherapy (chemo) is the use of drugs to destroy or control cancer cells. These drugs can be taken by mouth or given in a vein or a muscle. They enter the bloodstream and reach all areas of the body, making this treatment useful for cancers such as multiple myeloma that often spread widely.
Many different types of drugs are used to treat multiple myeloma.
Chemo drugs that may be used to treat multiple myeloma include
- Vincristine (Oncovin®)
- Cyclophosphamide (Cytoxan®)
- Etoposide (VP-16)
- Doxorubicin (Adriamycin®)
- Liposomal doxorubicin (Doxil®)
- Bendamustine (Treanda®)
Combinations of these drugs are more effective than any single drug. Often these drugs are combined with other types of drugs like corticosteroids or immunomodulating agents.
Chemo side effects
Chemo drugs kill cancer cells but also can damage normal cells. Careful attention is given to avoid or reduce the side effects of chemotherapy. These side effects depend on the type and dose of drugs given and the length of time they are taken. Common side effects of chemotherapy include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea, and vomiting
- Low blood counts
Chemotherapy often leads to low blood counts, which can cause the following:
- Lowered resistance to infection (low white blood cell counts)
- Easy bruising or bleeding (low blood platelets)
- Fatigue and anemia (low red blood cells).
Most side effects are temporary and go away after treatment is finished.
If you have side effects, your cancer care team can suggest steps to ease them. For example, drugs can be given along with the chemo to prevent or reduce nausea and vomiting.
In addition to these temporary side effects, some chemo drugs can permanently damage certain organs such as the heart or kidneys. The possible risks of these drugs are carefully balanced against their benefits, and the function of these organs is carefully monitored during treatment. If serious organ damage occurs, the drug that caused it is stopped and replaced with another.
Corticosteroids are an important part of the treatment of multiple myeloma and can be used alone or combined with other drugs. Corticosteroids also help decrease the nausea and vomiting that other chemotherapy may cause. These drugs have side effects for patients including high blood sugar, increased appetite, and problems sleeping. When used for a long time, corticosteroids also suppress the immune system. This leads to an increased risk of serious infections. Most of these side effects go away over time after the drug is stopped. Dexamethasone and prednisone are most often used when treating myeloma.
The way immunomodulating agents affect the immune system isn’t entirely clear. There are 3 immunomodulating agents used to treat multiple myeloma. The first of these drugs to be developed, thalidomide, caused severe birth defects when taken during pregnancy. Because the other immunomodulating agents are related to thalidomide, there is concern that they would also cause birth defects. That is why all of these drugs can only be obtained through a special program run by the drug company that makes them.
Thalidomide(Thalomid®) was first used decades ago as a sedative and as a treatment for morning sickness in pregnant women. When it was found to cause birth defects, it was taken off the market. Later, it became available again as a treatment for multiple myeloma. Side effects of thalidomide can include drowsiness, fatigue, severe constipation, and neuropathy (painful nerve damage). The neuropathy can be severe, and might not go away after the drug is stopped. There is also an increased risk of serious blood clots (that start in the leg and can travel to the lungs).
Lenalidomide (Revlimid®) is a similar to thalidomide. It works well in multiple myeloma. The most common side effects of lenalidomide are thrombocytopenia (low platelets) and low white blood cell counts. It can also cause painful nerve damage. The risk of blood clots is not as high as that seen with thalidomide, but it is still increased.
Pomalidomide (Pomalyst®) is also related to thalidomide and is used to treat multiple myeloma. Some common side effects include low red blood cell counts (anemia) and low white blood cell counts. The risk of nerve damage is not as severe as it is with the other immunomodulating drugs. It is also linked to an increased risk of blood clots.
Proteasome inhibitors work by stopping enzyme complexes (proteasomes) in cells from breaking down proteins important for keeping cell division under control. They appear to affect tumor cells more than normal cells, but they are not without side effects.
Bortezomib (Velcade®) was the first of this type of drug to be approved, and it is often used to treat multiple myeloma. It may be especially helpful in treating patients with kidney problems from their myeloma. It is injected into a vein (IV) or under the skin, once or twice a week.
Common side effects of this drug include nausea and vomiting, tiredness, diarrhea, constipation, decreased blood counts, fever, and decreased appetite. Blood counts most often affected include the platelet count (which can cause easier bruising and bleeding) and the white blood cell count (which can increase the risk of serious infection). Bortezomib can also cause nerve damage (peripheral neuropathy) which can lead to problems with numbness, tingling, or even pain in the hands and feet. Some patients develop shingles (herpes zoster) while taking this drug. To help prevent this, your doctor may have you take an anti-viral medicine (like acyclovir) while you take bortezomib.
Carfilzomib (Kyprolis™) is a newer proteasome inhibitor that was recently approved to treat multiple myeloma in patients who have already been treated with bortezomib and an immunomodulating agent. It is given as an injection into a vein, often in a 4 week cycle. To prevent problems like allergic reactions during the infusion, the steroid drug dexamethasone is often given before each dose in the first cycle.
Common side effects include tiredness, nausea and vomiting, diarrhea, shortness of breath, fever, and low blood counts. The blood counts most often affected are the platelet count (which can cause easier bruising and bleeding) and the red blood cell count (which can lead to tiredness, shortness of breath, and being pale). People on this drug can also have more serious problems, such as pneumonia, heart problems, and kidney or liver failure.
These drugs can be used alone or in combination. Often different classes of drugs are combined for treatment. For example:
- Melphalan and prednisone (MP), with or without thalidomide or bortezomib
- Vincristine, doxorubicin (Adriamycin), and dexamethasone (called VAD)
- Thalidomide (or lenalidomide) and dexamethasone
- Bortezomib and dexamethasone, with or without doxorubicin or thalidomide
- Liposomal doxorubicin, vincristine, dexamethasone
- Dexamethasone, cyclophosphamide, etoposide, and cisplatin (called DCEP)
- Dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide (called DT-PACE), with or without bortezomib
The choice and dose of drug therapy depend on many factors, including the stage of the cancer and the age and kidney function of the patient. If a stem cell transplant is planned, most doctors avoid using a drug like melphalan that can damage the bone marrow.
Last Medical Review: 01/15/2013
Last Revised: 02/12/2013