Multiple Myeloma Overview

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Treating Multiple Myeloma TOPICS

Chemotherapy and other drugs for multiple myeloma

Chemotherapy (chemo) is the use of drugs to kill or control the cancer cells. These drugs are either taken by mouth as a pill or given into a vein or a muscle. The drugs enter the blood and reach throughout the body. This treatment is useful for cancers such as multiple myeloma that often spreads widely. To learn more about chemo for multiple myeloma, please see the chemotherapy section in our document Multiple Myeloma.

Chemo side effects

Chemo drugs kill cancer cells but also can damage normal cells. These side effects depend on the type and dose of drugs given and the length of time they are taken. Common side effects of chemo include:

  • Hair loss
  • Mouth sores
  • Loss of appetite
  • Nausea, and vomiting
  • Low blood counts

Chemo often leads to low blood counts, which can cause:

  • Greater chance of 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 instance, drugs can be given along with the chemo to prevent or reduce nausea and vomiting.

Some chemo drugs can also permanently damage certain organs such as the heart or kidneys. The risks of using these drugs are carefully balanced against their benefits. The doctor will watch these organs during treatment. If damage occurs, the drug that caused it is stopped and replaced with another.

Chemo drugs can be used alone or along with other drugs, like those listed below.

Other drugs used to treat multiple myeloma


These drugs are an important part of the treatment of multiple myeloma and can be used alone or combined with other drugs. They also help decrease the nausea and vomiting caused by chemo. These drugs have short term side effects like high blood sugar, increased appetite, and problems sleeping. They can also weaken the immune system while you are taking them. This leads to an increased risk of serious infections. If taken for a long time, corticosteroids can cause the bones to become weak.

The corticosteroids most often used in treating multiple myeloma are dexamethasone and prednisone.

Immunomodulating agents

There are 3 immunomodulating agents (drugs that affect a person’s immune system in unclear ways) used to treat multiple myeloma:

  • Thalidomide (Thalomid)
  • Lenalidomide (Revlimid)
  • Pomalidomide (Pomalyst)

Because these drugs can cause birth defects if taken during pregnancy, they are only available through a special program run by the drug company that makes them.

Side effects of these drugs can include low blood counts, painful nerve damage, and an increased risk of serious blood clots that start in the leg and can travel to the lungs. Each of these drugs can have its own side effects, so ask your doctor about what to expect.

Proteasome inhibitors

These drugs work by stopping enzyme complexes (proteasomes) in cells from breaking down proteins that help keep cell division under control. Some of these drugs can be used to treat multiple myeloma:

  • Bortezomib (Velcade)
  • Carfilzomib (Kyprolis)
  • Ixazomib (Ninlaro)

Some common side effects of these drugs include nausea and vomiting, tiredness, diarrhea, low blood counts, and fever. Some other, more serious side effects can also occur. Bortezomib and ixazomib can also cause nerve damage that can lead to numbness, tingling, or even pain in the arms and legs. Each of these drugs can have its own side effects, so ask your doctor about what to expect.

Histone deacetylase (HDAC) inhibitors

Panobinostat (Farydak) is an HDAC inhibitor, a drug that can alter which genes are active inside cells by affecting proteins called histones. This drug is taken as a capsule, typically several times a week.

Common side effects include diarrhea (which can be severe), feeling tired, nausea, vomiting, loss of appetite, swelling in the arms or legs, fever, and weakness. This drug can also affect blood cell counts and the levels of certain minerals in the blood. Less common but more serious side effects can include bleeding inside the body, liver damage, and changes in heart rhythm, which can sometimes be life threatening.

Monoclonal antibodies

Man-made versions of immune proteins, called monoclonal antibodies, can be made to attack a specific target, such as a substance on the surface of myeloma cells.

Daratumumab (Darzalex) is a monoclonal antibody that attaches to a protein on myeloma cells. This can help the body’s immune system attack the cells. This drug is given as an injection into a vein (IV).

This drug can cause a reaction in some people during or soon after it is given, which can sometimes be severe. Symptoms can include coughing, wheezing, trouble breathing, tightness in the throat, a runny or stuffy nose, feeling dizzy or lightheaded, headache, rash, and nausea.

Other side effects can include tiredness, nausea, back pain, fever, and cough. This drug can also lower blood cell counts, which can increase a person’s risk of infections and bleeding or bruising.

Drug treatment

The choice and dose of the drugs depend on many things, such as:

  • The stage of the cancer
  • The patient’s age
  • The health of the patient’s kidneys
  • Whether a stem cell transplant is planned (If a stem cell transplant is planned, most doctors avoid using drugs that can damage the bone marrow.)

Last Medical Review: 05/22/2014
Last Revised: 11/20/2015