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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. 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. Sometimes
they will be given a bisphosphanate to help protect their bones.
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.")
If the patient is not expected to have a transplant,
chemotherapy with melphalan and prednisone (MP) is often used.
Sometimes thalidomide is given with MP, but other drug combinations can
be used as well.
Because it can have long-term effects on the bone marrow, MP
is used less often if a transplant is planned. The combination of
vincristine, doxorubicin (Adriamycin), and dexamethasone (VAD) once was
often used before transplant, but now newer drugs are used more often.
Thalidomide or lenalidomide plus dexamethasone may be used. Sometimes
bortezomib is given as well.
Bisphosphonate treatment is often started along with chemo. If
the areas of damaged bone continue to cause symptoms, radiation therapy
may be used.
For an autologous transplant, stem cells are collected from
the patient. Often this means treatment with chemo followed by daily
doses of a drug that signals the body to make white blood cells. The
stem cells are removed from the blood with a pheresis machine and
stored until they are needed. Then, high doses of chemo are given to
kill the myeloma cells. Most often, melphalan is the chemo drug that is
used. Later, the patient gets back their own stem cells. The transplant
may be repeated in 6 to 12 months if myeloma cells are still present.
Another possible treatment is allogeneic SCT. This may be able
to cure the myeloma, but it has more severe side effects than the
autologous transplant. Because they are so toxic, allogeneic
transplants are only offered to younger patients who are otherwise in
good health. The non-myeloablative allogeneic transplant may be a
better option for some patients, such as those who are older.
Treatment with thalidomide after transplant may help keep the
myeloma from coming back, 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: 02/13/2009
Last Revised: 05/12/2009
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