Treatment Options for Multiple Myeloma, by Stage
Early myeloma includes smoldering myeloma and stage I disease. Patients with early myeloma can do well for years without treatment. For many patients, 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.
Based on how abnormal the plasma cells look under the microscope and the levels of immunoglobulins, some patients with early myeloma have a high risk of progressing to active myeloma and needing treatment. In one study, treating these patients with lenalidomide (Revlimid) and dexamethasone before they developed symptoms or problems helped them live longer.
Active (symptomatic) myeloma
Patients whose myeloma is stage II or higher or who have light chain amyloidosis are often given drug therapy. The drugs chosen depend on the patient’s health (including their kidney function) and whether a transplant is planned. (These drugs are discussed in more detail in Chemotherapy and Other Drugs for Multiple Myeloma.)
Often, a combination containing bortezomib (Velcade), thalidomide or lenalidomide, and dexamethasone is used. Combinations containing bortezomib are especially helpful in patients with kidney problems and those whose myeloma cells contain certain high risk chromosome abnormalities.
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.
Patients with multiple myeloma also receive supportive treatments, such as transfusions to treat low blood cell counts, and antibiotics and sometimes intravenous immunoglobulin (IVIG) for infections.
A stem cell transplant may be part of treatment. Options for stem cell transplant are discussed in 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, lenalidomide, 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: May 22, 2014 Last Revised: January 19, 2016
- Chemotherapy and Other Drugs for Multiple Myeloma
- Bisphosphonates for Multiple Myeloma
- Radiation Therapy for Multiple Myeloma
- Surgery for Multiple Myeloma
- Stem Cell Transplant for Multiple Myeloma
- Supportive Treatments for Patients With Multiple Myeloma
- Treatment Options for Multiple Myeloma, by Stage