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.

Smoldering multiple myeloma

Smoldering myeloma patients can do well for years without treatment. For many patients, starting treatment early does not seem to help them live longer. These patients are watched closely without starting chemo or other treatments for myeloma.

Based on how abnormal the plasma cells look under the microscope and the levels of immunoglobulins, some patients with smoldering multiple myeloma have a high risk of progressing to active myeloma. 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 with active myeloma or light chain amyloidosis are often given a combination of 2 or 3 drugs. The drugs chosen depend on the patient’s health (including their kidney function) and whether a stem cell transplant is planned.

Often, a combination containing bortezomib, 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 as well.

For more on these drugs and the more common combinations used, see Drug Therapy for Multiple Myeloma.

Treatment for bone disease (bisphosphonates) 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 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 combination stops working (or the myeloma comes back), others can be tried.

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Last Medical Review: February 28, 2018 Last Revised: May 9, 2018

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