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 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.
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.
Many other combinations may be considered as well. If one drug combination stops working (or the myeloma comes back), other drugs can be tried. For more on these drugs and some of 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 a transplant. This is called consolidation treatment and increases the chance of a complete response (where all 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. It can help delay the return of the myeloma, but it can also cause serious side effects in some people.
CAR T-cell therapy may be another treatment option for some people, especially if several other treatments have already been tried. This treatment helps the body’s own immune system attack the cancer cells. While it can be very effective for many people, it can also cause very serious side effects.
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Boussi L and Niesvizky R. Advances in immunotherapy in multiple myeloma. Curr Opin Oncol 2017, 29:460–466.
Dhodapkar MV et al. Hematologic Malignancies: Plasma Cell Disorders. 2017 ASCO EDUCATIONAL BOOK.
Dingli D et al. Therapy for Relapsed Multiple Myeloma: Guidelines From the Mayo Stratification for Myeloma and Risk-Adapted Therapy. Mayo Clin Proc. 2017 April ; 92(4): 578–598.
Jung SH, et al. Immunotherapy for the treatment of multiple myeloma. Critical Reviews in Oncology/Hematology. 2017; 111:87-93.
Mateos MV, Hernández MT, Giraldo P, et al. Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma. N Engl J Med. 2013;369(5):438-447.
Munshi NC, Anderson KC. Ch. 112 Plasma cell neoplasms. In: DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 10th edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2015.
National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. Multiple myeloma. V.3.2018. Accessed at www.nccn.org on Dec. 7, 2017.
Palumbo A, Anderson K. Multiple myeloma. N Engl J Med. 2011;364(11):1046-1060.
Rajkumar SV. Treatment of Multiple Myeloma. Nat Rev Clin Oncol. 2011; 8(8): 479–491.
Rajkumar SV, Dispenzieri A. Multiple myeloma and related disorders. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE. Abeloff’s Clinical Oncology. 5th edition. Philadelphia, PA. Elsevier: 2014:1991-2017.
Last Revised: March 1, 2022