Mutiple Myeloma

General Information | Treatment Options | Additional Resources

Treatment
  • Overview
  • Standard Treatment
  • Clinical Trials
  • Treatment By Type

There are different types of treatment for patients with multiple myeloma and other plasma cell neoplasms.

Different types of treatments are available for patients with multiple myeloma and other plasma cell neoplasms. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Nine types of standard treatment are used:

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other drug therapy

  • Corticosteroid therapy
    Corticosteroids are steroids that have antitumor effects in lymphomas and lymphoid leukemias.
  • Thalidomide and lenalidomide
    Thalidomide and lenalidomide are drugs called angiogenesis inhibitors that prevent the growth of new blood vessels into a solid tumor.
  • Bortezomib
    Bortezomib is a type of drug called a proteasome inhibitor that targets certain proteins in cancer cells and may prevent the growth of tumors.

High-dose chemotherapy with stem cell transplant

This treatment is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Monoclonal antibody therapy is one type of biologic therapy. It is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Surgery

Surgery to remove the tumor may be done, usually followed by radiation therapy. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Watchful waiting

Watchful waiting is closely monitoring a patient's condition without giving any treatment until symptoms appear or change.

Plasmapheresis

Plasmapheresis is a procedure in which blood is removed from the patient and sent through a machine that separates the plasma (the liquid part of the blood) from the blood cells. The patient's plasma contains the unneeded antibodies and is not returned to the patient. The normal blood cells are returned to the bloodstream along with donated plasma or a plasma replacement. Plasmapheresis does not prevent new antibodies from forming.

Supportive care

This therapy controls problems or side effects caused by the disease or its treatment, and improves quality of life. Supportive care is given to treat bone problems or amyloidosis related to multiple myeloma and other plasma cell neoplasms.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

New combinations of therapies

Clinical trials are studying different combinations of biologic therapy, chemotherapy, steroid therapy, and drugs such as thalidomide or lenalidomide.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Multiple Myeloma

Patients without symptoms may not need treatment. When symptoms appear, the treatment of multiple myeloma may be done in phases:

  • Induction therapy: This is the first phase of treatment. Its purpose is to reduce the amount of disease, and may include one or more of the following:
    • Corticosteroid therapy.
    • Thalidomide or lenalidomide therapy.
    • Bortezomib therapy.
    • Chemotherapy.
  • Consolidation chemotherapy: This is a type of high-dose chemotherapy often given as the second phase of treatment, and may include either:
    • autologous stem cell transplant, in which the patient's own stem cells are used; or
    • allogeneic stem cell transplant, in which the patient receives stem cells from a donor.
  • Maintenance therapy: After the initial treatment, maintenance therapy is often given to help keep the disease in remission for a longer time. Several types of treatment are being studied for this use, including:
    • Chemotherapy.
    • Biologic therapy.
    • Corticosteroid therapy.
    • Thalidomide therapy.

Supportive care to treat bone problems and amyloidosis may include:

  • Bisphosphonate therapy to slow bone loss and reduce bone pain.
  • Radiation therapy for tumors of the spine.
  • Chemotherapy to reduce back pain from osteoporosis or compression fractures of the spine.
  • Chemotherapy and corticosteroid therapy to treat amyloidosis.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with multiple myeloma.

Isolated Plasmacytoma of Bone

Standard treatment of isolated plasmacytoma of bone is usually radiation therapy.

Supportive care to treat amyloidosis may include chemotherapy and corticosteroid therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with isolated plasmacytoma of bone.

Extramedullary Plasmacytoma

Standard treatment of extramedullary plasmacytoma may include the following:

  • Radiation therapy to the tumor and nearby lymph nodes.
  • Surgery, usually followed by radiation therapy.
  • Watchful waiting after initial treatment, followed by radiation therapy, surgery, or chemotherapy if the tumor grows or causes symptoms.

Supportive care to treat amyloidosis may include chemotherapy and corticosteroid therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with extramedullary plasmacytoma.

Waldenström Macroglobulinemia (Lymphoplasmacytic Lymphoma)

Treatment of Waldenström macroglobulinemia may include the following:

  • Plasmapheresis and chemotherapy.
  • Chemotherapy with one or more drugs.
  • Watchful waiting.
  • Biologic therapy with monoclonal antibodies.
  • A clinical trial of stem cell transplant.

Supportive care to treat amyloidosis may include chemotherapy and corticosteroid therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with Waldenstrom macroglobulinemia.

Monoclonal Gammopathy of Undetermined Significance

Treatment of monoclonal gammopathy of undetermined significance (MGUS) is usually watchful waiting, which will include regular blood tests to check the level of M protein in the blood.

Supportive care to treat amyloidosis may include chemotherapy and corticosteroid therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with monoclonal gammopathy of undetermined significance.

Refractory Plasma Cell Neoplasms

Treatment of refractory plasma cell neoplasms may include the following:

  • Watchful waiting for patients whose disease is stable.
  • A different treatment than previously given. (See Multiple Myeloma treatment options.)

Supportive care to treat amyloidosis may include chemotherapy and corticosteroid therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with refractory plasma cell neoplasm.

Cancer information from the NCI PDQ service