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Treatment decisions

How your doctor decides which treatment you need, and information about the types of treatment you might have for myeloma.

Treatment overview

The main treatments for myeloma are:

  • chemotherapy
  • steroids
  • biological therapy

You often have a combination of these.

Doctors also use radiotherapy to help control pain. You might also have bisphosphonates to help prevent bone damage and relieve pain.

If you are fit enough, your specialist might suggest intensive treatment using high dose chemotherapy with a stem cell transplant.

The main aim of your treatment is to try to get the myeloma under control. When there's no sign of active myeloma in your body, the myeloma is said to be in remission.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • how far your myeloma has developed (the stage)
  • your symptoms
  • the results of your blood and bone marrow tests
  • your general health and levels of fitness
  • your personal wishes

Your doctor will discuss your treatment, its benefits and the possible side effects with you.


The stage of your myeloma helps your doctor decide what treatment you need. Treatment also depends on:

  • your symptoms
  • the results of your blood and bone marrow tests
  • your general health and levels of fitness
  • your personal wishes

If you don't have any symptoms

You don't usually have any treatment. Your doctor will keep a close eye on your myeloma. This is called active monitoring. You start treatment if your myeloma gets worse or you develop symptoms.

If you have symptoms

You are likely to have a combination of:

  • chemotherapy
  • biological therapy
  • steroids

If you're under 70 and are fit enough, your doctor might suggest further intensive treatment with high dose chemotherapy and stem cell transfusion (a stem cell transplant).

Once your myeloma is under control (in remission), you might have a course of biological therapy such as lenalidomide or thalidomide. This is to try to keep it under control for longer and is called maintenance therapy. 

Controlling symptoms

To treat symptoms you might have:

  • radiotherapy
  • surgery to make your bone stronger
  • bisphosphonate treatment - these drugs can reduce pain, lower levels of calcium in your blood and lower the risk of fractures of the spine
  • plasmapheresis to remove protein from your blood - this can help if high levels of protein are making your blood too thick and causing symptoms such as headaches
  • a blood transfusion, to help with symptoms of anaemia

If your myeloma comes back (relapses)

Your treatment depends on your individual situation, such as how long you were in remission for, what treatment you had and your current level of health and fitness.

If your myeloma was in remission for longer than 18 months after initial treatment, you might have the same combination of drugs again.

If it comes back sooner than that, your doctor may suggest a different type of treatment.

You might have treatment with:

  • the biological therapy bortezomib (Velcade)
  • a combination of chemotherapy drugs with or without a biological therapy, such as thalidomide or lenaliodmide
  • the steroid drug dexamethasone

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Information and help

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