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Chemotherapy drugs for myeloma and their side effects

Men and women discussing myeloma

This page is about which chemotherapy drugs you might have for myeloma, and their possible side effects. You can find the following information


A quick guide to what's on this page

Chemotherapy drugs for myeloma and their side effects

For myeloma, your doctor may treat you with chemotherapy drugs alongside a steroid drug. They may also use a biological therapy. The chemotherapy drugs doctors commonly use to treat myeloma include cyclophosphamide, melphalan (Alkeran), doxorubicin (Adriamycin) and idarubicin (Zavedos).

Side effects of chemotherapy for myeloma

Drugs affect people in different ways. Some people will have very few side effects, others will have more. The common side effects that you are likely to have with chemotherapy for myeloma are

  • Tiredness (fatigue)
  • Low levels of blood cells
  • Feeling and being sick
  • Hair loss or thinning of hair
  • A sore mouth and mouth ulcers
  • Diarrhoea or constipation
  • Tingling of your hands and feet
  • An increased risk of blood clots


CR PDF Icon You can view and print the quick guides for all the pages in the treating myeloma section.



Having chemotherapy for myeloma

For myeloma, you might have a combination of chemotherapy drugs with a biological therapy and steroids. Most chemotherapy is given in cycles. Some chemotherapy drugs are given daily and some drugs are given weekly. Cycles of treatment usually last 3 to 4 weeks. Usually 4 to 6 cycles make up one course of treatment. So a whole course of treatment may last for 4 to 6 months.

Drugs affect people in different ways. Not all patients have the same side effects with the same drug. Some people have very few side effects. It is not possible to tell how you will react until you have had that particular drug.

Some chemotherapy drugs cause infertility, which means that you can no longer have children. As myeloma usually affects older people, this may not be a concern for you. But if it is, you can discuss it with your doctor or specialist nurse before you start treatment. 

Read about fertility and chemotherapy.


Chemotherapy drugs used for myeloma

The chemotherapy drugs doctors commonly use to treat myeloma include

You can click on the links for information about the specific side effects of these drugs.

Sometimes other drugs are used such as in the combination DT-PACE or DR-PACE, which includes the steroid dexamethasone, the biological therapy thalidomide or lenalidomide (Revlimid), and the chemotherapy drugs cisplatin, doxorubicin, cyclophosphamide and etoposide. Doctors sometimes use one of these combinations if myeloma comes back after treatment.


Common side effects

Each chemotherapy drug can cause different side effects. But some side effects are common with many of the drugs. The side effects that you are likely to have with treatment for myeloma are

You can click on the links above for information about the side effects and how to cope with them. 

All the drugs will make your blood cell levels fall. This includes the red cells and platelets, as well as the white cells. You will be at risk of infection during treatment and for a few weeks afterwards. Most people need antibiotics into a vein at some point when they are having treatment.

Low numbers of platelets means you are at risk of bleeding or bruising. You can have platelet transfusions to top up your platelet count.

Red blood cells carry the oxygen around our body that is taken into our lungs when we breathe. Red cells grow in the bone marrow and can be crowded out by myeloma cells. If our red blood cell count gets too low it can cause breathlessness, weakness and tiredness. This condition is called anaemia and you may have blood transfusions to boost your level of red blood cells. Erythropoietin (EPO) is a drug that can help to correct anaemia. Your doctor may suggest that you have EPO if you can't have blood transfusions or if you have chronic kidney failure.


Steroid therapy

Steroids are substances made naturally in the body. They can also be made artificially and given as tablets or injections. Steroids are used in many different situations. You may have them alongside chemotherapy to treat myeloma because steroids can help the chemotherapy to work better. The steroid drugs doctors most commonly use are dexamethasone, prednisolone and methylprednisolone. Older patients usually have lower doses of steroids to reduce the side effects. 

Read about steroid treatment for myeloma


Growth factors

Growth factors are natural substances that are involved in the development of blood cells. They can now be produced in the laboratory and given to increase the number of white blood cells and stem cells in the blood. You may have G-CSF treatment, which is also called filgrastim (Neupogen) or lenograstim (Granocyte).

You have growth factors as an injection under the skin. This will usually be in the tummy, arm or leg. They may be given as part of your treatment because chemotherapy causes a drop in your white blood cell count. A low white blood cell count is called neutropenia (pronounced new-tro-peenia). This increases your risk of infection. Growth factors can help the white blood cell count recover more quickly and reduce the chance of getting an infection.

You may also have growth factor injections if you are having intensive treatment with a stem cell transplant. Growth factor injections increase the number of blood stem cells in your blood. So more are available to collect. 

Read about intensive treatment for myeloma.

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Updated: 15 December 2015