Types of treatment for myeloma | Cancer Research UK
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Types of treatment for myeloma

The main treatments for myeloma are chemotherapy, steroids and biological therapies. Radiotherapy may also be used for pain control. Doctors use bisphosphonates to reduce bone damage. 

If you are fit enough, your specialist may suggest intensive treatment with high dose chemotherapy and a stem cell transplant. The aim of treatment is to get the myeloma under control (into remission). Remission means that there is no sign of the myeloma in examinations or tests.

Myeloma without symptoms

Doctors do not routinely give treatment for asymptomatic (smouldering) myeloma. At the moment, there is no strong evidence that treating asymptomatic myeloma helps people to live longer. But researchers are looking into this. Doctors will monitor you regularly to check for symptoms.

Myeloma with symptoms

If your myeloma is causing symptoms you are most likely to have chemotherapy treatment. You often have this alongside a steroid and a biological therapy drug. The drugs you have depend on how the myeloma is affecting you, your general health, and your level of fitness. 

High levels of abnormal protein (immunoglobulin) in your blood can make it too thick. If you have this you may have a treatment called plasmapharesis, which uses a machine to remove the excess protein. 

Treatment of myeloma that has come back

The treatment you have will depend on your individual situation, such as how long you were in remission for, the treatment you had and your current level of health and fitness. Generally, if your myeloma was in remission for longer than 18 months after initial treatment, you may have the same combination of drugs again. But if it comes back sooner than that, your doctor may suggest a different type of treatment. 

Even if it is not possible to get your myeloma into remission, you can have treatment to help control any symptoms it causes.

 

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The main treatments

Chemotherapy, steroids and biological therapies are the main treatments for myeloma. Radiotherapy is also used to help control pain. You may also have bisphosphonates to help prevent bone damage and relieve pain. If you are fit enough, your specialist may suggest intensive treatment using high dose chemotherapy with a bone marrow or stem cell transplant.

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

Read about the different treatments for myeloma.

 

Deciding on the right treatment

Which treatments are right for you will depend 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
 

Treatment for myeloma without symptoms

Myeloma without symptoms is also called asymptomatic myeloma or smouldering myeloma. Doctors do not routinely give treatment for this type of myeloma. Currently, there is no strong evidence to show that treating asymptomatic myeloma helps people to live longer. But researchers are looking into this. Some research has shown that for some people treatment with the biological therapy lenalidomide (Revlimid) and the steroid dexamethasone may lengthen the amount of time it takes for symptoms to show. 

Your doctor will keep a close watch on your health. They call this active monitoring. They will start treatment if your myeloma gets worse or you develop symptoms (symptomatic myeloma).

 

Treatment for myeloma with symptoms

If you have myeloma that is causing symptoms, you are most likely to have a combination of chemotherapy, a biological therapy (such as thalidomide or bortezomib) and steroids. Which drugs you have depend on how the myeloma is affecting you and on your general health. For example, if you have kidney damage, this will affect the choice of treatment that your doctor can use.

Generally if you are under 70 and are fit enough, your doctor may suggest further intensive treatment with high dose chemotherapy and stem cell transfusion. This is called a stem cell transplant. Doctors usually use your own stem cells, rather than those of another person. 

Once the myeloma is under control (in remission), your doctor may suggest a course of biological therapy to try to keep it under control for longer. This is called maintenance therapy. Doctors most often use lenalidomide or thalidomide. But other drugs are being researched in clinical trials.

Older people and those unable to have intensive treatment with a stem cell transplant may have the chemotherapy drugs cyclophosphamide or melphalan, a biological therapy such as thalidomide or bortezomib and a steroid.

If you have signs of bone damage or have bone pain, you may have radiotherapy to that area. Your haematologist may refer you to a bone specialist (orthopaedic doctor) if you have areas of bone that are weak and could break easily. You may need to have an operation to try to make the bone stronger.

People with symptomatic myeloma will also have bisphosphonate treatment. Bisphosphonates are drugs that can reduce pain and other symptoms when cancer affects the bones. They are particularly good for lowering levels of calcium in your blood. They can also lower the risk of fractures of the spine. 

High levels of protein (immunoglobulin) in your blood can make it too thick. This is called hyperviscosity. Symptoms of this include blurred vision, headaches, confusion, drowsiness and shortness of breath. Your doctor may suggest a treatment called plasmapheresis, which uses a machine to remove the excess protein.

 

Treatment for myeloma that comes back

Your doctor may call this relapsed myeloma. The treatment you have 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. Generally, if your myeloma was in remission for longer than 18 months after initial treatment, you may have the same combination of drugs again. If it comes back sooner than that, your doctor may suggest a different type of treatment.

You may have treatment with the biological therapy bortezomib (Velcade). Or you may have a combination of chemotherapy drugs with or without a biological therapy, such as thalidomide or lenalidomide. You may also have the steroid drug dexamethasone.

 

Controlling your symptoms

Even if it is not possible to get your myeloma into remission, you can have treatment to help control the symptoms it causes. This may be with chemotherapy. Or you may have radiotherapy to any trouble spots in your bones. Bisphosphonates can also be used to try to prevent and treat bone damage. They can also lower the level of calcium in your blood, if this is too high. You may need blood transfusions to treat the symptoms of anaemia

Read about controlling myeloma symptoms.

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Updated: 19 December 2013