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First treatment for myeloma

Your team plans your treatment depending on your:

  • symptoms
  • results of blood tests, bone marrow tests and scans
  • general health and levels of fitness 
  • personal wishes

Your first or initial treatment is likely to be a combination of different types of drugs. The team caring for may call this treatment chemotherapy or chemo but it includes other types of cancer drugs not just chemotherapy. These work in different ways to kill the myeloma cells. They are:

  • targeted drugs (such as thalidomide, lenalidomide, bortezomib, daratumumab)
  • chemotherapy (such as cyclophosphamide or melphalan)
  • steroids (such as prednisolone or dexamethasone)

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. Myeloma is not usually curable but treatment can control it.

You usually have treatment for four to six months. Then if you are fit enough, your specialist might suggest intensive treatment using high dose chemotherapy with a stem cell transplant.

If you can’t have high dose treatment with a transplant you usually have up to eight months of treatment or continue until the treatment is not controlling your myeloma.

When you are first diagnosed you may also need treatment for any symptoms that you have. These symptoms might include bone pain, tiredness and infections.

How treatment works

Targeted drugs for myeloma

Cancer cells have changes in their genes (DNA) that make them different from normal cells. These changes mean that they behave differently. Cancer cells can grow faster than normal cells and sometimes spread. Targeted cancer drugs work by ‘targeting’ those differences that a cancer cell has.

You might hear some targeted drugs called biological therapies. For myeloma the most common ones you might have are:

  • thalidomide
  • lenalidomide
  • bortezomib
  • daratumumab

Chemotherapy for myeloma

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy myeloma cells. The drugs circulate around the body in the bloodstream.

The most common types of chemotherapy drugs you might have for myeloma include:

  • cyclophosphamide
  • melphalan

Steroids

Steroids are naturally made by our bodies in small amounts. They help to control many functions including the immune system, reducing inflammation and blood pressure. Prednisolone and dexamethasone are types of steroids.

What treatment will I have?

The combination of treatment you need depends on whether you might be able to have high dose treatment with a transplant.

If you might be able to have transplant your first treatment might be one of the following:

  • bortezomib, thalidomide and dexamethasone (VTD)
  • bortezomib, cyclophosphamide and vincristine (VCD)

Stem cell transplants are not suitable for everyone and you might have one of these combinations:

  • melphalan, prednisolone, and bortezomib (VMP)
  • lenalidomide and dexamethasone

Or your doctor might ask you if you would take part in a clinical trial with a new combination of drugs.

How you have treatment

You have treatment in cycles or blocks. Each cycle lasts for between 21 and 35 days. You have some drugs every day and others weekly. After each cycle of treatment, your team will monitor your side effects. They will also check how well treatment is working. Most people have between 4 and 6 cycles of treatment. If you're having lenolidamide treatment you might carry on with this until it stops working.

Depending on how well the treatment works, you will either have a stem cell transplant or more chemotherapy.

Treatment can be tablets alone, or tablets together with an injection under the skin or less commonly into the vein as a drip (intravenously).

Usually, you have treatment as an outpatient unless there is another reason to be in hospital, such as an infection. Most treatments mean that you go to the hospital once a week. You are usually at the hospital for about an hour if you're having just an injection under the skin.

Stem cell transplants

High dose treatment destroys cancer cells, but also damages the stem cells that make blood cells in the bone marrow. So if you need high dose treatment you need a way of replacing the stem cells that have been destroyed. This is called having a stem cell transplant. They are sometimes called stem cell rescue or intensive treatments.

Other treatments to prevent problems

Myeloma can damage your bones which can cause pain and fractures. To try to prevent this your doctor will offer you a medicine called a bisphosphonate.

The most common bisphosphonates are pamidronate and zoledronic acid (Zometa). You have them into the vein as a drip (intravenously) every 4 weeks.

These drugs can affect healing after dental treatment. So it is better to see your dentist for a check up before starting treatment. 

Myeloma and its treatment can increase your risk of having a blood clot. Your doctor might suggest you have treatment to reduce your risk of having a blood clot. This might be tablets or an injection just under the skin.

Treatment can increase your risk of infection. Your doctor might suggest you have the flu vaccination. They might also give you antibiotics and antivirals to reduce your risk of infection.

Changes in bowel habit are common during treatment. You might have medicines to stop constipation or diarrhoea. And treatment can cause indigestion so you might also have medicines to stop indigestion.

Follow up and monitoring

You will have regular follow up.

You will usually have blood and urine tests at each visit. This is to check whether the myeloma is active and whether you need more treatment. 

Your team will ask about how you are feeling, whether you had symptoms or side effects, and if you are worried about anything. You might need x-rays or scans (such as CT, PET or MRI) if you have new bone pain. 

Let your team know if you are worried or notice any new symptoms between appointments.

Treatment when myeloma comes back

When myeloma comes back, it is called relapse. The treatment you need depends on your individual situation.

Treatment for symptoms

Myeloma can affect you in different ways. There are treatments that can help to control or reduce the symptoms of myeloma.

Coping with myeloma

Coping with a diagnosis of myeloma can be difficult. There is lots of support available inlcuding specialist nurses. It is important to get the support you need.