The main treatments for myeloma are:
- targeted cancer drugs
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.
If you don't have 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:
- targeted cancer drugs
Some of the common combinations include:
- bortezomib, cyclophosphamide and vincristine (VCD)
- bortezomib, doxorubicin and dexamethasone (PAD)
- cyclophosphamide, thalidomide and dexamethasone (CTD)
- melphalan, prednisolone and thalidomide (MPT)
If you are fit enough, your specialist might suggest high dose chemotherapy and a stem cell transplant. This is called intensive treatment.
Once your myeloma is under control (in remission) you might have a targeted cancer drug (such as thalidomide or lenalidomide). This aims to keep it under control for longer (maintenance therapy).
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. You usually take this as a tablet. Before you start this treatment you need to see your dentist and have any dental treatment.
Some of the treatments for myeloma can increase your risk of having a blood clot. Your doctor might suggest you have treatment to reduce your risk of developing a blood clot. This might be a tablet or an injection.
Myeloma and its treatment can increase your risk of infection. Your doctor will suggest you have the flu vaccination. You may have other treatments to reduce your risk of infection. What you need depends on the treatment you are having.
To treat symptoms you might have:
- surgery to strengthen weak bones
- bisphosphonates to reduce pain, lower calcium levels in the blood, and lower the risk of spinal fractures
- plasma exchange (plasmapheresis) to lower protein levels in the blood
- a blood transfusion
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.
You might have:
- a targeted cancer drug such as bortezomib (Velcade)
- a combination of chemotherapy drugs, with or without targeted cancer drugs
- a steroid such as dexamethasone
If it comes back sooner than that, your doctor may suggest a different type of 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.