Your team plans your treatment depending on your:
- results of blood tests, bone marrow tests and scans
- general health and levels of fitness
- personal wishes
You are likely to have a combination of:
- targeted drugs (such as thalidomide, lenalidomide, bortezomib, daratumumab)
- chemotherapy (such as cyclophosphamide or melphalan)
- steroids (such as prednisalone or dexamethasone)
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.
Your treatment team
A team of doctors, and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).They include:
- a haematologist- a doctor that specialises in blood conditions
- a radiotherapist - a doctor specialising in radiotherapy treatment
- a pathologist
- a radiologist
- clinical nurse specialists (CNS)
Your team will discuss your treatment, it's benefits and possible side effects with you.
If you don't have symptoms
You don't usually have any treatment if you are well and your myeloma has been found by chance. Sometimes your team might suggest starting treatment straight away, even if you are well. This depends on results of your blood tests, bone marrow tests or scans.
If you don’t need treatment when you’re diagnosed your doctor will keep a close eye on your myeloma. This is called active monitoring, or 'watch and wait'. 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, thalidomide and dexamethasone (VTD)
- bortezomib, cyclophosphamide and vincristine (VCD)
- bortezomib, melphalan and prednisalone (VMP)
- lenalidomide and dexamethasone (RD)
Most people are treated as outpatients unless there is a reason to be in hospital such as infection, or severe bone or kidney damage.
Treatment can be as tablets on their own, or with an injection (either under the skin or intravenously in a drip).Your might also need:
- antibiotics (to prevent infections)
- anti sickness medicine
- anti indigestion remedies
- blood thinners (such as heparing injections)
If you are fit enough, your specialist might suggest high dose chemotherapy and a stem cell transplant. This is called intensive treatment. Before you can have this high dose treatment you need 4 to 6 months of cancer drug treatment to lower the levels of myeloma cells.
If you can’t have high dose treatment you have either:
- around 8 months of your first treatment, or
- you carry on with treatment until you have problems
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 often have this as a drip into your blood stream (intravenously) once every 4 weeks.
Before you start this treatment you need to see your dentist and have any dental treatment, because these medicines can slow wound healing after 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.
You might have one or more of these treatments:
- radiotherapy to an area of myeloma that is causing pain
- surgery to a broken bone, or to stop a weakened bone from breaking
- bisphosphonates to reduce bone pain or lower calcium levels
- plasma exchange (plasmapheresis) to lower protein levels in the blood
- a blood transfusion to treat tiredness (caused by low red blood cell levels)
Treatment for myeloma that 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.
You might have:
- a targeted cancer drug such as bortezomib (Velcade), carfilzomib, lenalidomide, pomalidomide, and daratumumab
- a combination of chemotherapy drugs, with or without targeted cancer drugs
- a steroid such as dexamethasone
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.