Treatment of Multiple Myeloma

Chemotherapy (chemo) is the use of drugs to kill or control the cancer cells. These drugs are either taken by mouth as a pill or given into a vein or a muscle. The drugs enter the blood and reach all parts the body. This treatment is useful for cancers such as multiple myeloma that often spread widely. Chemo drugs can be used alone or along with other drugs. Your physician ill discuss your treatment options with you and determine the best option for you.


Drug Treatment

The choice and dose of the drugs depend on many things, such as:

  • The stage of the cancer
  • The patient's age
  • The health of the patient's kidneys
  • Whether a stem cell transplant is planned
    (If a stem cell transplant is planned, most doctors avoid using drugs that can damage the bone marrow.)

Side Effects
Chemo can cause side effects. These side effects will depend on the type of drugs given, the amount taken, and how long the treatment lasts. Side effects could include:

  • Hair loss (hair grows back after treatment)
  • Mouth sores
  • Loss of appetite
  • Nausea and vomiting
  • Low blood counts

Low blood counts can cause:

  • Increased chance of infection (from a shortage of white blood cells)
  • Easy bruising or bleeding (from a shortage of platelets)
  • Tiredness (from a shortage of red blood cells)

Most side effects go away after treatment ends. But some chemo drugs can cause long-term damage to certain organs, like the heart or kidneys. Risks and benefits of treatment will be discussed with you before you begin treatment. And the health of these organs is carefully watched during treatment. If serious organ damage starts, doctors will switch to a different drug.

Your doctor or nurse can suggest steps to ease some side effects. For instance, there are drugs that can prevent or reduce nausea and vomiting.


Bisphosphonates for Multiple Myeloma
Myeloma cells can cause bone to dissolve. This can lead to bone weakness and broken bones. Drugs called bisphosphonates can help bones stay strong by slowing down this process.

Bisphosphonate treatment does have a rare but serious side effect. Some patients complain of pain in the jaw and doctors find that part of the bone of the upper or lower jaw bone has died. This can lead to loss of teeth in that area. Infections of the jaw bone may also develop. The cause of this is unknown and currently we are unable to determine who may have this side effect r how to prevent it. Many doctors suggest that patients have a dental check-up and have any tooth or jaw problems treated before they start bisphosphonate treatment.

Radiation Therapy for Multiple Myeloma
Radiation therapy is the use of high-energy x-rays to kill cancer cells. It may be used to treat areas of damaged bone that have not responded to chemo and are causing pain. It is also the most common treatment for solitary plasmacytomas.

Myeloma can weaken back bones so badly that they collapse and put pressure on the spinal cord and spinal nerves, causing sudden numbness, tingling, weakness of leg muscles or problems urinating or having a bowel movement. This is a medical emergency that must be treated right away with radiation and/or surgery.

Stem Cell Transplant for Multiple Myeloma
This has become the standard treatment for younger myeloma patients in good health because it allows higher doses of chemo to be used. Many centers are using this treatment for older patients, too. Studies have shown that this treatment increases how long patients live compared to standard chemo.

The first step in the transplant process is to lower the amount of cancer in a patient's body. This is done with chemo drugs. At the same time, blood-forming cells are taken from the patient's (or a donor's) blood or bone marrow. These cells, called stem cells, are then frozen.

Next, the patient gets high-dose chemo to kill any remaining myeloma cells; this treatment also destroys all the bone marrow stem cells. This would normally kill the patient. But the frozen stem cells are given to the patient after chemo. They are put into the bloodstream through an IV. The stem cells travel to the bone marrow where they begin to make new blood cells.

There are two types of stem cell transplant (SCT):

Autologous Transplant
If the patient's own stem cells are used, it is called an autologous transplant. These transplants are fairly safe and have a low risk of serious complications; this allows it to be used for older patients as well. It is hard to kill all the myeloma cells with high-dose chemo so most patients will have their myeloma return later. Some patients will be free of myeloma for a long time, but this procedure doesn't cure the disease.

The high doses of chemo used in autologous transplant can cause many problems. Many patients have high fevers from infections. These are treated with IV antibiotics. Another common problem is mouth sores, which can be very painful. Morphine may be given to reduce the pain. The chemo also kills cells in the intestines, which may lead to cramps and diarrhea. Since the bone marrow is unable to make blood cells, transfusions of red blood cells and platelets are often needed. When the new stem cells start making new blood cells, the transfusions are no longer needed.

Autologous transplants are better than regular chemo at treating myeloma and help patients live longer and are a standard part of myeloma treatment. Some doctors recommend that patients have two autologous transplants, six to 12 months apart. Studies show that this may help patients live longer than a single transplant. The drawback, of course, is that it causes more side effects.

Allogeneic Transplant
When stem cells from a donor are used, the transplant is called an allogeneic transplant. The donor is usually a close relative; however it could be an unrelated person who has a tissue type that closely matches that of the patient. Allogeneic transplants carry a higher risk of severe complications, even death, but they may lead to longer remissions. This is because the donor's immune system cells may help to destroy the myeloma cells. Allogeneic transplants are not used often in myeloma patients. There are two reasons for this: First, the patient must be fairly young and healthy to withstand the side effects of transplant - most myeloma patients are elderly. Second, a donor's tissue type must match the patient's and these matches can be hard to find. 

Some allogeneic transplants use low doses of certain kinds of chemo drugs to allow the transplanted stem cells to "take" without all the side effects of high doses. This is sometimes called a "mini-transplant" or a non-myeloablative transplant. This type of transplant allows the treatment to be done on older patients. The low-dose chemo does not destroy the myleoma, rather the transplanted stem cells act against the myeloma cells and destroy them. This type of transplant has less risk than a standard allogeneic transplant but it can still have serious side effects.


Plasmapheresis for Multiple Myeloma
Plasmapheresis involves removing blood from a vein, the blood cells are then separated from the plasma (the liquid part of the blood) and returned into another vein. Large amounts of abnormal proteins released by the myeloma cells are in the plasma, when the plasma is removed it is discarded and replaced with a salt solution and plasma from donors. This treatment is helpful when the build-up of myeloma proteins thickens the blood and slows circulation. While it does not kill the myeloma cells, this treatment does lower protein levels and relieves some symptoms for a time. Without further treatment, the level of myeloma protein will go back up again. For that reason, plasmapheresis is often followed by chemo or some other type of drug treatment to kill the cells that make the proteins.


More Multiple Myeloma Treatment Information

The treatment options available to you will be discussed with you by your physician. Make sure that all of your questions have been answered and that you have a clear understanding of the risks and benefits of treatment. For more information about our Outpatient Chemotherapy and Infusion Center or our Radiation Therapy Center, call (561) 263-4400. If you need a physician, contact our Physician Referral Department at (561) 263-5737.