Multiple Myeloma (cont.)
Methods of treatment
The choice of treatment depends mainly on the stage and symptoms of your
disease. If you have multiple myeloma without symptoms, you may not need
treatment for the cancer. The doctor monitors your health closely so that
treatment can start when you begin to have symptoms.
If you have symptoms, your treatment will probably involve anticancer drugs
(including steroids). Sometimes stem cell transplantation
or radiation therapy
is part of the treatment plan. Your doctor can describe your treatment choices
and the expected results of each. You and your doctor can work together to
develop a treatment plan that meets your needs.
Because standard treatment may not control myeloma, you may want to talk to
your doctor about taking part in a
clinical trial. Clinical trials are research studies of new treatment
methods. The section on "The Promise of Cancer Research" has more information
about clinical trials.
At any stage of disease, you may receive supportive care to control health
problems (such as infections) caused by multiple myeloma. (See the "Supportive
Care" section.)
You may want to ask the doctor these questions before treatment begins:-
What is the stage of my disease?
- Is the disease affecting my kidneys?
- What are my treatment choices? Which do you recommend for me? Will I have
more than one kind of treatment? How will my treatment change over time?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible
side effects of each treatment? What can we do to control my side effects?
- How will treatment affect my normal activities?
- What can I do to take care of myself during treatment?
- What is the treatment likely to cost? Does my insurance cover this
treatment?
- How often will I need to have checkups?
- Would a clinical trial (research study) be appropriate for me?
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Anticancer drug therapy
Treatment of myeloma usually involves
anticancer drugs. This treatment is called systemic therapy because the drugs
enter the bloodstream and can affect myeloma cells all over the body.
Many different types of drugs are used to treat myeloma. Each type kills
cancer cells in a different way.
Types of chemotherapy in
common use include melphalan,
cyclophosphamide, vincristine, and doxorubicin.
Prednisone is a
steroid that is often used. In some cases, the doctor may suggest new
options, such as thalidomide
and bortezomib.
People often receive a combination of drugs.
You may receive the drugs by mouth or through a vein. The treatment usually
takes place in an outpatient part of the hospital, at your doctor's office, or
at home. Patients rarely need to stay in the hospital during treatment.
You may want to ask the doctor these questions before having anticancer
drug therapy:- Which drug or drugs will I have?
- What are the expected benefits of the treatment?
- What are the risks and possible side effects of treatment? What can we do
about them?
- Are there any long-term effects?
- When will treatment start? When will it end?
- How will treatment affect my normal activities?
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Stem cell transplantation
Some people with multiple myeloma have stem cell transplantation. A stem cell
transplant allows a person to receive high doses of chemotherapy, radiation
therapy, or both. The high doses destroy both myeloma cells and normal blood
cells in the bone marrow. Later, the patient receives healthy stem cells through
a flexible tube placed in a large vein in the neck or chest area. New blood
cells develop from the transplanted stem cells.
Stem cell transplants take place in the hospital. Some patients have two or
more transplants.
Stem cells may come from the patient or from a donor:
- Autologous stem cell transplantation: This type of transplant
uses the patient's own stem cells. The stem cells are removed from the
patient, and the cells may be treated to kill myeloma cells that may be
present. The stem cells are frozen and stored. After the patient receives
high-dose treatment, the stored stem cells are thawed and returned to the
patient.
- Allogeneic stem cell transplantation: Sometimes healthy stem cells
from a donor are available. The patient's brother, sister, or parent may be the
donor. Or the stem cells may come from an unrelated donor. Doctors use blood
tests to be sure the donor's cells match the patient's cells.
- Syngeneic stem cell transplantation: This type of transplant uses
stem cells from the patient's healthy identical twin.
You may want to ask the doctor these questions before having a stem cell
transplant:- What are the possible benefits and risks of different
types of transplants?
- What kind of stem cell transplant will I have? If I need a donor, how will
we find one?
- Will I need to be in the hospital? If so, for how long? Will I need special
care?
- How will we know if the treatment is working?
- What can we do about side effects?
- How will treatment affect my normal activities?
- What is my chance of a full recovery?
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Radiation therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill
myeloma cells and to help control pain. People receive radiation therapy at a
hospital or clinic.
Radiation therapy is given two ways for people with myeloma:
- Local radiation: A large machine aims radiation at the bone or
the part of the body where myeloma cells have collected. It is local therapy
because it affects cells only in the treated area. This is the main
treatment for people with a single plasmacytoma. People receive radiation
for 4 to 5 weeks. A shorter course of radiation therapy can be used to
control the growth of tumors in bones and help relieve pain.
- Total-body irradiation: Some patients receive radiation to their
whole body before stem cell transplantation. The radiation treatments may be
given 2 to 3 times a day for several days.
You may want to ask the doctor these questions before having radiation
therapy:
- Why do I need this treatment?
- What are the risks and side effects of this treatment? What can we do about
them?
- Are there any long-term effects?
- When will the treatments begin? When will they end?
- How will I feel during therapy?
- How will treatment affect my normal activities?
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