Treatment
People with multiple myeloma have many treatment options. The options are
watchful waiting, induction therapy, and stem cell transplant. Sometimes a
combination of methods is used.
Radiation therapy is used sometimes to treat painful bone disease. It may be
used alone or along with other therapies. See the Supportive Care section to learn about ways to relieve pain.
The choice of treatment depends mainly on how advanced the disease is and
whether you have symptoms. If you have multiple myeloma without symptoms
(smoldering myeloma), you may not need cancer treatment right away. The doctor
monitors your health closely (watchful waiting) so that treatment can start when
you begin to have symptoms.
If you have symptoms, you will likely get induction therapy. Sometimes a stem
cell transplant is part of the treatment plan.
When treatment for myeloma is needed, it can often control the disease and
its symptoms. People may receive therapy to help keep the cancer in remission,
but myeloma can seldom be cured. 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. See the Taking Part in Cancer Research section.
Your doctor can describe your treatment choices, the expected results, and
the possible side effects. You and your doctor can work together to develop a
treatment plan that meets your needs.
Your doctor may refer you to a specialist, or you may ask for a referral.
Specialists who treat multiple myeloma include hematologists and medical
oncologists. Your health care team may also include an oncology nurse and a
registered dietitian.
Before treatment starts, ask your health care team to explain possible side
effects and how treatment may change your normal activities. Because cancer
treatments often damage healthy cells and tissues, side effects are common. Side
effects may not be the same for each person, and they may change from one
treatment session to the next.
You may want to ask your doctor these questions before you begin
treatment:
- What stage of myeloma do I have?
- Is the disease affecting my kidneys?
- How do I get a copy of the report from the pathologist?
- What are my treatment choices? Which do you recommend for me? Why?
- 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 the side effects?
- What can I do to prepare for treatment?
- Will I need to stay in the hospital? If so, for how long?
- What is the treatment likely to cost? Will my insurance cover the
cost?
- How will treatment affect my normal activities?
- Would a clinical trial be right for me? Can you help me find one?
- How often should I have checkups?
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Watchful waiting
People with smoldering myeloma or Stage I myeloma may be able to put off
having cancer treatment. By delaying treatment, you can avoid the side effects
of treatment until you have symptoms.
If you and your doctor agree that watchful waiting is a good idea, you will
have regular checkups (such as every 3 months). You will receive treatment if
symptoms occur.
Although watchful waiting avoids or delays the side effects of cancer
treatment, this choice has risks. In some cases, it may reduce the chance to
control myeloma before it gets worse.
You may decide against watchful waiting if you don't want to live with
untreated myeloma. If you choose watchful waiting but grow concerned later, you
should discuss your feelings with your doctor. Another approach is an option in
most cases.
You may want to ask your doctor these questions before choosing watchful
waiting:
- If I choose watchful waiting, can I change my mind later on?
- Will the cancer be harder to treat later?
- How often will I have checkups?
- Between checkups, what problems should I tell you about?
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