Multiple Myeloma - Treatment

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What kinds of treatment have you, a friend, or loved one received for multiple myeloma?

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What is the treatment for multiple myeloma?

There is no known treatment that cures multiple myeloma. However, there are methods to decrease the occurrence and severity of symptoms and prolong life. The therapy is decided based upon the patient's condition and the cancer management team, made with the patient's input. The team will likely involve both a medical specialist in the treatment of myeloma called a medical oncologist, as well as a radiation oncologist and other consultants as appropriate. Oncology trained nurses and other personnel will likely be important members of the treatment team.

The choices for treatment(s) often include combinations of drugs, some of which are given as pills and others by intravenous injection. These include drugs which affect or modulate the immune system, steroids, and some oral or injectable chemotherapy drugs. These are usually used in combinations. There may be a role for high-dose chemotherapy followed by the administration of bone marrow stem cells called a stem cell transplant or autotransplantation. Numerous factors come into play in determining whether or not to do such a transplant. Further information may be obtained from the National Comprehensive Cancer Network Guidelines (NCCN.org), which are updated at least yearly.

Painful areas of bone damage may be treated with radiation therapy. Broken bones can be surgically repaired in many cases.

There are many drugs used to treat multiple myeloma. The following drugs are used often in combination with dexamethasone, sometimes orally or by IV, depending on the patient's individual disease status:

  • Dexamethasone (Decadron) -- immune cell modulation
  • Bortezomib (Velcade) -- protease inhibitor
  • Lenalidomide (Revlimid) -- immune cell modulation
  • Pamidronic acid (Aredia) -- inhibits bone resorption
  • Zoledronic acid (Zometa) -- inhibits bone resorption
  • Melphalan (Alkeran) -- alkylating agent that is toxic to myeloma cells

There are at least seven or eight other drugs that are occasionally used alone or in combination with others to aid patients. In addition, some patients with anemia can benefit from blood transfusions although the transfusion effects are temporary. Research is ongoing and newer drugs and drug combinations are being investigated and used for treatment with some frequency. Most doctors who specialize in cancer treatment are aware of the newest treatments for multiple myeloma.

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Comment from: pw, 65-74 Male (Patient) Published: February 17

I was diagnosed with MGUS (monoclonal gammopathy of unknown significance) after a simple blood test result showed too high a level of phosphorus. Follow up blood work showed elevated IGG-L protein. In about a year it became high enough to change the diagnosis to multiple myeloma. I tried chemical for about a year (VAD). This worked for a while. The year was 1998. My IGG level became unacceptably high, so I obtained an allogeneic bone marrow transplant. My brother was the donor, with a 4/4 match. This was followed 6 months later with a DLI (donor lymphocyte infusion of T-cells) from my brother. This treatment worked for me. I have now survived 18 years from initial diagnosis, and have had no recurrence.

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Comment from: Raziye YAZ, 65-74 Female (Patient) Published: June 01

She is my wife. She had multiple myeloma in 1999. She had two operations, from back bone she had first autologous stem cell transplants. Ten years later she again needs treatment for myeloma. She had also PET scans, bone cell biopsy and doctors decided on second transplant. First time she had chemotherapies four times. First time heavy chemotherapy before they wanted to have stem cells, but she did not have. Now we have to wait, I think till June 2016, when she will go to the hospital for transplant.

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