Multiple myeloma is considered incurable, but treatment can put the cancer into remission for long periods. It’s typical for people with the disease to experience periods of symptomatic myeloma, which requires treatment, followed by stretches of remission, during which treatment may not be necessary.
Current treatments aim to relieve symptoms, prolong the length of remissions, and extend survival. Oncologists have many ways to treat multiple myeloma and will typically use more than one treatment at a time.
Induction Therapy
The first-line therapy for multiple myeloma is typically induction therapy, followed by a stem cell transplant. (A stem cell is a special kind of cell that can make copies of itself and turn into many different types of cells your body needs to function properly.)
If your doctors determine you aren’t a candidate for a transplant — a decision based on various factors, including the stage and specific nature of the cancer — you may continue induction therapy for longer, followed by maintenance therapy.
Induction therapy consists of a three-drug or four-drug combination given over three to four cycles, each of which typically lasts 3 or 4 weeks. The goal is to kill as many cancer cells as possible prior to transplant.
Three-drug regimens (triplet therapy) generally include:
- Proteasome inhibitors stop enzyme complexes (proteasomes) in your cells from breaking down certain proteins that are important for controlling cell division. These drugs affect tumor cells more than normal cells.
- Immunomodulatory drugs work by activating certain cells in the immune system, preventing myeloma cell growth, and directly killing myeloma cells.
- Steroids can kill multiple myeloma cells when given in high doses. They can also decrease inflammation, relieve pain, and reduce side effects from other treatments.
Four-drug regimens (quadruplet therapy) are similar to three-drug regimens but also include monoclonal antibodies. These drugs are man-made versions of antibodies made in the immune system that can be designed to attack a specific target. In the case of multiple myeloma, the target is the CD38 protein on the surface of myeloma cells.
Stem Cell Transplantation
Once induction therapy is complete, you may have a stem cell transplant. Here are the steps involved in the procedure:
- Stem cells are collected from your blood and stored for later use. Most transplants for multiple myeloma are autologous stem cell transplants, in which a person’s own stem cells are removed and later transplanted back into the bloodstream. Stem cells from a donor (allogeneic transplants) are used primarily in research.
- You will undergo high-dose chemotherapy (with a drug called melphalan) to kill any remaining cancer cells.
- Your saved stem cells will be infused back into your bloodstream.
- You will go on maintenance therapy, typically with an oral immodulatory drug called lenalidomide.
Other Treatments
These treatments may also be used to treat multiple myeloma
- CAR T-cell therapy involves genetically engineering a person’s own T cells (a type of white blood cell) to recognize and attack cancer cells.
- Chemotherapy is used during the stem cell transplant process. It is rarely used on its own to treat multiple myeloma.
- Radiation therapy uses high-energy rays to kill cancer cells. It’s often used in the case of a solitary bone plasmacytoma, in which the disease has only presented as a single bone lesion and hasn’t spread to the bloodstream, or to target areas of bone damaged by multiple myeloma.
- Surgery is sometimes used to relieve spinal cord compression or stabilize bones that have deteriorated due to the effects of multiple myeloma.
- Novel therapies are some of the newest drugs used to treat multiple myeloma that do not fit the classification of any existing drug. These new drugs work in different ways than drugs in the other classes (meaning they have novel mechanisms of action).
For every treatment approach, outcomes for people with multiple myeloma depend on several factors, including overall health and the ability to tolerate treatment. Quality of care also makes a difference. It’s important to seek out a doctor who has experience treating multiple myeloma or will work in concert with a specialist, such as a hematologist oncologist.
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