Treatment
Getting a Second Opinion
Methods of Treatment
Anticancer Drug Therapy
Stem Cell Transplantation
Radiation Therapy
Many people with multiple myeloma want to take an active part in making
decisions about their medical care. It is natural to want to learn all you can
about your disease and your treatment choices. However, shock and stress after
the diagnosis can make it hard to think of everything you want to ask the
doctor. It often helps to make a list of questions before an appointment.
To help remember what the doctor says, you may take notes or ask whether you
may use a tape recorder. You may also want to have a family member or friend
with you when you talk to the doctor - to take part in the discussion, to take
notes, or just to listen.
You do not need to ask all your questions at once. You will have other chances
to ask your doctor to explain things that are not clear and to ask for more
information.
Your doctor may refer you to a specialist, or you may ask for a referral.
Specialists who treat multiple myeloma include
medical oncologists,
radiation oncologists, and
hematologists.
Before starting treatment, you might want a second opinion about the diagnosis
and treatment plan. Many insurance companies cover a second opinion if you or
your doctor requests it. It may take some time and effort to gather medical
records and arrange to see another doctor. Usually it is not a problem to take
several weeks to get a second opinion. In most cases, the delay in starting
treatment will not make treatment less effective. To make sure, you should
discuss this delay with your doctor. Some people with multiple myeloma need
treatment right away.
There are a number of ways to find a doctor for a second opinion:
-
Your doctor may refer you to one or more specialists. At cancer centers,
several specialists often work together as a team.
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The NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about
nearby treatment centers. Information Specialists also can provide online
assistance through
LiveHelp at http://www.cancer.gov.
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A local or state medical society, a nearby hospital, or a medical school can
usually provide the names of specialists in your area.
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The American Board of Medical Specialties (ABMS) has a list of doctors who have
had training and passed exams in their specialty. You can find this list in the Official
ABMS Directory of Board Certified Medical Specialists. This Directory
is in most public libraries. Or you can look up doctors at
http://www.abms.org. (Click on "Who's Certified.")
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The NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment
Facility If You Have Cancer."
-
Nonprofit organizations with an interest in multiple myeloma may be of help.
See the NCI fact sheet "National Organizations That Offer Services to People
With Cancer and Their Families."
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?
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Is the disease affecting my kidneys?
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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?
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How will treatment affect my normal activities?
-
What can I do to take care of myself during treatment?
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What is the treatment likely to cost? Does my insurance cover this treatment?
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How often will I need to have checkups?
-
Would a clinical trial (research study) be appropriate for me?
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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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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?
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How will we know if the treatment is working?
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What can we do about side effects?
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How will treatment affect my normal activities?
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What is my chance of a full recovery?
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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?
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When will the treatments begin? When will they end?
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How will I feel during therapy?
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How will treatment affect my normal activities?
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