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.

Getting a Second Opinion

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.
• 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.
• A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists in your area.
• 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.")
• 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."

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.)

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.

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.

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.

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