Treatment
Watchful Waiting
Induction Therapy
Stem Cell Transplant
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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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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Many different types of drugs are used to treat
myeloma. People often receive a combination of drugs,
and many different combinations are used to treat
myeloma.
Each type of drug kills cancer cells in a different
way:
- Chemotherapy: Chemotherapy kills fast-growing
myeloma cells, but the drug can also harm normal
cells that divide rapidly.
- Targeted therapy: Targeted therapies use drugs that
block the growth of myeloma cells. The targeted
therapy blocks the action of an abnormal protein
that stimulates the growth of myeloma cells.
- Steroids: Some steroids have antitumor effects. It is
thought that steroids can trigger the death of
myeloma cells. A steroid may be used alone or with
other drugs to treat myeloma.
You may receive the drugs by mouth or through a
vein (IV). The treatment usually takes place in an
outpatient part of the hospital, at your doctor's office,
or at home. Some people may need to stay in the
hospital for treatment.
The side effects depend mainly on which drugs are
given and how much:
- Blood cells: When a drug used for myeloma
treatment lowers the levels of healthy blood cells,
you're more likely to get infections, bruise or bleed
easily, and feel very weak and tired. Your health
care team will check for low levels of blood cells. If
your levels are low, your health care team may stop
therapy for a while or reduce the dose of drug.
There are also medicines that can help your body
make new blood cells.
- Cells in hair roots: Chemotherapy may cause hair
loss. If you lose your hair, it will grow back, but it
may be somewhat different in color and texture.
- Cells that line the digestive tract: Chemotherapy
and targeted therapy can cause poor appetite, nausea
and vomiting, diarrhea, constipation, or mouth and
lip sores. Ask your health care team about medicines
and other ways to help you cope with these
problems.
The drugs used for myeloma may also cause
dizziness, drowsiness, numbness or tingling in hands or
feet, and low blood pressure. Most of these problems
go away when treatment ends.
You may find it helpful to read the NCI booklet
Chemotherapy and You. You may also want to read the
NCI fact sheet Targeted Cancer Therapies: Questions and Answers.
You may want to ask your doctor these questions before having induction therapy:
- Which drugs will I get? What will the
treatment do?
- When will treatment start? When will it end?
How often will I have treatments?
- Where will I go for treatment? Will I have to
stay in the hospital?
- Will I have side effects during treatment? What
side effects should I tell you about? Can I
prevent or treat any of these side effects?
- Will there be lasting side effects? How long
will they last? What can I do about them?
- How often will I need checkups?
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Many people with multiple myeloma may get a
stem cell transplant. A stem cell transplant allows you
to be treated with high doses of drugs. The high doses
destroy both myeloma cells and normal blood cells
in the bone marrow. After you receive high-dose
treatment, you receive healthy stem cells through a
vein. (It's like getting a blood transfusion.) New blood
cells develop from the transplanted stem cells. The new
blood cells replace the ones that were destroyed by
treatment.
Stem cell transplants take place in the hospital.
Some people with myeloma have two or more
transplants.
Stem cells may come from you or from someone
who donates their stem cells to you:
- From you: An autologous stem cell transplant uses
your own stem cells. Before you get the high-dose
chemotherapy, your stem cells are removed. The
cells may be treated to kill any myeloma cells
present. Your stem cells are frozen and stored. After
you receive high-dose chemotherapy, the stored
stem cells are thawed and returned to you.
- From a family member or other donor: An
allogeneic stem cell transplant uses healthy stem
cells from a donor. Your brother, sister, or parent
may be the donor. Sometimes the stem cells come
from a donor who isn't related. Doctors use blood
tests to be sure the donor's cells match your cells.
Allogeneic stem cell transplants are under study for
the treatment of multiple myeloma.
- From your identical twin: If you have an identical
twin, a syngeneic stem cell transplant uses stem
cells from your healthy twin.
There are two ways to get stem cells for people with
myeloma. They usually come from the blood
(peripheral blood stem cell transplant). Or they can
come from the bone marrow (bone marrow transplant).
After a stem cell transplant, you may stay in the
hospital for several weeks or months. You'll be at risk
for infections because of the large doses of
chemotherapy you received. In time, the transplanted
stem cells will begin to produce healthy blood cells.
You may find it helpful to read the NCI fact sheet
Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation: Questions and Answers.
You may want to ask your doctor these questions before having a stem cell transplant:
- What kind of stem cell transplant will I have? If I need a donor, how will we find one?
- How long will I be in the hospital? Will I need special care? How will I be protected from
germs? Will my visitors have to wear a mask? Will I?
- What care will I need when I leave the
hospital?
- How will we know if the treatment is working?
- What are the risks and the side effects? What
can we do about them?
- What changes in normal activities will be
necessary?
- What is my chance of a full recovery? How
long will that take?
- How often will I need checkups?
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